HeartlandBlue Gold 1000 NEtwork Blue w/ Adult Vision PPO

Blue Cross and Blue Shield of Nebraska · 2026 plan year

Gold

Ind. deductible: $1,000
Family deductible: $2,000
Ind. OOP max: $5,500
Family OOP max: $11,000

Compare with other Gold plans in NE

Side by side: deductibles, out-of-pocket limits and copays.

Clear Gold + Vision + Adult DentalAmbetter Health · Deductible $1,200 · Out-of-pocket max $9,150
Clear GoldAmbetter Health · Deductible $1,200 · Out-of-pocket max $9,150
Gold Elite | with Bryan HealthOscar Insurance Company · Deductible $500 · Out-of-pocket max $6,500

Compare 4 plans Browse all Gold plans in NE

Other cost-sharing reduction variants for this plan:

Limited Cost Sharing Plan Variation Standard Gold Off Exchange Plan Zero Cost Sharing Plan Variation

More Blue Cross and Blue Shield of Nebraska plans in NE

HeartlandBlue Silver Standard 6000 NEtwork Blue HeartlandBlue Gold 1000 NEtwork Blue w/ Adult Vision HeartlandBlue Silver Standard 6000 Premier Select BlueChoice HeartlandBlue Silver $0 PCP Visit 4500 Premier Select BlueChoice HeartlandBlue Bronze Standard 7500 Premier Select BlueChoice

Monthly premiums by age

Rating Area 3 — the lowest-priced of the 2 areas this plan covers. Premiums differ by area.

Age	Individual	Individual + tobacco
Under 15	$692	$692
21	$905	$995
30	$1,027	$1,129
40	$1,156	$1,272
50	$1,616	$1,777
60	$2,455	$2,701
64 and over	$2,714	$2,985

Live premium estimate

Benefits & cost sharing

Primary Care

Benefit	In-network
Preventive Care/Screening/Immunization	No charge
Primary Care Visit to Treat an Injury or Illness	$30.00

Specialist

Benefit	In-network
Specialist Visit	$100.00

Hospital

Benefit	In-network
Emergency Room Services	35.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	35.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	35.00% Coinsurance after deductible
Urgent Care Centers or Facilities	$50.00

Pharmacy

Benefit	In-network
Generic Drugs	$5.00
Non-Preferred Brand Drugs	55.00% Coinsurance after deductible
Off Label Prescription Drugs	35.00% Coinsurance after deductible
Preferred Brand Drugs	$100.00
Specialty Drugs	60.00% Coinsurance after deductible
Tier 2 Generic Drugs	$10.00
Tier 2 Specialty Drugs	70.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	35.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	35.00% Coinsurance after deductible

Other

Benefit	In-network
Basic Dental Care - Child	35.00% Coinsurance after deductible
Abortion for Which Public Funding is Prohibited	Not covered
Accidental Dental	35.00% Coinsurance after deductible
Acupuncture	Not covered
Allergy Testing	35.00% Coinsurance after deductible
Bariatric Surgery	Not covered
Basic Dental Care - Adult	Not covered
Chemotherapy	35.00% Coinsurance after deductible
Chiropractic Care	35.00% Coinsurance after deductible
Cosmetic Surgery	Not covered
Delivery and All Inpatient Services for Maternity Care	35.00% Coinsurance after deductible
Dental Anesthesia	35.00% Coinsurance after deductible
Dental Check-Up for Children	No charge
Diabetes Care Management	35.00% Coinsurance after deductible
Diabetes Education	35.00% Coinsurance after deductible
Dialysis	35.00% Coinsurance after deductible
Durable Medical Equipment	35.00% Coinsurance after deductible
Emergency Transportation/Ambulance	35.00% Coinsurance after deductible
Eye Glasses for Children	35.00% Coinsurance after deductible
Gender Affirming Care	35.00% Coinsurance after deductible
Habilitation Services	35.00% Coinsurance after deductible
Hearing Aids	35.00% Coinsurance after deductible
Home Health Care Services	35.00% Coinsurance after deductible
Hospice Services	35.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)	35.00% Coinsurance after deductible
Infertility Treatment	Not covered
Infusion Therapy	35.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	35.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	35.00% Coinsurance after deductible
Long-Term/Custodial Nursing Home Care	Not covered
Major Dental Care - Adult	Not covered
Major Dental Care - Child	35.00% Coinsurance after deductible
Nutritional Counseling	35.00% Coinsurance after deductible
Orthodontia - Adult	Not covered
Orthodontia - Child	70.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)	$30.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	35.00% Coinsurance after deductible
Outpatient Rehabilitation Services	35.00% Coinsurance after deductible
Prenatal and Postnatal Care	35.00% Coinsurance after deductible
Private-Duty Nursing	Not covered
Prosthetic Devices	35.00% Coinsurance after deductible
Radiation	35.00% Coinsurance after deductible
Reconstructive Surgery	35.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	35.00% Coinsurance after deductible
Rehabilitative Speech Therapy	35.00% Coinsurance after deductible
Routine Dental Services (Adult)	Not covered
Routine Eye Exam (Adult)	No charge
Routine Eye Exam for Children	No charge
Routine Foot Care	Not covered
Skilled Nursing Facility	35.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	35.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	35.00% Coinsurance after deductible
Transplant	35.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders	35.00% Coinsurance after deductible
Weight Loss Programs	Not covered
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	35.00% Coinsurance after deductible