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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

Calendar Year Deductible

Individual

Family

 

$1,500

$3,000

 

$3,000

$6,000

Out-Of-Pocket Maximum

Individual

Family

 

$4,000

$8,000

 

$8,000

$16,000

Preventive Care

No Charge

0%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Services

 

$25 Copay

$75 Copay

0%*

 

50%*

50%*

50%*

Complex Imaging: MRI/CT/PET Scans

0%*

50%*

Hospital Services

0%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

0%*

0%*

 

50%*

50%*

Urgent Care Services

$50 Copay

50%*

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

No Charge

$85 Copay

No Charge

No Charge

No Charge

 

No Charge

$85 Copay

No Charge

No Charge

No Charge

Mental Health / Chemical Dependency

Inpatient

Office Visit

 

0%*

$75 copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$10 Copay

$35 Copay

$75 Copay

Not Available

Mail Order 90 day Supply

$25 Copay

$87.50 Copay

$187.50 Copay

Not Available

* Coinsurance After deductible

 

 

** True emergencies covered at in-network level

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

 

 

 

 

Copay Plan 2

In-Network

Out-Of-Network

Calendar Year Deductible

Individual

Family

 

$4,000

$8,000

 

$8,000

$16,000

Out-Of-Pocket Maximum

Individual

Family

 

$8,150

$16,300

 

$16,300

$32,600

Preventive Care

No Charge

0%*

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

$25 Copay

$75 Copay

0%*

 

50%*

50%*

50%*

Complex Imaging: MRI/CT/PET Scans

0%*

50%*

Hospital Services

0%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

0%*

0%*

 

50%*

50%*

Urgent Care Services

$50 Copay

50%*

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

No Charge

$85 Copay

No Charge

No Charge

No Charge

 

No Charge

$85 Copay

No Charge

No Charge

No Charge

Mental Health / Chemical Dependency

Inpatient

Office Visit

 

0%*

$75 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$10 Copay

$35 Copay

$75 Copay

Not Available

Mail Order 90 day Supply

$25 Copay

$87.50 Copay

$187.50 Copay

Not Available

* 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

Calendar Year Deductible

Individual

Family

 

$6,350

$12,700

 

$12,700

$25,400

Out-Of-Pocket Maximum

Individual

Family

 

$6,350

$12,700

 

$12,700

$25,400

Preventive Care

No Charge

0%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

50%*

50%*

50%*

Complex Imaging: MRI/CT/PET Scans

0%*

50%*

Hospital Services

0%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

0%*

0%*

 

50%*

50%*

Urgent Care Services

0%*

50%*

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

$45 Copay

$85 Copay

$45 Copay

$45 Copay

$45 Copay

 

$45 Copay

$85 Copay

$45 Copay

$45 Copay

$45 Copay

Mental Health / Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

0%*

0%*

0%*

Not Available

Mail Order 90 day Supply

0%*

0%*

0%*

Not Available

* 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 844-669-1945