Copay, Deductible/Coinsurace & HSA-Compatible Plans Comparison Nebraska Farm Bureau Member Health Plan CHOOSE YOUR PLAN. It's important for you to have a plan that fits you. So we offer different types of short term plans to meet your individual needs and preferences .
COPAY PLANS
INSURE TIERED NETWORK
MEDICA WITH CHI HEALTH NETWORK
NETWORK BENEFITS
TIER 1 - PREFERRED
TIER 2 - STANDARD
Deductible
Individual plan: $3,800 Family plan: $7,300 Individual plan: $6,800 Family plan: $11,300
Individual plan: $4,800 Family plan: $10,300 Individual plan: $7,800 Family plan: $11,800
Individual plan: $3,800 Family plan: $7,300 Individual plan: $6,800 Family plan: $11,300
Out-of-pocket maximum
Family plan cost sharing details
Embedded deductible Embedded out-of-pocket maximum
Embedded deductible Embedded out-of-pocket maximum
Embedded deductible Embedded out-of-pocket maximum
OFFICE VISITS Preventive care
You pay nothing – 100% coverage You pay nothing – 100% coverage You pay nothing – 100% coverage
Primary and urgent care
$60 copay
$120 copay
$60 copay
Convenience or retail care
$10 copay
$20 copay
$20 copay
Specialty care
$100 copay
$200 copay
$100 copay
PRESCRIPTION DRUGS (MEDICA DRUG LIST) Generic $20 copay
$20 copay
$20 copay
Preferred brand
$120 copay
$120 copay
$120 copay
Non-preferred brand
50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible
Insulin
$25 copay
$25 copay
$25 copay
MEDICAL SERVICES Lab, X-rays and imaging services
30% coinsurance after deductible 30% coinsurance after deductible 30% coinsurance after deductible
Emergency room services
30% coinsurance after deductible 30% coinsurance after deductible 30% coinsurance after deductible
Emergency medical transportation (e.g. Ambulance) Hospital services (Facility & physicians services)
30% coinsurance after deductible 30% coinsurance after deductible 30% coinsurance after deductible
30% coinsurance after deductible 30% coinsurance after deductible 30% coinsurance after deductible
Maternity (Delivery & inpatient services)
30% coinsurance after deductible 30% coinsurance after deductible 30% coinsurance after deductible
Home health care, rehabilitation services, habilitation services and skilled nursing care
30% coinsurance after deductible 30% coinsurance after deductible 30% coinsurance after deductible
Other eligible health care services
30% coinsurance after deductible 30% coinsurance after deductible 30% coinsurance after deductible
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