Introducing Eyewear Discounts

Need eyeglasses or contact lenses?

HNE members can get up to 25% off glasses or contact lenses.  For a list of participating eyewear providers, please see our Provider Directory or contact HNE Member Services.

Screening colonoscopies

HNE has removed the outpatient surgical services copayment for one in-plan screening colonoscopy every five calendar years.  For plans with a deductible, the deductible will not apply for in-plan services.   Members pay $0 for this service in a facility, or the standard office copayment if performed in a doctor’s office.  For additional colonoscopy services during the five calendar years, members remain responsible for any applicable deductibles or copayments.

Infertility Services

HNE requires prior approval for all intra-uterine insemination procedures. 

Travel Vaccines

HNE covers travel vaccines.  Before January 1, 2008, travel vaccines were not subject to deductibles and copayments for certain HNE plans.  After January 1, 2008, travel vaccines are subject to applicable deductibles and copayments.  This change affects the following plans:

• HNE Wise^Max and HNE Wise^Plus (Options HDHP HMO H and M)
• HNE PPO Wise (Option HDHP PPO)
• HNE Focus (Option 8H)
• HNE Essential^Max and HNE Essential^Plus (Options 9H and 9M)
• MyHNE – Our Young Adult Plan

Human Organ Transplants

• HNE does not cover the charges for an HNE member who is donating an organ to a non-HNE member. This applies whether or not the services are covered by the recipient’s plan.
• If an HNE member is the recipient of a human organ and the donor’s costs are not covered by any other insurance, HNE will cover the donor charges for no more than 90 days post-operatively or until the HNE member’s coverage ends, whichever happens first.

Human Organ Transplants and Bone Marrow Transplants

HNE covers these services at transplant centers of excellence

Prosthetic limbs

HNE covers prosthetic limbs. There is no annual limit for the purchase of prosthetic limbs. Members are responsible for a 20% copayment for these items. Some items (including electronic or myoelectric limbs) require prior approval. For information about which items require prior approval, please contact HNE Member Services.

NOTE:

• For HMO plans with a deductible (except HDHP plans), copayment amounts for DME items and prosthetic limbs apply to the copayment maximum.  This includes:
  • HNE Essential^Max (Option 9H)
  • HNE Essential^Plus (Option 9M)
  • MyHNE (Young Adult Plan)
• For plans with an out-of-plan benefit: if an item requires prior approval and the member does not obtain prior approval, or if prior approval is denied, the member is responsible for the full cost of the item. This includes:
  • HNE Advantage plans
  • HNE PPO plans

Behavioral Health

To look up In-Plan behavioral health providers, please check your Provider Directory or visit our web site, hne.com.  If you need help with choosing a provider, you may also call HNE’s Behavioral Health Department at 413 787-4000 or 800-842-4464, ext. 5028.  Our staff can help you choose a provider based on the nature of your concerns, your location, and appointment availability.

Mental Health Services (Outpatient)
For outpatient mental health services with an in-plan provider, you do not have to contact HNE before receiving services.  HNE does require your mental health provider to send us a treatment plan prior to your 16^th visit.

You do not need prior approval for medication management services with an in-plan psychiatrist or clinical nurse specialist. There is no annual limit to the number of medication management visits you may obtain.

Substance Abuse Services (Outpatient)
For outpatient substance abuse services with an in-plan provider, you do not have to contact HNE before receiving services.  HNE does require your substance abuse provider to send us a treatment plan prior to your 9^th visit.  

Drug Specific Formulary Changes

HNE limits the coverage of specific drugs to control costs and ensure safe and effective use. HNE may place limits on the quantity of a drug covered, the amount that can be obtained for each Copayment, or the medical conditions for which a covered drug may be prescribed.

Tier Status indicated is effective January 1, 2008 unless other wise noted.

Prior Approval
HNE requires Prior Approval for the following drugs:

• Iplex®
• Soliris®
• Vivaglobulin®

Prescription Drug Limitations

• Suboxone® 2mg:  There is a quantity limit of 270 tablets per 30 day period.
• Suboxone® 8mg:  There is a quantity limit of 90 tablets per 30 day period.
• Subutex® 2mg:  There is a quantity limit of 270 tablets per 30 day period.
• Subutex® 8mg:  There is a quantity limit of 90 tablets per 30 day period.

Tier assignments
The following Prescription Drugs are changing from a Tier 2 Copayment to a Tier 3 Copayment: 

The following Prescription Drug is changing from a Tier 3 Copayment to a Tier 2 Copayment for the HNE Formulary: