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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
2021 Armor Health Armor Health 5000 NB
2021 Armor Health Armor Health 7500 NB
2021 Armor Health Armor Health 2500 NB
2020 Armor Health Armor Health 2500 NB
2020 Armor Health Armor Health 5000 NB
2020 Armor Health Armor Health 7500 NB

Small Group (2-50)

Effective Date Plan Name Product Name
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
2020 BluePride BluePride BHA20 Bronze HSA
2020 BluePride BluePride SPB20 Silver
2020 BluePride BluePride SPA20 Silver
2020 BluePride BluePride SHA20 Silver HSA
2020 BluePride BluePride SHB20 Silver HSA
2020 BluePride BluePride GPA20 Gold
2020 BluePride BluePride GPB20 Gold
2020 BluePride BluePride GHA20 Gold HSA
2020 BluePride BluePride GHB20 Gold HSA
2020 BluePride BluePride GPC20 Gold
2020 BluePride BluePride SPC20 Silver
2020 BlueFlex BlueFlex FPA20
2020 BlueFlex BlueFlex FPB20
2020 BlueFlex BlueFlex FPC20
2020 BlueFlex BlueFlex FPD20
2020 BlueFlex BlueFlex FHA20
2020 BlueFlex BlueFlex FHB20
2020 BlueFlex BlueFlex FHC20
2020 BlueFlex BlueFlex FHD20
2019 BluePride BluePride BHA19 Bronze HSA
2019 BluePride BluePride SPB19 Silver
2019 BluePride BluePride SPA19 Silver
2019 BluePride BluePride SHA19 Silver HSA
2019 BluePride BluePride SHB19 Silver HSA
2019 BluePride BluePride GPA19 Gold
2019 BluePride BluePride GPB19 Gold
2019 BluePride BluePride GHA19 Gold HSA
2019 BluePride BluePride GHB19 Gold HSA
2019 BluePride BluePride BPA19 Bronze
2019 BluePride BluePride SPC19 Silver
2019 BlueFlex BlueFlex FPA19
2019 BlueFlex BlueFlex FPB19
2019 BlueFlex BlueFlex FPC19
2019 BlueFlex BlueFlex FPD19
2019 BlueFlex BlueFlex FHA19
2019 BlueFlex BlueFlex FHB19
2019 BlueFlex BlueFlex FHC19
2019 BlueFlex BlueFlex FHD19

Mid-Size Group (51-150)

Effective Date Plan Name Product Name
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
2020 BlueFreedom BlueFreedom Option 15 Rx Option 1
2020 BlueFreedom BlueFreedom Option 15 Rx Option 6
2020 BlueFreedom BlueFreedom Option 18 Rx Option 1
2020 BlueFreedom BlueFreedom Option 18 Rx Option 6
2020 BlueFreedom BlueFreedom Option 19 Rx Option 1
2020 BlueFreedom BlueFreedom Option 19 Rx Option 6
2020 BlueFreedom BlueFreedom Option 20 Rx Option 1
2020 BlueFreedom BlueFreedom Option 20 Rx Option 6
2020 BlueFreedom BlueFreedom Option 23 Rx Option 1
2020 BlueFreedom BlueFreedom Option 23 Rx Option 6
2020 BlueFreedom BlueFreedom Option 25 Rx Option 1
2020 BlueFreedom BlueFreedom Option 25 Rx Option 6
2020 BlueFreedom BlueFreedom Option 26 Rx Option 1
2020 BlueFreedom BlueFreedom Option 26 Rx Option 6
2020 BlueFreedom BlueFreedom Option 28 Rx Option 1
2020 BlueFreedom BlueFreedom Option 28 Rx Option 6
2020 BlueFreedom BlueFreedom Option 29 Rx Option 1
2020 BlueFreedom BlueFreedom Option 29 Rx Option 6
2020 BlueFreedom BlueFreedom Option 31 Rx Option 1
2020 BlueFreedom BlueFreedom Option 31 Rx Option 6
2020 BlueFreedom BlueFreedom Option 34 Rx Option 1
2020 BlueFreedom BlueFreedom Option 34 Rx Option 6
2020 BlueFreedom BlueFreedom Option 35 Rx Option 1
2020 BlueFreedom BlueFreedom Option 35 Rx Option 6
2020 BlueFreedom BlueFreedom Option 39 Rx Option 1
2020 BlueFreedom BlueFreedom Option 39 Rx Option 6
2020 BlueFreedom BlueFreedom Option 41 Rx Option 1
2020 BlueFreedom BlueFreedom Option 41 Rx Option 6
2020 BlueFreedom BlueFreedom Option 42 Rx Option 1
2020 BlueFreedom BlueFreedom Option 42 Rx Option 6
2020 BlueFreedom BlueFreedom Option 43 Rx Option 1
2020 BlueFreedom BlueFreedom Option 43 Rx Option 6
2020 BlueFreedom BlueFreedom Option 44 Rx Option 1
2020 BlueFreedom BlueFreedom Option 44 Rx Option 6
2020 BlueFreedom BlueFreedom HSA Opt 49
2020 BlueFreedom BlueFreedom HSA Opt 52
2020 BlueFreedom BlueFreedom HSA Opt 54
2020 BlueFreedom BlueFreedom HSA Opt 55
2020 BlueFreedom BlueFreedom HSA Opt 57
2020 BlueFreedom BlueFreedom HSA Opt 60
2020 BlueFreedom BlueFreedom Option 65 Rx Option 1
2020 BlueFreedom BlueFreedom Option 65 Rx Option 6
2020 BlueFreedom BlueFreedom HSA Opt 66
2020 BlueFreedom BlueFreedom Option 8 Rx Option 1
2020 BlueFreedom BlueFreedom Option 8 Rx Option 6
2020 BlueFreedom BlueFreedom HSA Opt 58
2020 BlueFreedom BlueFreedom Option 67 Rx Option 1
2020 BlueFreedom BlueFreedom Option 67 Rx Option 6
2020 BlueFreedom BlueFreedom Option 68 Rx Option 1
2020 BlueFreedom BlueFreedom Option 68 Rx Option 6
2020 BlueFreedom BlueFreedom Opt 69 Rx Opt 1
2020 BlueFreedom BlueFreedom Option 70 Rx Option 1
2020 BlueFreedom BlueFreedom Opt 69 Rx Opt 6
2020 BlueFreedom BlueFreedom Option 70 Rx Option 6
2019 BlueFreedom BlueFreedom Option 15 Rx Option 1
2019 BlueFreedom BlueFreedom Option 15 Rx Option 6
2019 BlueFreedom BlueFreedom Option 18 Rx Option 1
2019 BlueFreedom BlueFreedom Option 18 Rx Option 6
2019 BlueFreedom BlueFreedom Option 19 Rx Option 1
2019 BlueFreedom BlueFreedom Option 19 Rx Option 6
2019 BlueFreedom BlueFreedom Option 20 Rx Option 1
2019 BlueFreedom BlueFreedom Option 20 Rx Option 6
2019 BlueFreedom BlueFreedom Option 23 Rx Option 1
2019 BlueFreedom BlueFreedom Option 23 Rx Option 6
2019 BlueFreedom BlueFreedom Option 25 Rx Option 1
2019 BlueFreedom BlueFreedom Option 25 Rx Option 6
2019 BlueFreedom BlueFreedom Option 26 Rx Option 1
2019 BlueFreedom BlueFreedom Option 26 Rx Option 6
2019 BlueFreedom BlueFreedom Option 28 Rx Option 1
2019 BlueFreedom BlueFreedom Option 28 Rx Option 6
2019 BlueFreedom BlueFreedom Option 29 Rx Option 1
2019 BlueFreedom BlueFreedom Option 29 Rx Option 6
2019 BlueFreedom BlueFreedom Option 31 Rx Option 1
2019 BlueFreedom BlueFreedom Option 31 Rx Option 6
2019 BlueFreedom BlueFreedom Option 34 Rx Option 1
2019 BlueFreedom BlueFreedom Option 34 Rx Option 6
2019 BlueFreedom BlueFreedom Option 35 Rx Option 1
2019 BlueFreedom BlueFreedom Option 35 Rx Option 6
2019 BlueFreedom BlueFreedom Option 39 Rx Option 1
2019 BlueFreedom BlueFreedom Option 39 Rx Option 6
2019 BlueFreedom BlueFreedom Option 41 Rx Option 1
2019 BlueFreedom BlueFreedom Option 41 Rx Option 6
2019 BlueFreedom BlueFreedom Option 42 Rx Option 1
2019 BlueFreedom BlueFreedom Option 42 Rx Option 6
2019 BlueFreedom BlueFreedom Option 43 Rx Option 1
2019 BlueFreedom BlueFreedom Option 43 Rx Option 6
2019 BlueFreedom BlueFreedom Option 44 Rx Option 1
2019 BlueFreedom BlueFreedom Option 44 Rx Option 6
2019 BlueFreedom BlueFreedom HSA Opt 49
2019 BlueFreedom BlueFreedom HSA Opt 52
2019 BlueFreedom BlueFreedom HSA Option 54
2019 BlueFreedom BlueFreedom HSA Opt 55
2019 BlueFreedom BlueFreedom HSA Opt 57
2019 BlueFreedom BlueFreedom HSA Opt 60
2019 BlueFreedom BlueFreedom Option 65 Rx Option 1
2019 BlueFreedom BlueFreedom Option 65 Rx Option 6
2019 BlueFreedom BlueFreedom HSA Opt 66
2019 BlueFreedom BlueFreedom Option 8 Rx Option 1
2019 BlueFreedom BlueFreedom Option 8 Rx Option 6
2019 BlueFreedom BlueFreedom HSA Option 58
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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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