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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

$1,500 Copay Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$1,500

$4,500

 

$3,000

$9,000

Coinsurance

20%

50%

Out-Of-Pocket Maximum

Employee Only

Family

 

$3,500

$7,000

 

$9,000

$18,000

Preventive Care

No Charge

50%*

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

$30 Copay

$30 Copay

$30 Copay

 

50%*

50%*

50%*

Urgent Care Services

$30 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

20%*

50%*

Hospital Services- Inpatient & Outpatient Care

20%*

50%*

Emergency Room Services**

Emergency Medical Transportation**

20%*

20%*

50%*

50%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

20%*

$30 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$12 Copay

$50 Copay

$90 Copay

20% Coinsurance up to $200

Mail Order 90 day Supply

$24 Copay

$100 Copay

$180 Copay

Not Available

*After Deductible

 

 

**Covered as in-network in true emergency

 

 

$5,000 - 3 For Free Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$5,000

$10,000

 

$10,000

$20,000

Coinsurance

0%

50%

Out-of-Pocket Maximum

Employee Only

Family

 

$5,000

$10,000

 

$20,000

$40,000

Preventative Care

No Charge

50%*

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

First 3 visits 100% covered, additional visits apply to deductible (combined with other services)

First 3 visits 100% covered, additional visits apply to deductible (combined with other services)

0%*

 

50%*

50%*

50%*

Urgent Care Services

First 3 visits 100% covered, additional visits apply to deductible (combined with other services)

50%*

Complex Imaging: MRI/CT/PET Scans

0%*

50%*

Hospital Services - Inpatient & Outpatient

0%*

50%*

Emergency Room Services**

Emergency Medical Transportation**

0%*

0%*

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Outpatient

 

0%*

First 3 visits 100% covered, additional visits apply to deductible (combined with other services)

 

50%*

50%*

Prescription Drug Coverage

Generic

Formulary

Non-Formulary

Specialty

Retail 30 Day Supply

$12 Copay

$50 Copay

$90 Copay

20% Coinsurance up to $200

Mail Order 90 Day Supply

$24 Copay

$100 Copay

$180 Copay

Not Available

*After Deductible

 

 

**Covered as in-network in true emergency

 

 

$3,300 HSA Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual Coverage

Family

 

$3,300

$6,600

 

$6,000

$12,000

Coinsurance

20%

50%

Out-of-Pocket Maximum

Individual Coverage

Family

 

$4,000

$8,000

 

$12,000

$24,000

Preventative Care

No Charge

50%*

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

20%*

20%*

20%*

 

50%*

50%*

50%*

Urgent Care Services

20%*

50%*

Complex Imaging: MRI/CT/PET Scans

20%*

50%*

Hospital Services - Inpatient & Outpatient

20%*

50%*

Emergency Room Services**

Emergency Medical Transportation**

20%*

20%*

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Outpatient

 

20%*

20%*

 

50%*

50%*

Prescription Drug Coverage

Generic

Formulary

Non-Formulary

Specialty

Retail 30 Day Supply

20%*

20%*

20%*

20%*

Mail Order 90 Day Supply

20%*

20%*

20%*

Not Available

*After Deductible

 

 

**Covered as in-network in true emergency

 

 

$5,000 HSA Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$5,000

$10,000

 

$10,000

$20,000

Coinsurance

0%

50%

Out-Of-Pocket Maximum

Employee Only

Family

 

$5,000

$10,000

 

$20,000

$40,000

Preventive Care

No Charge

50%*

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

0%*

0%*

0%*

 

50%*

50%*

50%*

Urgent Care Services

0%*

50%*

Complex Imaging: MRI/CT/PET Scans

0%*

50%*

Hospital Services- Inpatient & Outpatient Care

0%*

50%*

Emergency Room Services**

Emergency Medical Transportation**

0%*

0%*

50%*

50%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

0%*

0%*

 

50%*

50%*

Prescription Drug Coverage

Generic

Formulary

Non-Formulary

Specialty

Retail 30 Day Supply

0%*

0%*

0%*

0%*

Mail Order 90 day Supply

0%*

0%*

0%*

Not Available

*After Deductible

 

 

**Covered as in-network in true emergency

 

 


If you prefer talking with a HealthEZ representative, call 855-520-4327