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| Value HMO |
| Plans |
Value HMO |
| Essential1000 |
|
HNE Focus
Option 8H |
| Up-front deductible |
$1,000 per individual
$2,000 per family per policy or calendar year |
$500 per individual
$1,000 per family
per policy or calendar year |
N/A |
| Doctor’s Office |
$0 Preventive Services
$20 All other office visits |
$0 Preventive Services
$20 All other office visits |
$0 Preventive Services
$25 All other office visits |
Emergency
(waived if admitted directly from ER) |
$150 per visit |
$150 per visit |
$150 per visit |
High Cost Diagnostics:
Diagnostic Imaging:CT Scans, MRI, PET Scans, Nuclear Cardiac
Sleep Studies
Genetic Testing:
BRCA & Colaris |
$75 after deductible |
$75after deductible |
$150 |
| $75 after deductible |
$75 after deductible |
$150 |
| $75 after deductible |
$75 after deductible |
$150 |
| Outpatient Surgical |
$0 after deductible |
$0 after deductible |
$500 |
| Hospital Stay |
$0 after deductible |
$0 after deductible |
$1,000 |
| Out-of-Pocket Maximum |
$2,000 per individual
$4,000 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 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 |
