Compare Plans

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 1

In-Network

Out-Of-Network

Deductible

Employee Only

Family

 

$1,000

$2,000

 

$5,000

$10,000

Out-Of-Pocket Maximum

Employee Only

Family

 

$3,500

$7,000

 

$8,000

$16,000

Preventive Care

No Charge

40%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$40 Copay

$40 Copay

20%*

 

40%*

40%*

40%*

Urgent Care Services

$40 Copay

40%*

Complex Imaging: MRI/CT/PET Scans

20%*

40%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

40%*

40%*

Outpatient Procedure

Facility Fee

Physician Fee

 

20%*

20%*

 

40%*

40%*

Emergency Room

Emergency Medical Transportation

20%*

20%*

40%*

40%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

20%*

$40 Copay

 

40%*

40%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$15 Copay

$50 Copay

$100 Copay

20% up to $200/prescription

Mail Order 90 Day Supply

$30 Copay

$100 Copay

$200 Copay

Not Available

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

$40 Copay

$40 Copay

$40 Copay

$40 Copay

$40 Copay

 

$40 Copay

$40 Copay

$40 Copay

$40 Copay

$40 Copay

NOTE: *Coinsurance after deductible

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

 

 

 

 

HSA Plan 1

In-Network

Out-Of-Network

Deductible

Employee Only

Family

 

$3,500

$7,000

 

$17,500

$24,000

Out-Of-Pocket Maximum

Employee Only

Family

 

$3,500

$7,000

 

$40,000

$70,000

Preventive Care

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

50%*

50%*

50%*

Urgent Care Services

0%*

50%*

Complex Imaging: MRI/CT/PET Scans

0%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

50%*

50%*

Outpatient Procedure

Facility Fee

Physician Fee

 

0%*

0%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

0%*

0%*

50%*

50%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

0%*

0%*

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

0%*

0%*

0%*

0%*

Mail Order 90 Day Supply

0%*

0%*

0%*

Not Available

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

$40 Copay After Deductible

$40 Copay After Deductible

$40 Copay After Deductible

$40 Copay After Deductible

$40 Copay After Deductible

 

$40 Copay After Deductible

$40 Copay After Deductible

$40 Copay After Deductible

$40 Copay After Deductible

$40 Copay After Deductible

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 844-623-5047