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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

EPO (Copay 1) Plan

In-Network

Out-Of-Network

Deductible

Individual

Family

 

$0

$0

 

$5,000

$10,000

Out-Of-Pocket Maximum

Individual

Family

 

$2,500

$5,000

 

$9,000

$18,000

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$20 Copay

$20 Copay

 

50%*

50%*

50%*

Urgent Care Services

$20 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

Office: No Charge
Hospital: $100 Copay

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

$250 Copay

$250 Copay

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

$125 Copay

$125 Copay

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

$100 Copay

No Charge

$100 Copay

$100 Copay

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

$250 Copay

$20 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$10 Copay

$30 Copay

$50 Copay

30% Coinsurance up to $250

Mail Order 90 day Supply

$25 Copay

$90 Copay

$150 Copay

50% Coinsurance up to $250

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$20 Copay

$20 Copay

$20 Copay

$20 Copay

$20 Copay

 

$20 Copay

$20 Copay

$20 Copay

$20 Copay

$20 Copay

NOTE: * Coinsurance after deductible

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

 

 

 

 

PPO (Copay 2) Plan

In-Network

Out-Of-Network

Deductible

Individual

Family

 

$250

$750

 

$250

$750

Out-Of-Pocket Maximum

Individual

Family

 

$2,500

$5,000

 

$7,500

$15,000

Preventive Care Services

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$15 copay

$15 Copay

$15 Copay

 

30%*

30%*

30%*

Urgent Care Services

$15 Copay

30%*

Complex Imaging: MRI/CT/PET Scans

Office: No Charge
Hospital: 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

$100 Copay, then 10%*

No Charge

$100 Copay, then 10%*

No Charge

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

10%*

$15 Copay

 

30%*

30%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$10 Copay

$25 Copay

$45 Copay

30% Coinsurance up to $250

Mail Order 90 day Supply

$25 Copay

$75 Copay

$150 Copay

50% Coinsurance up to $250

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$15 Copay

$15 Copay

$15 Copay

$15 Copay

$15 Copay

 

$15 Copay

$15 Copay

$15 Copay

$15 Copay

$15 Copay

NOTE: * Coinsurance after deductible

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

 

 

 

 

HDHP (HSA 1 Plan)

In-Network

Out-Of-Network

Deductible

Individual

Family

 

$3,300

$6,600

 

$8,100

$16,200

Out-Of-Pocket Maximum

Individual

Family

 

$5,000

$10,000

 

$15,000

$30,000

Preventive Care Services

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

30%*

30%*

30%*

Urgent Care Services

0%*

30%*

Complex Imaging: MRI/CT/PET Scans

0%*

30%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

30%*

30%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

30%*

30%*

Emergency Room

Emergency Medical Transportation

0%*

0%*

0%*

0%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

0%*

0%*

 

30%*

30%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$10 Copay*

$40 Copay*

$60 Copay*

30% Coinsurance up to $250

Mail Order 90 day Supply

$25 Copay*

$120 Copay*

$180 Copay*

30%*

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

0%*

0%*

0%*

0%*

0%*

 

0%*

0%*

0%*

0%*

0%*

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 1-844-609-7790