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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 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