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| Large Groups: 51+ Eligible Employees |
| Plans |
Value HMO |
HNE Choice
Option 7L |
HNE ChoicePlus
Option 7M |
HNE CompletePlus
Option 7H |
HNE CompleteMax *
Option 5 |
| 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 PCP
$40 Specialist
|
$0 Preventive Services
$10 PCP
$25 Specialist
|
$0 Preventive Services
$20 |
Emergency
(waived if admitted directly from ER) |
$100 per visit |
$75 per visit |
$50 per visit |
$50 per visit |
Diagnostic Imaging:
CT Scans, MRI, PET Scans |
$0 |
$0 |
$0 |
$0 |
| Outpatient Surgical |
$500 |
$250 |
$250 |
$250 |
| Hospital Stay |
$1,000 |
$500 |
$500 |
$500 |
| Out-of-Pocket Maximum |
$2,000 per individual
$4,000 per family
|
$1,000 per individual
$2,000 per family
|
$1,000 per individual
$2,000 per family
|
$1,000 per individual
$2,000 per family
|
| Out-of-Pocket Maximum Includes: |
Services with a copayment of $100 or greater |
Services with a copayment of $250 or greater |
Services with a copayment of $250 or greater |
Services wth a copayment of $250 or greater |
| Prescription Drugs |
|
