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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

Deductible

Individual

Family

 

$500

$1,000

 

$2,500

$5,000

Out-Of-Pocket Maximum

Individual

Family

 

$5,000

$5,000

 

$5,000

$10,000

Preventive Care Services

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$20 Copay

50%* up to $500 per benefit per year

 

30%*

30%*

50%* up to $500 per benefit per year

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

 

$300 Copay

10%*

 

30%*

30%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

$20 Copay

 

30%*

30%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$5 Copay

$30 Copay

$75 Copay

$150 Copay

Mail Order 90 day Supply

$10 Copay

$60 Copay

$150 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

 

 

 

 

 

 

Copay Plan 2

In-Network

Out-Of-Network

Deductible

Individual

Family

 

$3,000

$6,000

 

$6,000

$12,000

Out-Of-Pocket Maximum

Individual

Family

 

$6,000

$12,000

 

$12,000

$24,000

Preventive Care Services

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$30 Copay

$50 Copay

50%* up to $500 per benefit per year

 

30%*

30%*

50%* up to $500 per benefit per year

Urgent Care Services

20%*

30%*

Complex Imaging: MRI/CT/PET Scans

20%*

30%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

30%*

30%*

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

30%*

30%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$300 Copay

20%*

 

30%*

30%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$50 Copay

 

30%*

30%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$5 Copay

$30 Copay

$75 Copay

$150 Copay

Mail Order 90 Day Supply

$10 Copay

$60 Copay

$150 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

 

 

 

 

 

 

Dental Plan

In-Network

Out-Of-Network

Calendar Year Deductible

$50 per individual

$50 per individual

Calendar Year Maximum

$1,200

$1,200

Preventive Services

100% Covered

100% Covered

Basic Services

20%*

20%*

Major Services

50%*

50%*

Orthodontia

50%*

50%*

NOTE: * Coinsurance After Deductible

 

 


If you prefer talking with a HealthEZ representative, call 1-844-449-5552