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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

$1,000 Copay Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$1,000

$3,000

 

$3,000

$9,000

Out-of-Pocket Maximum

Individual

Family

 

$4,000

$12,000

 

$12,000

$36,000

Preventive Care Services

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$40 Copay

10%*

 

30%*

30%*

30%*

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 Room

Emergency Medical Transportation

10%*

10%*

10%*

10%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

No Charge

 

30%*

30%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay

$40 Copay

$60 Copay

25% Coinsurance

Mail Order 90 Day Supply

$10 Copay

$40 Copay

$60 Copay

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$37 Copay

$79 Copay

$37 Copay

$37 Copay

$37 Copay

 

$37 Copay

$79 Copay

$37 Copay

$37 Copay

$37 Copay

NOTE: * Coinsurance After Deductible

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

 

 

 

 

$2,500 HSA Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$2,500

$5,000

 

$5,000

$10,000

Out-of-Pocket Maximum

Individual

Family

 

$5,000

$10,000

 

$10,000

$20,000

Preventive Care Services

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

10%*

10%*

10%*

 

30%*

30%*

30%*

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 Room

Emergency Medical Transportation

10%*

10%*

10%*

10%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

10%*

 

30%*

30%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

10%*

10%*

10%*

10%*

Mail Order 90 Day Supply

10%*

10%*

10%*

10%*

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$37 Copay

$79 Copay

$37 Copay

$37 Copay

$37 Copay

 

$37 Copay

$79 Copay

$37 Copay

$37 Copay

$37 Copay

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 844-839-6734