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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

Plan Year Deductible

Individual only

Individual under Family

Family

 

$100

$100

$200

 

$1,000

$1,000

$2,000

Coinsurance

0%

50%

Out-Of-Pocket Maximum

Individual Only

Individual under Family

Family

 

$2,500

$2,500

$6,000

 

$5,000

$5,000

$15,000

Preventive Care

100% Covered

50%*

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

$25 Copay

$40 Copay

$40 Copay

 

50%*

50%*

50%*

Hospital Services

0%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$200 Copay

0%*

 

50%*

50%*

Urgent Care Services

$40 Copay

50%*

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

$25 Copay

$40 Copay

$25 Copay

$25 Copay

$25 Copay

 

$25 Copay

$40 Copay

$25 Copay

$25 Copay

$25 Copay

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

0%*

$40 Copay

 

50%*

50%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

$15 Copay

$35 Copay

$75 Copay

$200 Copay

 

$30 Copay

$70 Copay

$150 Copay

Not Available

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

 

 

* After deductible

 

 

** True emergencies covered at in-network level

 

 

HSA Plan 1

In-Network

Out-Of-Network

Plan Year Deductible

Individual only

Individual under Family

Family

 

$2,850

$3,000

$5,700

 

$5,700

$5,700

$11,400

Coinsurance

10%

50%

Out-Of-Pocket Maximum

Individual Only

Individual under Family

Family

 

$4,000

$4,000

$8,000

 

$8,000

$8,000

$16,000

Preventive Care

100% Covered

50%*

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

10%*

10%*

10%*

 

50%*

50%*

50%*

Hospital Services

10%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

10%*

10%*

 

50%*

50%*

Urgent Care Services

10%*

50%*

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

10%*

10%*

10%*

10%*

10%*

 

50%*

50%*

50%*

50%*

50%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

10%*

10%*

 

50%*

50%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

$15 Copay*

$35 Copay*

$75 Copay*

$200 Copay*

 

$30 Copay*

$70 Copay*

$150 Copay*

Not Available

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

 

 

* After deductible

 

 

** True emergencies covered at in-network level

 

 


If you prefer talking with a HealthEZ representative, call 844-302-7782