Compare Plans

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.

Summary Of Medical Benefits

Copay Plan 1

In-Network

Out-Of-Network

Calendar Year Deductible

Individual Coverage

Individual Under Family Coverage

Family

 

$500

$500

$1,500

 

$750

$750

$2,250

Out-of-Pocket Maximum

Individual Coverage

Individual Under Family Coverage

Family

 

$2,500

$2,500

$5,000

 

$5,000

$5,000

$10,000

Preventive Care

No Charge

40%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$40 Copay

$40 Copay

 

40%*

40%*

40%*

Urgent Care Services

$50 Copay

40%*

Complex Imaging: MRI/CT/PET Scans

20%*

40%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

40%*

40%*

Outpatient Procedures

Facility Fee

Physician Fee

 

$200 Copay

20%*

 

40%*

40%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$300 Copay

20%*

 

40%*

40%*

Mental Health / Chemical Dependency

Inpatient Facility Fee

Office Visit

 

20%*

$20 Copay

 

40%*

40%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty Drugs

Retail 30 Day Supply

$10 Copay

$50 Copay

$80 Copay

$250 Copay

Mail Order 90 day Supply

$20 Copay

$100 Copay

$160 Copay

Not Covered

NOTE: * Coinsurance After Deductible

** Covered as in-network in true-emergency

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 Coverage

Individual Under Family Coverage

Family

 

$3,000

$3,000

$6,000

 

$5,000

$5,000

$10,000

Out-of-Pocket Maximum

Individual Coverage

Individual Under Family Coverage

Family

 

$5,000

$5,000

$10,000

 

$10,000

$10,000

$20,000

Preventive Care

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$35 Copay

$75 Copay

$75 Copay

 

50%*

50%*

50%*

Urgent Care Services

$75 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

30%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

30%*

30%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

30%*

30%*

 

50%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$350 Copay

30%*

 

50%*

50%*

Mental Health / Chemical Dependency

Inpatient Facility Fee

Office Visit

 

30%*

$35 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Formulary

Non-Formulary

Specialty

Retail 30 Day Supply

$10 Copay

$50 Copay

$80 Copay

$250 Copay

Mail Order 90 day Supply

$20 Copay

$100 Copay

$160 Copay

Not Covered

NOTE: * Coinsurance After Deductible

** Covered as in-network in true-emergency

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 Coverage

Individual Under Family Coverage

Family Coverage

 

$3,200

$3,300

$6,400

 

$6,400

$6,400

$12,800

Out-of-Pocket Maximum

Individual Coverage

Individual Under Family Coverage

Family Coverage

 

$3,200

$3,300

$6,400

 

$12,800

$12,800

$25,600

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

50%*

50%*

50%*

Urgent Care Services

0%*

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 Room Services**

Emergency Medical Transportation**

0%*

0%*

50%*

50%*

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%*

0%*

Mail Order 90 Day Supply

0%*

0%*

0%*

Not Covered

NOTE: * Coinsurance After Deductible

** Covered as in-network in true-emergency

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

 

 

 

 

 

 


If you prefer talking with a HealthEZ representative, call 1-877-840-3874