Plan Details

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

Deductible

Individual

Family

 

$6,000

$12,000

 

$6,500

$13,000

Out-Of-Pocket Maximum

Individual

Family

 

$6,850

$13,700

 

$13,700

$27,400

Preventive Care

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$40 Copay

$85 Copay

$85 Copay

 

50%*

50%*

50%*

Urgent Care Services

$85 Copay

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 Services

Emergency Room

Emergency Medical Transportation

 

$500 Copay

10%*

 

$500 Copay

10%*

Mental health/Chemical Dependency

Inpatient

Office Visit

 

10%*

PCP: $40 Copay

Specialist: $85 Copay

 

50%*

50%*

 

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$30 Copay

$85 Copay

$170 Copay

50% Coinsurance

Mail Order 90 day Supply

$60 Copay

$170 Copay

$340 Copay

Not Available

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 855-520-1888