New health insurance rates have been set. You will see these new rates reflected in your February 18 paycheck.

Here are the details:

Health Insurance – Blue Cross Blue Shield HMO Blue NE  w/2000 with HCCS and 4-tier RX plan.

 Dental Insurance – Blue Cross Blue Shield Dental Blue

Vision Insurance – Blue Cross 20/20

 Effective February 1, 2021 through January 31, 2022

Blue Cross Blue Shield HMO Blue NE 2000 Hospital Choice Cost Sharing*
PCP Office$25 per visit
Preventative Care$0
Specialist Office Visit or Chiropractor Visit$40 per visit
Labs, Diagnostic, X-ray, Including CT scans, MRIs, PET scans & Nuclear cardiac imagingDeductible, then 100%*
Emergency Room$150 per visit
Inpatient  Hospital Co-pay Surgical Day Care (Outpatient surgery)Deductible, then 100%*
Annual Deductible Individual / Family$2,000 / $4,000
Prescription Drugs  
Rx Deductible (calendar yr.)$0
Generic / Preferred / Non-Preferred$20/$40/$60/$120
Mail Order (90 days)$40/$80/$120/$360
Out-of-Pocket Limit  
Individual Out-of-Pocket Max.$4,000
Family Out-of-Pocket Max.$8,000

*additional fees may apply if you receive services at a higher cost hospital

RATES

Health Insurance Dental Insurance Vision Insurance 
Individual$130.77Individual$6.36Individual$3.42
   Emp + 1$5.81
   Emp + Children$5.98
Family$343.01Family$18.97Family$9.40