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Not all coverage is the right coverage.

The healthcare coverage you need is probably very different than the coverage some of your co-workers need. Age, family status, medical conditions, hobbies, lifestyle and a myriad of other factors will help you determine if you need a lot or a very little amount of health coverage. That’s why HealthEZ provides multiple coverage options, so you’re never caught paying too much money, or worse, having too little coverage.

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Summary Of Medical Benefits

Copay Plan 1

In-Network

Out-Of-Network

Deductible

Individual

Individual under Family

Family

 

$3,500

$3,500

$7,000

 

$7,000

$7,000

$14,000

Out-Of-Pocket Maximum

Individual

Individual under Family

Family

 

$8,150

$8,150

$16,300

 

$14,000

$14,000

$28,000

Preventive Care

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$75 Copay

20%*

 

50%*

50%*

50%*

Urgent Care Services

$50 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$300 Copay, then 20%*

20%*

 

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Outpatient

 

20%*

$75 Copay

 

50%*

50%*

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

$25 Copay

$25 Copay

$25 Copay

$25 Copay

$25 Copay

 

$25 Copay

$25 Copay

$25 Copay

$25 Copay

$25 Copay

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$10 Copay

$35 Copay

$75 Copay

$250 Copay

Mail Order 90 day Supply

$25 Copay

$87.50 Copay

$187.50 Copay

Not Available

NOTE: * Coinsurance after deductible

** True emergencies covered at in-network level

Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions

 

 

 

 

 

 

HSA Plan 1

In-Network

Out-Of-Network

Deductible

Individual

Individual under Family

Family

 

$3,300

$3,300

$6,000

 

$6,000

$6,000

$12,000

Out-Of-Pocket Maximum

Individual

Individual under Family

Family

 

$6,900

$6,900

$13,800

 

$11,400

$11,400

$22,800

Preventive Care

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay after Deductible

$75 Copay after Deductible

0%*

 

50%*

50%*

50%*

Urgent Care Services

$50 Copay after Deductible

50%*

Complex Imaging: MRI/CT/PET Scans

0%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

50%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

0%*

0%*

 

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Outpatient

 

0%*

$75 Copay

 

50%*

50%*

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

$25 Copay after Deductible

$25 Copay after Deductible

$25 Copay after Deductible

$25 Copay after Deductible

$25 Copay after Deductible

 

$25 Copay after Deductible

$25 Copay after Deductible

$25 Copay after Deductible

$25 Copay after Deductible

$25 Copay after Deductible

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$10 Copay after Deductible

$35 Copay after Deductible

$75 Copay after Deductible

$250 Copay after Deductible

Mail Order 90 day Supply

$25 Copay after Deductible

$87.50 Copay after Deductible

$187.50 Copay after Deductible

Not Available

NOTE: * Coinsurance after deductible

** True emergencies covered at in-network level

Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions

 

 

 

 

 

 


If you prefer talking with a HealthEZ representative, call 844-668- 6554