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| Intermediary Groups: 1-5 Eligible Employees |
| Plans |
Value HMO |
HNE ChoicePlus
Option 7M |
HNE CompletePlus
Option 7H |
| Up-front deductible |
N/A |
N/A |
| Doctor’s Office |
$0 Preventive Services
$20 PCP
$40 Specialist
|
$0 Preventive Services
$10 PCP
$25 Specialist
|
Emergency
(waived if admitted directly from ER) |
$75 per visit |
$50 per visit |
Diagnostic Imaging:
CT Scans, MRI, PET Scans |
$0 |
$0 |
| Outpatient Surgical |
$250 |
$250 |
| Hospital Stay |
$500 |
$500 |
| Out-of-Pocket Maximum |
$1,000 per individual
$2,000 per family
|
$1,000 per individual
$2,000 per family
|
| Out-of-Pocket Maximum Includes: |
Services with a copayment of $250 or greater |
Services with a copayment of $250 or greater |
