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| Plans |
Basic HMO |
HNE Wise Plus
HDHP M HMO |
HNE Essential2000
|
HNE
Essential1500 |
HNE
Essential1000
|
|
| Up-front deductible |
$2,000 per individual
$4,000 per family
per policy OR calendar year |
$2,000 per individual
$4,000 per family
per policy OR calendar year |
$1,500 per individual
$3,000 per family
per policy or calendar year |
$1,000 per individual
$2,000 per family
per policy OR calendar year |
|
| Doctor’s Office |
$0 Preventive Services
$25 after deductible
for all other office visits |
$0 Preventive Services
$20 All other office visits
|
$0 Preventive Services
$20 All other office visits |
$0 Preventive Services
$20 All other office visits
|
|
Emergency
(waived if admitted directly from ER) |
$75 after deductible |
$100 per visit |
$100 per visit |
$100 per visit |
|
Diagnostic Imaging:
CT Scans, MRI, PET Scans |
$0 after deductible |
$0 after deductible |
$0 after deductible |
$0 after deductible |
|
| Outpatient Surgical |
$250 after deductible |
$0 after deductible |
$0 after deductible |
$0 after deductible |
|
| Hospital Stay |
$500 after deductible |
$0 after deductible |
$0 after deductible |
$0 after deductible |
|
| Out-of-Pocket Maximum |
$5,000 per individual
$10,000 per family |
$4,000 per individual
$8,000 per family |
$3,000 per individual
$6,000 per family |
$2,000 per individual
$4,000 per family |
|
| Out-of-Pocket Maximum Includes: |
Deductible and copayments |
Deductible and services
with a copayment of
$100 or greater |
Deductible and services
with a copayment of
$100 or greater |
Deductible and services
with a copayment of
$100 or greater |
|
