Choice Bronze HSA

26289NE0020002
Expanded Bronze
HMO

Choice Bronze HSA is an Expanded Bronze HMO plan by Ambetter from Nebraska Total Care.

IMPORTANT: You are viewing the 2023 version of Choice Bronze HSA 26289NE0020002. You can enroll in this plan if you qualify for special enrollment until the end of 2023.

Locations

Choice Bronze HSA is offered in the following counties.

Plan Overview

This is a plan overview for 2023 version of Choice Bronze HSA 26289NE0020002.
Insurer: Ambetter from Nebraska Total Care
Network Type: HMO
Metal Type: Expanded Bronze
HSA Eligible?: Yes
Plan ID: 26289NE0020002

Cost-Sharing Overview

Choice Bronze HSA offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for Choice Bronze HSA?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

Choice Bronze HSA offers the following features and referral requirements.

Wellness Program: No
Disease Program: Asthma, Heart Disease, Diabetes, Pregnancy
Notice Pregnancy: Yes
Referral Specialist: No
Specialist Requiring Referral:
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what Choice Bronze HSA covers when you are out of the service area or out of the country.

Out of Country Coverage: No
Out of Country Coverage Description:
Out of Service Area Coverage: No
Out of Service Area Coverage Description:
National Network: No

Additional Benefits and Cost-Sharing

Choice Bronze HSA includes the following benefits at the cost sharing rates listed below.

Free Preventive Services

There is no copayment or coinsurance for any of the following Choice Bronze HSA preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Additional Resources

Below are additional resources for Choice Bronze HSA including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.

Summary of Benefits: Summary of Benefits Link
Plan Brochure: Plan Brochure Link
Formulary: Formulary Link
Premium Payment Website: Premium Payment Link
Ready to sign up for Choice Bronze HSA?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Table of Contents