See something you like? Follow the links at the Plan Names for more details.
| Intermediary Groups: 1-5 Eligible Employees | ||||||||||||
| Plans | Basic HMO | Value HMO | Premium HMO | Preferred Provider Organization (PPO) | ||||||||
| HNE WisePlus HDHP M HMO |
HNE WiseMax HDHP H HMO |
HNE EssentialMax Option 9H |
Option 8H |
HNE ChoicePlus Option 7M |
HNE CompletePlus Option 7H |
HNE Principle * Option 4 |
HNE Health |
HNE PPO Focus | HNE PPO Complete | |||
| In-Plan | Out-of-Plan | In-Plan | Out-of-Plan | |||||||||
| 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 |
$1,000 per individual
$2,000 per family per policy OR calendar year |
N/A | N/A | N/A | N/A | N/A | N/A | $1,000 per individual $2,000 per family per calendar year |
N/A | $1,000 per individual
$2,000 per family per calendar year |
| Doctor’s Office | $0 Preventive Services
$25 after deductible for all other office visits |
$0 Preventive
Services
$0 after deductible for all other office visits |
$0 Preventive Services
$20 PCP $40 Specialist |
$0 Preventive Services $20 All other office visits |
$0 Preventive Services
$20 PCP $40 Specialist |
$0 Preventive Services $10 PCP $25 Specialist |
$0 Preventive Services $15 |
$0 Preventive Services $15 PCP $25 Specialist |
$0 Preventive Services $25 |
20% after deductible | $0 Preventive Services $20 |
20% after deductible |
| Emergency (waived if admitted directly from ER) |
$75 after deductible | $0 after deductible | $100 after deductible | $100 per visit | $75 per visit | $50 per visit | $50 per visit | $75 per visit | $100 per visit | $100 per visit | $50 per visit | $50 per visit |
| Diagnostic Imaging: CT Scans, MRI, PET Scans |
$0 after deductible | $0 after deductible | $100 after deductible | $150 | $0 | $0 | $0 | $0 | $100 per visit | 20% after deductible | $0 | 20% after deductible |
| Outpatient Surgical | $250 after deductible | $0 after deductible | $0 after deductible | $500 | $250 | $250 | $150 | $100 | $500 | 20% after deductible | $250 | 20% after deductible |
| Hospital Stay | $500 after deductible | $0 after deductible | $0 after deductible | $1,000 | $500 | $500 | $250 | $100 | $1,000 | 20% after deductible | $500 | 20% after deductible |
| Out-of-Pocket Maximum | $5,000 per individual
$10,000 per family |
$5,000 per individual
$10,000 per family |
$2,000 per individual
$4,000 per family |
$2,000 per individual $4,000 per family |
$1,000 per individual
$2,000 per family |
$1,000 per individual
$2,000 per family |
$500 per individual
$1,000 per family |
$500 per individual $1,000 per family |
$2,000 per individual $4,000 per family |
$4,000 per individual $8,000 per family |
$1,000 per individual
$2,000 per family |
$3,000 per individual
$6,000 per family |
| Out-of-Pocket Maximum Includes: | Deductible and copayments | Deductible and copayments | Deductible and services with a copayment of $100 or greater | 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 with copayment of $150 or greater | Services with copayment of $100 or greater | Services with a copayment of $100 or greater | Deductible and 20% coinsurance | Services with a copayment of $250 or greater | Deductible and 20% coinsurance |
| Prescription Drugs |
Pharmacy Riders are available for all plans. (Note: The Performance Formulary is the only pharmacy rider available for the HNE Alliance Network ) |
* Looking for lower Premiums? Ask your Sales Representative about the HNE Alliance Network. | ||||||||||