Plan Overview

Limited Network Plan logo

Health New England is an HMO that provides coverage through the plan’s network of doctors, hospitals, and other providers.  Members must select a Primary Care Provider (PCP) to manage their care; referrals to network specialists are not required.

Contact the plan to see if your doctors and hospitals are in the network. There are no out-of-network benefits, with the exception of emergency care.

Specialist Tiering

Health New England tiers the following specialists based on quality and/or cost efficiency: Cardiologists, Endocrinologists, Gastroenterologists, General Surgeons, Obstetricians/Gynecologists, Orthopedists, Otolaryngologists (ENTs), Pulmonologists, and Rheumatologists. Members pay lower office visit copays when they see Tier 1 or Tier 2 specialists.  Contact the plan to see how your provider is rated.

! Your Responsibility

Do your doctors and hospitals participate in Health New England?

Contact the Plan.

Plan Contact Information

Contact the plan for additional information on participating providers and benefits.

Health New England

1.800.842.4464

Fiscal Year Deductible

$300 per individual up to a maximum of $900 per family. 

In-Network Out of Pocket Maximum

$5,000 per individual; $10,000 per family

Copays Effective July 1, 2016

Primary Care Provider Office Visit

$20 per visit

Preventive Services

Most covered at 100% - no copay

Specialist Physician Office Visit

Health New England tiers the following specialists based on quality and/or cost efficiency: Cardiologists, Endocrinologists, Gastroenterologists, General Surgeons, Obstetricians/Gynecologists, Orthopedists, Otolaryngologists (ENTs), Pulmonologists, and Rheumatologists.

***Tier 1 (excellent):  $30 per visit
**Tier 2 (good):          $60 per visit
*Tier 3 (standard): $90 per visit

Retail Clinic and Urgent Care Center

$20 per visit

Outpatient Mental Health and Substance Abuse Care

$20 per visit

Inpatient Hospital Care -Medical (Maximum one copay per person per calendar year quarter; waived if readmitted within 30 days in the same calendar year)
$275 per admission

Outpatient Surgery (Maximum four copays per person per calendar year)

$250 per occurrence

High-Tech Imaging (e.g., MRI, PET and CT scans) (Maximum one copay per day)

$100 per scan

Emergency Room
$100 per visit (waived if admitted)

Prescription Drug

Retail up to 30 day supply:        Mail Order up to 90 day supply:
Tier 1:   $10                                         Tier 1:   $25
Tier 2:   $30                                        Tier 2:   $75
Tier 3:   $65                                         Tier 3:   $165

Who is Eligible?

Employees, Retirees, GIC Retired Municipal Teachers (RMTs), Elderly Governmental Retirees (EGRs), Survivors, and their eligible dependents without Medicare are eligible. 

Where You Live Determines Which Plan You May Enroll In

Health New England is available in the following Massachusetts counties:

Berkshire, Franklin, Hampden, Hampshire, Worcester

Health New England is available only in certain parts of the following state, contact the plan to find out if you live in the service area.

Connecticut

Health New England January 1, 2016 Amendment docx format of HNE_1_1_16notice.docx

Handbook

Health New England FY17 Schedule of Benefits  docx format of Health New England FY17 Schedule of Benefits

Health New England FY17 Schedule of Benefits  pdf format of Health New England FY17 Schedule of Benefits

Health New England FY17 Handbook  docx format of Health New England FY17 Handbook
file size 1MB

Health New England FY17 Handbook  pdf format of Health New England FY17 Handbook
file size 1MB

Health New England FY17 Handbook cover letter  pdf format of Health New England FY17 Handbook cover letter


This information provided by the Group Insurance Commission .