HNE Core 3000
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Customer Reviews: Not Yet Rated
Plan Summary | |
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Plan Type | HMO |
Office Visit for Primary Doctor
Find Doctors |
$0 Copay for the first visit then $40 Copay |
Office Visit for Specialist | $60 Copay after deductible |
Office Visit for Other Practitioner (Nurse, Physician Assistant) | $40 Copay |
Annual Deductible | Individual: $3,000 |
Separate Prescription Drugs Deductible | Medical Plan Deductible Applies |
Coinsurance | 0% |
Retail Prescription Drugs | Generic Drugs: $30 Copay; Preferred Brand Drugs: $80 Copay after deductible; Non-Preferred Brand Drugs: $125 Copay after deductible; Specialty Drugs: $150 Copay after deductible; |
Annual Out-of-Pocket Limit | Individual: $7,800 Includes deductible |
Lifetime Maximum | Unlimited |
Health Savings Account (HSA) Eligible | No |
Out-of-Network Coverage | Emergency Care Only |
Out-of-Country Coverage | Yes. Urgent or Emergency |
Office Visit | |
Primary Care Physician Required | Yes |
Specialist Referrals Required | No |
Preventive Care Coverage | |
Periodic Health Exam | No Charge |
Periodic OB-GYN Exam | No Charge |
Well Baby Care | No Charge |
Emergency and Urgent Care | |
Emergency Room | $500 Copay after deductible |
Emergency Ambulance Services | $100 Copay after deductible |
Urgent Care Facility | $60 Copay after deductible |
Prescription Drug Coverage | |
Retail Prescription Drugs | Generic Drugs: $30 Copay; Preferred Brand Drugs: $80 Copay after deductible; Non-Preferred Brand Drugs: $125 Copay after deductible; Specialty Drugs: $150 Copay after deductible; |
Separate Prescription Drugs Deductible | Medical Plan Deductible Applies |
Mail Order Prescription Drugs | N/A |
Mail Order Supply | N/A |
Outpatient Coverage | |
Outpatient Surgery | Outpatient Surgery Physician/Surgical Services: No Charge after deductible Outpatient Facility Fee: $500 Copay after deductible |
Outpatient Lab/X-Ray | Outpatient Lab: $100 Copay after deductible X-rays: $200 Copay after deductible |
Imaging (CT and PET scans, MRIs) | $500 Copay after deductible |
Outpatient Mental Health | $0 Copay for the first visit then $40 Copay |
Outpatient Substance Abuse | $0 Copay for the first visit then $40 Copay |
Outpatient Rehabilitation Services (PT, OT, ST) | $60 Copay after deductible |
Inpatient Coverage | |
Hospitalization | Inpatient Hospital Services: $1000 Copay per Stay after deductible Inpatient Physician and Surgical Services: No Charge after deductible |
Skilled Nursing Facility | $1000 Copay per Stay after deductible, limited to 100 Days per Year |
Inpatient Mental Health | $1000 Copay per Stay after deductible |
Inpatient Substance Abuse | $1000 Copay per Stay after deductible |
Home Healthcare | No Charge after deductible |
Maternity Coverage | |
Pre & Postnatal Office Visit | No Charge |
Labor & Delivery Hospital Stay | $1000 Copay per Stay after deductible |
Pediatric Services | |
Dental Checkup for Children | No Charge, limited to 2 Exam(s) per Year |
Vision Screening for Children | No Charge, limited to 1 Exam(s) per Year |
Eye Glasses for Children | No Charge, limited to 1 Item(s) per Year |
Major Dental Coverage (Pediatric) | 50% Coinsurance after deductible |
Additional Coverage | |
Chiropractic Coverage | $20 Copay after deductible |
Durable Medical Equipment | 20% Coinsurance after deductible |
Hospice | No Charge |
Major Dental Coverage (Adult) | Not Covered |
Vision Coverage (Adult) | No Charge, limited to 1 Visit(s) per Year |
Out-of-Network Coverage | |
Out-of-Network Authorization Required | N/A |
Out-of-Network Annual Deductible | N/A |
Out-of-Network Annual Coinsurance | N/A |
Out-of-Network Annual Out-of-Pocket Limit | N/A |
Additional Information | |
A.M. Best Rating | N/A as of 11/12/2024 |
Electronic Signature for Application Available | Yes |
Details and documents about this plan | |
View Plan Brochure Exclusions and Limitations |
Important notices and disclaimers
- The information shown here is a summary of benefits for informational purposes only. Review the official plan documents (such as evidence of coverage, plan brochure, or insurance policy) for a detailed description of coverage benefits, limitations, and exclusions. Only the terms and conditions of coverage benefits listed in the policy are binding.
- The benefits listed may be contingent on your use of physicians, hospitals, and services within the specific insurance company's provider network.
- The Copayment, Deductible, and Coinsurance amounts are your share of the costs for covered benefits. These amounts are subject to change.
- Each insurance carrier may have unique Notices, Disclaimers, and Fees. Please check below for information regarding the plans and carriers you selected.
- The quotes or rates shown above are estimates only. Your premium is subject to change based on the optional benefits you selected, if any, and other relevant factors, such as changes in rates that take effect before your coverage start date. The insurance company always determines your actual premium. Insurance companies reserve the right to change the terms of a policy upon proper notification.
- The Summary of Benefits & Coverage can be found at healthcare.gov. A paper copy of this Summary of Benefits & Coverage is available upon request by calling our toll free number. Click here to view the Uniform Glossary of Coverage and Medical Terms.