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| Value HMO |
| Plans |
Value HMO |
| HNE Essential500 |
HNE Focus
Option 8H |
HNE ChoicePlus
Option 7M |
| Up-front deductible |
$500 per Individual
$1,000 per Family per policy or calendar year |
N/A |
N/A |
| Doctor’s Office |
$0 Preventive Services
$20 All other office visits |
$0 Preventive Services
$25 All other office visits |
$0 Preventive Services
$20 PCP
$40 Specialist |
Emergency
(waived if admitted directly from ER) |
$100 per visit |
$100 per visit |
$75 per visit |
Diagnostic Imaging:
CT Scans, MRI, PET Scans |
$0 after deductible |
$150 |
$0 |
| Outpatient Surgical |
$0 after deductible |
$500 |
$250 |
| Hospital Stay |
$0 after deductible |
$1,000 |
$500 |
| Out-of-Pocket Maximum |
$2,000 per Individual
$4,000 per Family |
$2,000 per Individual
$4,000 per Family |
$1,000 per Individual
$2,000 per Family
|
| Out-of-Pocket Maximum Includes: |
Deductible and services with a copayment of $100 or greater |
Services with a copayment
of $100 or greater |
Services with a copayment of $250 or greater |
| Prescription Drugs |
|
