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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

Family

 

$2,000

$6,000

 

N/A

N/A

Out-Of-Pocket Maximum

Individual

Family

 

$5,000

$10,000

 

N/A

N/A

Preventive Care Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 copay

$50 Copay

$30 Copay

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

$75 Copay

Not Covered

Complex Imaging: MRI/CT/PET Scans

$100 Copay

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

Not Covered

Not Covered

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$150 Copay

0%*

 

Not Covered

Not Covered

Mental Health/Chemical Dependency

Inpatient - Facility Fee

Inpatient - Physician Fee

Office visit

 

0%*

$20 Copay

$20 copay

 

Not Covered

Not Covered

$20 Copay

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

No Charge

$40 Copay

$100 Copay

$250 Copay

Mail Order 90 Day Supply

No Charge

$100 Copay

$250 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 $3,000 Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual Coverage

Individual Under Family Coverage

Family Coverage

 

$3,000

$3,300

$6.000

 

$6,000

$6,000

$12,000

Out-Of-Pocket Maximum

Individual Coverage

Individual Under Family Coverage

Family Coverage

 

$5,000

$5,000

$10,000

 

$10,000

$10,000

$20,000

Preventive Care Services

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

10%*

10%*

10%*

 

30%*

30%*

30%*

Urgent Care Services

10%*

30%*

Complex Imaging: MRI/CT/PET Scans

10%*

30%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

30%*

30%*

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

30%*

30%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

10%*

10%*

 

30%*

30%*

Mental Health / Chemical Dependency

Inpatient

Office visit

 

10%*

0%*

 

30%*

0%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

10%*

10%*

10%*

10%*

Mail Order 90 Day Supply

10%*

10%*

10%*

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 1-844-804-8120