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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

Calendar Year Deductible

Individual Coverage

Family Coverage

 

$2,500

$5,000

 

$10,000

$20,000

Out-Of-Pocket Maximum

Individual Coverage

Family Coverage

 

$4,500

$9,000

 

$20,000

$40,000

Preventive Care

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$50 Copay

20%*

 

50%*

50%*

50%*

Urgent Care Services

$75 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

20%*

50%*

Hospital Services Inpatient & Outpatient

20%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$200 Copay

20%*

 

$200 Copay

50%*

Mental Health / Chemical Dependency

Inpatient

Office Visit

 

20%*

$25 Copay

 

50%*

50%*

Teladoc Services

General Consultations

Dermatology

Mental Health -Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

$55 Copay

$55 Copay

$55 Copay

$55 Copay

$55 Copay

 

$55 Copay

$55 Copay

$55 Copay

$55 Copay

$55 Copay

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$20 Copay

$40 Copay

$60 Copay

$150 Copay

Mail Order 90 day Supply

$60 Copay

$120 Copay

$180 Copay

Not Available

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

Calendar Year Deductible

Individual Coverage

Family Coverage

 

$6,300

$12,600

 

$12,600

$25,200

Out-Of-Pocket Maximum

Individual Coverage

Family Coverage

 

$6,300

$12,600

 

$25,200

$50,400

Preventive Care

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%*

Hospital Services Inpatient & Outpatient

0%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

0%*

0%*

 

50%*

50%*

Mental Health / Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

50%*

50%*

Teladoc Services

General Consultations

Dermatology

Mental Health -Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

NOTE: * After Deductible

 

$55 Copay*

$55 Copay*

$55 Copay*

$55 Copay*

$55 Copay*

 

 

$55 Copay*

$55 Copay*

$55 Copay*

$55 Copay*

$55 Copay*

 

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 Available

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 844-839-6735