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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

Family

 

$2,000

$4,000

 

$10,000

$20,000

Out-of-Pocket Maximum

Individual

Family

 

$8,000

$16,000

 

$20,000

$40,000

Preventative Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$30 Copay

$60 Copay

$60 Copay

 

50%*

50%*

50%*

Urgent Care Services

$75 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Emergency Room Services

Emergency Medical Transportation**

$500 Copay

20%*

50%*

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$60 Copay

 

50%*

50%*

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$10 Copay

$10 Copay

$10 Copay

$10 Copay

$10 Copay

 

$10 Copay

$10 Copay

$10 Copay

$10 Copay

$10 Copay

Prescription Drug Coverage

Preventative

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail 30 Day Supply

No Charge

$15 Copay

$40 Copay

$100 Copay

20% Coinsurance

Mail Order 90 Day Supply

No Charge

$30 Copay

$80 Copay

$200 Copay

Not Available

* 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

Family

 

$8,050

$16,100

 

$15,000

$30,000

Out-of-Pocket Maximum

Individual

Family

 

$8,050

$16,100

 

$30,000

$60,000

Preventative 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%*

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$10 Copay

$10 Copay

$10 Copay

$10 Copay

$10 Copay

 

$10 Copay

$10 Copay

$10 Copay

$10 Copay

$10 Copay

Prescription Drug Coverage

Preventative

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

No Charge

0%*

0%*

0%*

0%*

Mail Order 90 Day Supply

No Charge

0%*

0%*

0%*

Not Available

* 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

Family

 

$3,500

$7,000

 

$15,000

$30,000

Out-of-Pocket Maximum

Individual

Family

 

$6,000

$12,000

 

$25,000

$50,000

Preventative Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

30%*

30%*

30%*

 

50%*

50%*

50%*

Urgent Care Services

30%*

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 Room Services

Emergency Medical Transportation**

30%*

30%*

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

30%*

30%*

 

50%*

50%*

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$10 Copay

$10 Copay

$10 Copay

$10 Copay

$10 Copay

 

$10 Copay

$10 Copay

$10 Copay

$10 Copay

$10 Copay

Prescription Drug Coverage

Preventative

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

No Charge

30%*

30%*

30%*

30%*

Mail Order 90 Day Supply

No Charge

30%*

30%*

30%*

Not Available

* 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 844-449-5544