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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

Base Plan (Copay 1)

In-Network

Out-of-Network

Deductible

Individual

Family

 

$1,500

$4,500

 

$5,000

$15,000

Out-of-Pocket Maximum

Individual

Family

 

$4,600

$13,200

 

$19,800

$39,600

Preventative Services

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$50 Copay

$25 Copay

 

40%*

40%*

$25 Copay

Urgent Care Services

$60 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 Room Services

Emergency Medical Transportation

$150 Copay, then 20% Coinsurance

20% Coinsurance

$150 Copay, then 20% Coinsurance

20% Coinsurance

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$25 Copay

 

40%*

40%*

Prescription Deductible**

Individual

Family

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

 

$200

$400

Retail 30 Day SUpply

$5 Copay

$40 Copay After Deductible

$75 Copay After Deductible

Not Covered

 

$200

$400

Mail Order 90 Day Supply

$20 Copay

$40 Copay After Deductible

$75 Copay After Deductible

Not Covered

NOTE: * Coinsurance After Deductible

**Separate from Medical Deductible

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

 

 

 

 

 

 

Buy-up Plan (Copay 2)

In-Network

Out-of-Network

Deductible

Individual

Family

 

$1,000

$3,000

 

$5,000

$15,000

Out-of-Pocket Maximum

Individual

Family

 

$3,000

$9,000

 

$12,700

$25,400

Preventative Services

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$50 Copay

$25 Copay

 

40%*

40%*

$25 Copay

Urgent Care Services

$60 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 Room Services

Emergency Medical Transportation

$150 Copay, then 20% Coinsurance

20% Coinsurance

$150 Copay, then 20% Coinsurance

20% Coinsurance

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$25 Copay

 

40%*

40%*

Prescription Deductible**

Individual

Family

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

 

$200

$400

Retail 30 Day Supply

$5 Copay

$40 Copay After Deductible

$75 Copay After Deductible

Not Covered

 

$200

$400

Mail Order 90 Day Supply

$20 Copay

$40 Copay After Deductible

$75 Copay After Deductible

Not Covered

NOTE: * Coinsurance After Deductible

**Separate from Medical Deductible

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

 

 

 

 

 

 

If you prefer talking with a HealthEZ representative, call 844-676-4641