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| Plans |
Basic HMO |
HNE Wise Plus
HDHP M HMO |
HNE WiseMax
HDHP H HMO |
HNE
EssentialPlus
Option 9M |
HNE
EssentialMax
Option 9H |
HNE Focus *
Option 8H |
| 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
|
$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 |
| 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
$30 PCP
$40 Specialist after deductible
|
$0 Preventive Services
$20 PCP
$40 Specialist
|
$0 Preventive Services
$25 All other office visits
|
Emergency
(waived if admitted directly from ER) |
$75 after deductible |
$0 after deductible |
$100 after deductible |
$100 after deductible |
$100 per visit |
Diagnostic Imaging:
CT Scans, MRI, PET Scans |
$0 after deductible |
$0 after deductible |
$0 after deductible |
$100 after deductible |
$150 |
| Outpatient Surgical |
$250 after deductible |
$0 after deductible |
$250 after deductible |
$0 after deductible |
$500 |
| Hospital Stay |
$500 after deductible |
$0 after deductible |
$500 after deductible |
$0 after deductible |
$1,000 |
| Out-of-Pocket Maximum |
$5,000 per individual
$10,000 per family
|
$5,000 per individual
$10,000 per family
|
$3,000 per individual
$6,000 per family
|
$2,000 per individual
$4,000 per family
|
$2,000 per individual
$4,000 per family
|
| Out-of-Pocket Maximum Includes: |
Deductible and copayments |
Deductible and copayments |
Deductible and services
with a copayment of
$100 or greater |
Deductible and services
with a copayment of
$100 or greater |
Services with a copayment
of $100 or greater |
