| Plans |
Premium HMO |
HNE CompleteMax
Option 5 |
HNE CompletePlus
Option 7H |
HNE Principle
Option 4 |
| Up-front deductible |
N/A |
N/A |
N/A |
| Doctor’s Office |
$0 Preventive Services
$20 |
$0 Preventive Services
$10 PCP
$25 Specialist |
$0 Preventive Services
$15 |
Emergency
(waived if admitted directly from ER) |
$50 per visit |
$50 per visit |
$50 per visit |
Diagnostic Imaging:
CT Scans, MRI, PET Scans |
$0 |
$0 |
$0 |
| Outpatient Surgical |
$250 |
$250 |
$150 |
| Hospital Stay |
$500 |
$500 |
$250 |
| Out-of-Pocket Maximum |
$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 wth a copayment of $250 or greater |
Services with a copayment of $250 or greater |
Services with a co-payment of $150 or greater |
