| Plans |
Premium HMO |
HNE HealthMax
Option 3 |
HNE Principle *
Option 4 |
|
| Up-front deductible |
N/A |
N/A |
| Doctor’s Office |
$0 Preventive Services
$10 |
$0 Preventive Services
$15 |
Emergency
(waived if admitted directly from ER) |
$50 per visit |
$50 per visit |
Diagnostic Imaging:
CT Scans, MRI, PET Scans |
$0 |
$0 |
| Outpatient Surgical |
$0 |
$150 |
| Hospital Stay |
$0 |
$250 |
| Out-of-Pocket Maximum |
N/A |
$500 per individual
$1,000 per family
|
| Out-of-Pocket Maximum Includes: |
N/A |
Services with a copayment of $150 or greater |
