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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.

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