Plans HNE WisePlus HNE EssentialMax HNE Principle
Alliance		 HNE Health MyHNE
for ages 18-26
Monthly premium: $ $$ $$
$$$
 $
Out-of-pocket costs for service $$$ $$ $$
$
 $$$
Up-front deductible: $2,000 individual
$4,000 family		 $1,000 individual
$2,000 family		 None
None
 $2,000 individual
Copayments:
Doctor’s Office: $25
after deductible
$0 for Preventive services		 $20 PCP
$40 Specialist
$0 Preventive services		 $15

$0 Preventive services
$15 PCP
$25 Specialist
$0 Preventive services
 $30 PCP
$40 Specialist after deductible
$0 Preventive services
Hospital Stay: 500
after deductible		 $0
after deductible		 $250
$100
 $500
after
deductible
Drugs: $10/$30/$60
after deductible		 $10/$30
Performance Formulary		 $10/$30
Performance Formulary
$10/$25/$45
 $10/$30
Performance Formulary
Out of Pocket Maximum $5,000 individual
$10,000 family
Includes deductible after the deductible amount.		 Deductible Plus
$1,000 individual
$2,000 family
for services with a $100 or
greater copayment		 $500 individual
$1,000 family
for services with a $150 or
greater copayment
$500 individual
$1,000 family
for services with a $100 or
greater copayment
 Deductible Plus
$1,000
for services with a $100 or
greater copayment