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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

$3,500 PPO Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$3,500

$7,000

 

$7,500

$15,000

Out-of-Pocket Maximum

Individual

Family

 

$8,750

$17,500

 

$15,500

$30,000

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit


Specialist Office Visit


Chiropractic Visit

 

First 3 Visits per year: $30 Copay;

After 3 Visits: 20%*

First 3 Visits per year: $60 Copay;

After 3 Visits: 20%*

$30 Copay

 

50%*

 

50%*

 

50%*

Urgent Care Services

$30 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

$500 Copay, then 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

Emergency Medical Transportation

$500 Copay, then 20%*

20%*

$500 Copay, then 20%*

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

First 3 Visits per year: $60 Copay
After 3 Visits: 20%*

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay

$55 Copay

$135 Copay

$350 Copay

Mail Order 90 Day Supply

$37.50 Copay

$137.50 Copay

$337.50 Copay

Not Covered

Teladoc Services

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

 

 

 

 

$6,500 HDHP Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$6,500

$13,000

 

$7,500

$15,000

Out-of-Pocket Maximum

Individual

Family

 

$7,850

$15,700

 

$15,000

$30,000

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

10%*

10%*

10%*

 

50%*

50%*

50%*

Urgent Care Services

10%*

50%*

Complex Imaging: MRI/CT/PET Scans

10%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

10%*

10%*

10%*

10%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

10%*

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay*

$55 Copay*

$135 Copay*

$350 Copay*

Mail Order 90 Day Supply

$37.50 Copay*

$137.50 Copay*

$337.50 Copay*

Not Covered

Teldadoc Services

General Consultations

Dermatology

Mental Health - Therapy

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Sessions

 

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

 

 

 

 

$4,000 HDHP Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$4,000

$8,000

 

$7,5000

$15,000

Out-of-Pocket Maximum

Individual

Family

 

$6,750

$13,500

 

$15,000

$30,000

Preventive Care Services

No Charge

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

20%*

20%*

20%*

 

50%*

50%*

50%*

Urgent Care Services

20%*

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

Emergency Medical Transportation

20%*

20%*

20%*

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

20%*

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay*

$55 Copay*

$135 Copay*

$350 Copay*

Mail Order 90 Day Supply

$37.50 Copay*

$137.50 Copay*

$337.50 Copay*

Not Covered

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapy

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Evaluation

 

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 877-251-5809