Monthly premium: $
Out-of-pocket costs for service $$$

This HMO plan is a federally qualified high deductible health plan (HDHP). HDHPs allow you to contribute pre-tax dollars into a health savings account (HSA). You can save the money in the HSA and carry it over from year to year, or use it to pay for qualified medical expenses.

Up-front deductible:	Copayments:			Out of Pocket Maximum
	Doctor’s Office:	Hospital Stay:	Drugs:
$2,000 individual $4,000 family	$25 after deductible $0 for Preventive services	$500 after deductible	$10/$30/$60 after deductible	$5,000 individual $10,000 family

 

HMO Summary of Benefits Chart

Get a price now!
For more information (including prices), or to sign up for any of the Connector Plans, contact either one of the agencies listed below.  Additional HNE plans that meet creditable coverage requirements also are available through Health Services Administrators.
1-877-MA-ENROLL (1-877-623-6765) or 1-877-623-7773(774)		Health Services Administrators 877-777-4414