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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

$1,500 Copay Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$1,500

$3,000

 

$3,000

$6,000

Out-of-Pocket Maximum

Individual

Family

 

$6,350

$12,700

 

$12,700

$25,400

Preventive Care Services

No Charge

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

Under age 19: No Charge, Age 19 and older: $35 Copay

$70 Copay

$35 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

 

20%*

20%*

 

40%*

40%*

Emergency Room

Emergency Medical Transportation

$250 Copay, then 20%*

20%*

$250 Copay, then 20%*

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$35 Copay

40%*

40%*

40%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay

$40 Copay

$75 Copay

$200 Copay

Mail Order 90 Day Supply

$45 Copay

$120 Copay

$225 Copay

Not Covered

Teledoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

No Charge

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

No Charge

NOTE: * Coinsurance After Deductible

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

 

 

 

 

$3,500 Copay Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$3,500

$7,000

 

$7,000

$14,000

Out-of-Pocket Maximum

Individual

Family

 

$6,350

$12,700

 

$12,700

$25,400

Preventive Care Services

No Charge

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

Under age 19: No Charge, Age 19 and older: $35 Copay

$70 Copay

$35 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

 

20%*

20%*

 

40%*

40%*

Emergency Room

Emergency Medical Transportation

$250 Copay, then 20%*

20%*

$250 Copay, then 20%*

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$35 Copay

40%*

40%*

40%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay

$40 Copay

$75 Copay

$200 Copay

Mail Order 90 Day Supply

$45 Copay

$120 Copay

$225 Copay

Not Covered

Teledoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

No Charge

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

No Charge

NOTE: * Coinsurance After Deductible

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

 

 

 

 

$6,000 HSA Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$6,000

$12,000

 

$12,000

$24,000

Out-of-Pocket Maximum

Individual

Family

 

$6,350

$12,700

 

$12,700

$25,400

Preventive Care Services

No Charge

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

20%*

20%*

20%*

Urgent Care Services

0%*

20%*

Complex Imaging: MRI/CT/PET Scans

0%*

20%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

20%*

20%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

20%*

20%*

Emergency Room

Emergency Medical Transportation

0%*

0%*

0%*

0%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

20%*

20%*

20%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay after Deductible

$40 Copay after Deductible

$75 Copay after Deductible

$200 Copay after Deductible

Mail Order 90 Day Supply

$45 Copay after Deductible

$120 Copay after Deductible

$225 Copay after Deductible

Not Covered after Deductible

Teledoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

No Charge

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

No Charge

NOTE: * Coinsurance After Deductible

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

 

 

 

 

If you prefer talking with a HealthEZ representative, call 844-281-5217