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Premium HMO |
| Plans |
Premium HMO |
HNE ChoicePlus
Option 7M
|
HNE CompleteMax
Option 5 |
HNE CompletePlus
Option 7H |
HNE Principle
Option 4 |
| Up-front deductible |
N/A |
N/A |
N/A |
N/A |
| Doctor’s Office |
$0 Preventive Services
$20 PCP
$40 Specialist |
$0 Preventive Services
$20 All other office visits |
$0 Preventive Services
$10 PCP
$25 Specialist |
$0 Preventive Services
$15 All other office visits |
Emergency
(waived if admitted directly from ER) |
$100 per visit |
$100 per visit |
$100 per visit |
$100 per visit |
High Cost Diagnostics:
Diagnostic
Imaging:
CT Scans, MRI, PET Scans, Nuclear Cardiac
Sleep Studies
Genetic Testing:
BRCA & Colaris |
$75 |
$75 |
$75 |
$75 |
| $75 |
$75 |
$75 |
$75 |
$75 |
$75 |
$75 |
$75 |
| Outpatient Surgical |
$250 |
$250 |
$250 |
$150 |
| Hospital Stay |
$500 |
$500 |
$500 |
$250 |
| Out-of-Pocket Maximum |
$1,000 per individual
$2,000 per family |
$1,000 per individual
$2,000 per family |
$1,000 per individual
$2,000 per family |
$500 per individual
$1,000 per family |
| Out-of-Pocket Maximum Includes: |
Services with copayment of $100 or greater |
Services with copayment of $100 or greater |
Services with copayment of $100 or greater |
Services with copayment of $100 or greater |
