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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

Deductible

Individual

Family

 

$2,000

$6,000

 

$4,000

$12,000

Out-Of-Pocket Maximum

Individual

Family

 

$5,000

$10,200

 

$10,000

$30,000

Preventive Care Services

No Charge

40%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$20 Copay

20%*

 

40%*

40%*

40%*

Urgent Care Services

$45 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

 

$100 Copay, then 20%* (Copay Waived if Admitted)

20%*

 

$100 Copay, then 20%* (Copay Waived if Admitted)

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$20 Copay

 

40%*

40%*

Teladoc Services

General Consultations

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

$20 Copay

$20 Copay

$20 Copay

$20 Copay

 

$20 Copay

$20 Copay

$20 Copay

$20 Copay

Prescription Out of Pocket Maximum

Individual

Family

 

$1,000

$3,000

 

$1,000

$3,000

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$15 Copay

$40 Copay

$55 Copay

$15 / $40 / $55 Copay

Mail Order 90 day Supply

$45 Copay

$120 Copay

$165 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

 

 

 

 

 

 

Copay Plan 2

In-Network

Out-Of-Network

Deductible

Individual

Family

 

$5,000

$10,000

 

$10,000

$20,000

Out-Of-Pocket Maximum

Individual

Family

 

$5,600

$10,200

 

$20,000

$60,000

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$40 Copay

$40 Copay

30%*

 

50%*

50%*

50%*

Urgent Care Services

$65 Copay

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 Services**

Emergency Room

Emergency Medical Transportation

 

$100 Copay, then 30%* (Copay Waived if Admitted)

30%*

 

$100 Copay, then 30%* (Copay Waived if Admitted)

30%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

30%*

$40 Copay

 

50%*

50%*

Teladoc Services

General Consultations

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

$40 Copay

$40 Copay

$40 Copay

$40 Copay

 

$40 Copay

$40 Copay

$40 Copay

$40 Copay

Prescription Out of Pocket Maximum

Individual

Family

 

$1,000

$3,000

 

$1,000

$3,000

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$20 Copay

$40 Copay

$60 Copay

$20 / $40 / $60 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

 

 

 

 

 

 


If you prefer talking with a HealthEZ representative, call 844-678-8452