HNE Wise 2000/20% HDHP

Individual Health Insurance (Obamacare)

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HNE Wise 2000/20% HDHP

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Monthly Cost

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Benefits & Coverage

Plan Name
HNE Wise 2000/20% HDHP
Plan Year
2018
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Silver
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
$25 Copay after deductible
Specialist Visit
$35 Copay after deductible
Laboratory Outpatient and Professional Services
20.00% Coinsurance after deductible
X-rays and Diagnostic Imaging
20.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans
20.00% Coinsurance after deductible
Deductible - Family
$4000 per group
Out-of-Pocket Maximum - Family
$12000 per group

Prescription drug coverage

Generic Drugs
$25 Copay after deductible
Preferred Brand Drugs
$50 Copay after deductible
Non-Preferred Brand Drugs
$100 Copay after deductible
Specialty Drugs
$100 Copay after deductible

Access to doctors and hospitals

Provider directory URL
http://healthnewengland.org/provider-search
Does this plan have access to a national provider network?
No
Is a referral required to see a Specialist?
Not Covered
Does this plan cover services outside plan service area?
Yes - Urgent or Emergency
Does this plan cover services outside the country?
Yes - Urgent or Emergency

Hospital services

Emergency Room Services
$100 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
20.00% Coinsurance after deductible
Inpatient Physician and Surgical Services
Not Applicable
Emergency Transportation or Ambulance Service
$100 Copay after deductible

Maternity

Prenatal and Postnatal Care
Not Applicable
Delivery and all inpatient services for maternity care
20.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services
$25 Copay after deductible
Mental/Behavioral Health Inpatient Services
20.00% Coinsurance after deductible
Substance use disorder outpatient services
$25 Copay after deductible
Substance use disorder inpatient services
20.00% Coinsurance after deductible

Medical Management Programs

Does this plan offer a wellness program?
Not Covered

Vision Coverage

Routine Eye Exam for Children
Included
Eye Glasses for Children
Included
Routine Eye Exam for Adults
Included

Child Dental Coverage

Child Dental Coverage - Routine Dental Care
Included
Child Dental Coverage - Basic Dental Care
Included
Child Dental Coverage - Orthodontia
Included
Child Dental Coverage - Major Dental Care
Included

Adult Dental Coverage

Adult Dental Coverage - Routine Dental Care
Not Covered
Adult Dental Coverage - Basic Dental Care
Not Covered
Adult Dental Coverage - Orthodontia
Not Covered
Adult Dental Coverage - Major Dental Care
Not Covered

Exclusions and Limitations

More Included Benefits
Other Practitioner Office Visit (Nurse, Physician Assistant)
Bariatric Surgery
Infertility Treatment
Weight Loss Programs
Imaging (CT/PET Scans, MRIs)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Durable Medical Equipment
Hospice Services
Chiropractic Care
Routine Foot Care
Abortion for Which Public Funding is Prohibited
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Radiation
Reconstructive Surgery
Rehabilitative Speech Therapy
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
More Limited Benefits
Preventive Care/Screening/Immunization
Skilled Nursing Facility
Hearing Aids
Dental Check-Up for Children
Nutritional Counseling
Rehabilitative Occupational and Rehabilitative Physical Therapy
Acupuncture/Massage
More Excluded Benefits
Acupuncture
Cosmetic Surgery
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing

What To Know

  • This is an ACA (Obamacare) compliant health plan.

Physician Directory

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Silver plan frequently asked questions (FAQ)

  • What Is the Silver Plan?

    ObamaCare’s Silver Plan is a type of Metal Plan on the Health Insurance Marketplace. Silver Plans qualify for both Tax Credits and Cost Sharing subsidies.Silver Plans have lower out-of-pocket costs than Bronze Plans but higher out- of-pocket costs than both Gold and Platinum Plans. All Silver Plans share the same minimum health benefits, but the way they charge out-of-pocket costs can differ significantly.

  • How are Silver Plans different than other Obamacare health plans?

    The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Silver Plan pays 70% of covered medical costs for a typical enrollee. Silver Plans are also the only metal plans which offer cost-sharing reduction (CSR) versions to consumers that require financial assistance for out-of-pocket costs.

  • How much does a Silver Plan cost?

    The monthly premium for a Silver Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and the region in which you live. You can use HealthPocket’s comparison tool to compare Silver Plan premiums in your area.

  • When Can I Enroll in a Silver Plan?

    The Open Enrollment period for the 2016 Affordable Care Act health plans begins November 1, 2015 and ends January 31, 2016. See our Open Enrollment article for more information.

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

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