The Connector:
A new state agency formed to help individuls and small employers get health insurance.

Copayment
A fixed dollar amount that you pay for covered services.

Deductible
The total dollar amount that you must meet for certain covered services each year before HNE will begin paying.

Health Savings Account (HSA)
A savings account that you can contribute to on a pre-tax basis and use to pay for current or future medical expenses.

Out of Pocket Maximum
You pay a certain amount when you get covered services – deductible, copayment, and/or coinsurance. For some services, there is a limit on how much you will have to pay out each year. This limit is the out of pocket maximum. If you meet the out-of-pocket maximum, you won’t have to pay for those types of services for the rest of that year.

Premium
A flat monthly payment you make to purchase a health plan.

Preventive services
These are services that help you stay healthy – like adult routine exams, well child care, or annual eye exams.

HNE Alliance Network
Working within our network of doctors, we’ve identified a group of primary care physicians (PCPs)who, along with our current network of specialists, make up the HNE Alliance Network. These PCPs were chosen by HNE based on quality data about their own past performance and their willingness to create a partnership with their patients. It will be up to your PCP to manage any specialty care you may need by submitting a care management request form to HNE. As an HNE Alliance Network member, it’s up to you to participate in a health risk assessment, and to follow the advice and direction of your PCP.

HNE Performance Formulary
The HNE Performance Formulary includes two tiers - all generic medications (Tier 1) and carefully selected brand name drugs (Tier 2). Each tier has a different copayment – with Tier 1 drugs having a lower copayment than Tier 2 drugs. If a medication is not listed in the HNE Performance Formulary, members are responsible for payment of the cost of the drug after the HNE drug discount is applied. The discount rate varies by the particular drug, but in general is between 10% and 30% of the retail cost.