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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

$2,500 PPO Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$2,500

$7,500

 

$5,000

$15,000

Out-of-Pocket Maximum

Individual

Family

 

$6,600

$13,200

 

$19,800

$39,600

Preventive Care Services

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$40 Copay

$35 Copay

 

30%*

30%*

30%*

Urgent Care Services

$60 Copay

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

$200 Copay (Copay waived if admitted)

10%*

$200 Copay (Copay waived if admitted)

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 Copay

$40 Copay*

$75 Copay*

$10/$40/$75 Copay*

Mail Order 90 Day Supply

$30 Copay

$120 Copay*

$225 Copay*

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

No Charge

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

No Charge

NOTE: * Coinsurance After Deductible

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

 

 

 

 

$3,000 HDHP Plan

In-Network

Out-of-Network

Deductible

Individual

Individual Under Family

Family

 

$3,000

$3,400

$6,000

 

$6,000

$6,000

$12,000

Out-of-Pocket Maximum

Individual

Individual Under Family

Family

 

$4,000

$4,000

$8,000

 

$12,000

$12,000

$24,000

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%*

 

30%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

0%*

 

30%*

30%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay*

$35 Copay*

$60 Copay*

$15/$35/$60 Copay*

Mail Order 90 Day Supply

$45 Copay*

$105 Copay*

$180 Copay*

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapy

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

No Charge

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

No Charge

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 844-302-7788