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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

In-Network

Out-Of-Network

Embedded Deductible

Individual

Family

 

$2,500

$4,500

 

$4,000

$12,000

Out-Of-Pocket Maximum

Individual

Family

 

$4,500

$9,000

 

$14,000

$24,000

Preventive Care

No Charge

40%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$50 Copay

$50 Copay

 

40%*

40%*

40%*

Urgent Care Services

$60 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

 

20%*

20%*

 

40%*

40%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$250 Copay

20%*

 

40%*

40%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$25 Copay

 

40%*

40%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$15 Copay

$35 Copay

$65 Copay

$15/$35/$65 Copay

Mail Order 90 day Supply

$30 Copay

$70 Copay

$120 Copay

Not Available

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

$5 Copay

$50 Copay

$5 Copay

$5 Copay

$5 Copay

 

$5 Copay

$50 Copay

$5 Copay

$5 Copay

$5 Copay

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

In-Network

Out-Of-Network

Embedded Deductible

Individual

Family

 

$3,000

$6,000

 

$6,000

$12,000

Out-Of-Pocket Maximum

Individual

Family

 

$4,000

$8,000

 

$15,000

$30,000

Preventive Care

No Charge

40%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

10%*

10%*

10%*

 

40%*

40%*

40%*

Urgent Care Services

10%*

40%*

Complex Imaging: MRI/CT/PET Scans

10%*

40%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

40%*

40%*

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

40%*

40%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

10%*

10%*

 

40%*

40%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

10%*

 

40%*

40%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$5 Copay

$35 Copay

$65 Copay

$15/$35/$65 Copay

Mail Order 90 day Supply

$15 Copay

$90 Copay

$165 Copay

Not Available

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

$5 Copay

$50 Copay, then 20%*

$5 Copay

$5 Copay

$5 Copay

 

$5 Copay

$50 Copay, then 20%*

$5 Copay

$5 Copay

$5 Copay

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 888-284-7195