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About SBC Individual and Family Small Group (2-50) Mid-Size Group (51-150)

Summary of Benefits and Coverage

To help you make an informed choice about your health care coverage, we are providing Summary of Benefits and Coverage (SBC) documents for each of our plans.

The SBC explains what a health insurance plan covers, what it doesn’t cover, and what your cost share will be. The plans vary by monthly premium costs, what portion of the bill you will pay for services like hospital visits or prescription medications, and how much your total out-of-pocket costs are.

Information in these SBCs is an overview of coverage. It is not a complete list of what is covered or excluded. Information is subject to change.

Please note that SBCs are not available for employer groups with more than 150 employees but can be obtained through your Human Resources department.

Individual and Family

Effective Date Plan Name Product Name
2022 Armor Health Armor Health 5000 NB
2022 Armor Health Armor Health 7500 NB
2022 Armor Health Armor Health 2500 NB
2021 Armor Health Armor Health 5000 NB
2021 Armor Health Armor Health 7500 NB
2021 Armor Health Armor Health 2500 NB

Small Group (2-50)

Effective Date Plan Name Product Name
2022 BluePride BluePride BHA22 Bronze HSA
2022 BluePride BluePride SPB22 Silver
2022 BluePride BluePride SPA22 Silver
2022 BluePride BluePride SHA22 Silver HSA
2022 BluePride BluePride SHB22 Silver HSA
2022 BluePride BluePride GPA22 Gold
2022 BluePride BluePride GPB22 Gold
2022 BluePride BluePride GHA22 Gold HSA
2022 BluePride BluePride GHB22 Gold HSA
2022 BluePride BluePride GPC22 Gold
2022 BluePride BluePride SPC22 Silver
2022 BluePride BluePride SHC22 Silver HSA
2022 BluePride BluePride SPD22 Silver
2022 BlueFlex BlueFlex FPA22
2022 BlueFlex BlueFlex FPB22
2022 BlueFlex BlueFlex FPC22
2022 BlueFlex BlueFlex FPD22
2022 BlueFlex BlueFlex FHA22
2022 BlueFlex BlueFlex FHB22
2022 BlueFlex BlueFlex FHC22
2022 BlueFlex BlueFlex FHD22
2022 BlueFlex BlueFlex EA22
2022 BlueFlex BlueFlex EB22
2022 BlueFlex BlueFlex EC22
2022 BlueFlex BlueFlex EHB22
2022 BlueFlex BlueFlex EHC22
2021 BluePride BluePride BHA21 Bronze HSA
2021 BluePride BluePride SPB21 Silver
2021 BluePride BluePride SPA21 Silver
2021 BluePride BluePride SHA21 Silver HSA
2021 BluePride BluePride SHB21 Silver HSA
2021 BluePride BluePride GPA21 Gold
2021 BluePride BluePride GPB21 Gold
2021 BluePride BluePride GHA21 Gold HSA
2021 BluePride BluePride GHB21 Gold HSA
2021 BluePride BluePride GPC21 Gold
2021 BluePride BluePride SPC21 Silver
2021 BluePride BluePride SHC21 Silver HSA
2021 BlueFlex BlueFlex FPA21
2021 BlueFlex BlueFlex FPB21
2021 BlueFlex BlueFlex FPC21
2021 BlueFlex BlueFlex FPD21
2021 BlueFlex BlueFlex FHA21
2021 BlueFlex BlueFlex FHB21
2021 BlueFlex BlueFlex FHC21
2021 BlueFlex BlueFlex FHD21

Mid-Size Group (51-150)

Effective Date Plan Name Product Name
2022 BlueFreedom BlueFreedom Option 15 Rx Option 1
2022 BlueFreedom BlueFreedom Option 15 Rx Option 6
2022 BlueFreedom BlueFreedom Option 18 Rx Option 1
2022 BlueFreedom BlueFreedom Option 18 Rx Option 6
2022 BlueFreedom BlueFreedom Option 20 Rx Option 1
2022 BlueFreedom BlueFreedom Option 20 Rx Option 6
2022 BlueFreedom BlueFreedom Option 25 Rx Option 1
2022 BlueFreedom BlueFreedom Option 25 Rx Option 6
2022 BlueFreedom BlueFreedom Option 28 Rx Option 1
2022 BlueFreedom BlueFreedom Option 28 Rx Option 6
2022 BlueFreedom BlueFreedom Option 29 Rx Option 1
2022 BlueFreedom BlueFreedom Option 29 Rx Option 6
2022 BlueFreedom BlueFreedom Option 31 Rx Option 1
2022 BlueFreedom BlueFreedom Option 31 Rx Option 6
2022 BlueFreedom BlueFreedom Option 34 Rx Option 1
2022 BlueFreedom BlueFreedom Option 34 Rx Option 6
2022 BlueFreedom BlueFreedom Option 35 Rx Option 1
2022 BlueFreedom BlueFreedom Option 35 Rx Option 6
2022 BlueFreedom BlueFreedom Option 39 Rx Option 1
2022 BlueFreedom BlueFreedom Option 39 Rx Option 6
2022 BlueFreedom BlueFreedom Option 41 Rx Option 1
2022 BlueFreedom BlueFreedom Option 41 Rx Option 6
2022 BlueFreedom BlueFreedom Option 42 Rx Option 1
2022 BlueFreedom BlueFreedom Option 42 Rx Option 6
2022 BlueFreedom BlueFreedom Option 44 Rx Option 1
2022 BlueFreedom BlueFreedom Option 44 Rx Option 6
2022 BlueFreedom BlueFreedom HSA Opt 49
2022 BlueFreedom BlueFreedom HSA Opt 52
2022 BlueFreedom BlueFreedom HSA Opt 54
2022 BlueFreedom BlueFreedom HSA Opt 55
2022 BlueFreedom BlueFreedom HSA Opt 57
2022 BlueFreedom BlueFreedom HSA Opt 60
2022 BlueFreedom BlueFreedom Option 65 Rx Option 1
2022 BlueFreedom BlueFreedom Option 65 Rx Option 6
2022 BlueFreedom BlueFreedom HSA Opt 66
2022 BlueFreedom BlueFreedom Option 8 Rx Option 1
2022 BlueFreedom BlueFreedom Option 8 Rx Option 6
2022 BlueFreedom BlueFreedom HSA Opt 58
2022 BlueFreedom BlueFreedom Option 68 Rx Option 1
2022 BlueFreedom BlueFreedom Option 68 Rx Option 6
2022 BlueFreedom BlueFreedom Opt 69 Rx Opt 1
2022 BlueFreedom BlueFreedom Opt 69 Rx Opt 6
2022 BlueFreedom BlueFreedom Option 71 Rx Option 1
2022 BlueFreedom BlueFreedom Option 71 Rx Option 6
2022 BlueFreedom BlueFreedom HSA Opt 72
2022 BlueFreedom BlueFreedom HSA Opt 73
2022 BlueFreedom BlueFreedom EPO Option 18
2022 BlueFreedom BlueFreedom EPO Option 31
2022 BlueFreedom BlueFreedom EPO Option 42
2022 BlueFreedom BlueFreedom EPO Option 55 HSA
2022 BlueFreedom BlueFreedom EPO Option 58 HSA
2021 BlueFreedom BlueFreedom Option 15 Rx Option 1
2021 BlueFreedom BlueFreedom Option 15 Rx Option 6
2021 BlueFreedom BlueFreedom Option 18 Rx Option 1
2021 BlueFreedom BlueFreedom Option 18 Rx Option 6
2021 BlueFreedom BlueFreedom Option 19 Rx Option 1
2021 BlueFreedom BlueFreedom Option 19 Rx Option 6
2021 BlueFreedom BlueFreedom Option 20 Rx Option 1
2021 BlueFreedom BlueFreedom Option 20 Rx Option 6
2021 BlueFreedom BlueFreedom Option 23 Rx Option 1
2021 BlueFreedom BlueFreedom Option 23 Rx Option 6
2021 BlueFreedom BlueFreedom Option 25 Rx Option 1
2021 BlueFreedom BlueFreedom Option 25 Rx Option 6
2021 BlueFreedom BlueFreedom Option 26 Rx Option 1
2021 BlueFreedom BlueFreedom Option 26 Rx Option 6
2021 BlueFreedom BlueFreedom Option 28 Rx Option 1
2021 BlueFreedom BlueFreedom Option 28 Rx Option 6
2021 BlueFreedom BlueFreedom Option 29 Rx Option 1
2021 BlueFreedom BlueFreedom Option 29 Rx Option 6
2021 BlueFreedom BlueFreedom Option 31 Rx Option 1
2021 BlueFreedom BlueFreedom Option 31 Rx Option 6
2021 BlueFreedom BlueFreedom Option 34 Rx Option 1
2021 BlueFreedom BlueFreedom Option 34 Rx Option 6
2021 BlueFreedom BlueFreedom Option 35 Rx Option 1
2021 BlueFreedom BlueFreedom Option 35 Rx Option 6
2021 BlueFreedom BlueFreedom Option 39 Rx Option 1
2021 BlueFreedom BlueFreedom Option 39 Rx Option 6
2021 BlueFreedom BlueFreedom Option 41 Rx Option 1
2021 BlueFreedom BlueFreedom Option 41 Rx Option 6
2021 BlueFreedom BlueFreedom Option 42 Rx Option 1
2021 BlueFreedom BlueFreedom Option 42 Rx Option 6
2021 BlueFreedom BlueFreedom Option 43 Rx Option 1
2021 BlueFreedom BlueFreedom Option 43 Rx Option 6
2021 BlueFreedom BlueFreedom Option 44 Rx Option 1
2021 BlueFreedom BlueFreedom Option 44 Rx Option 6
2021 BlueFreedom BlueFreedom HSA Opt 49
2021 BlueFreedom BlueFreedom HSA Opt 52
2021 BlueFreedom BlueFreedom HSA Opt 54
2021 BlueFreedom BlueFreedom HSA Opt 55
2021 BlueFreedom BlueFreedom HSA Opt 57
2021 BlueFreedom BlueFreedom HSA Opt 60
2021 BlueFreedom BlueFreedom Option 65 Rx Option 1
2021 BlueFreedom BlueFreedom Option 65 Rx Option 6
2021 BlueFreedom BlueFreedom HSA Opt 66
2021 BlueFreedom BlueFreedom Option 8 Rx Option 1
2021 BlueFreedom BlueFreedom Option 8 Rx Option 6
2021 BlueFreedom BlueFreedom HSA Opt 58
2021 BlueFreedom BlueFreedom Option 67 Rx Option 1
2021 BlueFreedom BlueFreedom Option 67 Rx Option 6
2021 BlueFreedom BlueFreedom Option 68 Rx Option 1
2021 BlueFreedom BlueFreedom Option 68 Rx Option 6
2021 BlueFreedom BlueFreedom Opt 69 Rx Opt 1
2021 BlueFreedom BlueFreedom Option 70 Rx Option 1
2021 BlueFreedom BlueFreedom Opt 69 Rx Opt 6
2021 BlueFreedom BlueFreedom Option 70 Rx Option 6
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Blue Cross and Blue Shield of Nebraska is an independent licensee of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield Association licenses Blue Cross and Blue Shield of Nebraska to offer certain products and services under the Blue Cross® and Blue Shield® brand names within the state of Nebraska.
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