WoodmenLife Associates at the Gym

Health Insurance

Quick Stats


Blue Cross and Blue Shield of Nebraska
Group #101498
NEtwork BLUE Network
Pharmacy Network: Network C
Drug List: PDL 10 (Formerly "BCBSNE Standard Formulary")


BCBSNE Tools and Resources

  • Find a Doctor
  • Rx Benefits
  • Cost Estimator
  • Telehealth

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Compare HRA and HSA

D/C  = Deductible/Coinsurance

Benefit Summary In-Network Out-of-Network In-Network Out-of-Network
Deductible/Coinsurance Aggregate Aggregate
Associate $1,500 $3,000 $2,000 $4,000
Associate Plus $3,000 $6,000 $4,000 $8,000
Coinsurance 25% 40% 30% 50%
Out-of-Pocket Maximum (includes Deductible, Coinsurance and Copays)
Associate $3,000 $6,000 $4,500 $9,000
Associate Plus $6,000 $12,000 $9,000 $18,000
WoodmenLife HSA or HRA Contributions
Associate $500 $1,000
Associate Plus $1,000 $2,000
Office Visit
Primary Care D/C D/C $30 Copay D/C
Specialist D/C D/C D/C D/C
Other Office Visit Services D/C D/C Included in Copay D/C
Preventive Care 100% D/C 100% D/C
Virtual Doctor D/C D/C $15 Fee D/C
Urgent and Emergency Care
Physician D/C D/C $55 Copay D/C
Other Urgent Care Services D/C D/C Included in Copay D/C
Emergency Care D/C Same as In-Network $175 Copay + D/C Same as In-Network
Prescription Drug Retail 30-day supply
Generic D/C In-Network + 25% $15 Copay In-Network + 25%
Formulary D/C In-Network + 25% 30%, $37.50 min to $150 max In-Network + 25%
Non-Formulary D/C In-Network + 25% 30%, $62.50 min to $250 max In-Network + 25%
Specialty D/C Not covered 30%, $75 min to $300 max Not covered
Prescription Drug Retail 90-day supply
Generic D/C Not covered $37.50 Copay Not covered
Formulary D/C Not covered 30%, $93.75 min to $375 max Not covered
Non-Formulary D/C Not covered 30%, $156.25 min to $625 max Not covered

Check out more details of each account.

HRA Details

HSA Details

Pre-Tax Premiums

Total health insurance cost, paid by you and WoodmenLife, is based on actual claims over the prior two years, projected claims, administrative expenses for the upcoming year, the plan and level of coverage you select, and your salary/earnings as of Sept. 30.

Benefits of an HSA

To help understand the benefits of a Health Savings Account, click here.

Tax Reporting

Click here for tax information related to health insurance.

The information on this page is a partial description of benefits, limitations, exclusions, and other provisions of the group benefits provided by Woodmen of the World Life Insurance Society (WoodmenLife). If there is a difference between the information in this summary and the plan document for each plan, the plan documents govern. Eligibility requirements apply to each of the benefits offered, criteria may include employment status and/or individual qualifications. For more detailed information, refer to the Summary Plan Description of each plan. WoodmenLife may amend these plans at any time. The description of the plan is not a guarantee of benefits and should not be construed as such.

This is the Life is a registered service mark of Woodmen of the World Life Insurance Society.