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

EPO (Copay 1) Plan

In-Network

Out-Of-Network

Embedded Deductible

Individual

Family

 

$0

$0

 

$5,000

$10,000

Coinsurance

20%

50%

Embedded Out-Of-Pocket Maximum

Individual

Family

 

$2,500

$5,000

 

$9,000

$18,000

Preventive Care

100% Covered

50%*

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

$20 Copay

$20 Copay

$20 Copay

 

50%*

50%*

50%*

Hospital Services

$250 Copay

50%*

Emergency Services

Emergency Room

Emergency Medical Transportation

 

$100 Copay

$100 Copay

 

$100 Copay

$100 Copay

Urgent Care Services

$20 Copay

50%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

$250 Copay

$20 Copay

 

50%*

50%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

$10 Copay

$30 Copay

$50 Copay

30% Coinsurance up to $250

 

$25 Copay

$90 Copay

$150 Copay

50% Coinsurance up to $250

* Coinsurance after deductible

 

 

PPO (Copay 2) Plan

In-Network

Out-Of-Network

Embedded Deductible

Individual

Family

 

$250

$750

 

$250

$750

Coinsurance

10%

30%

Embedded Out-Of-Pocket Maximum

Individual

Family

 

$2,500

$5,000

 

$7,500

$15,000

Preventive Care

100% Covered

30%*

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

$15 Copay

$15 Copay

$15 Copay

 

30%*

30%*

30%*

Hospital Services

10%*

30%*

Emergency Services

Emergency Room

Emergency Medical Transportation

 

$100 Copay, then 10%*

10%*

 

$100 Copay, then 10%*

10%*

Urgent Care Services

$15 Copay

30%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

10%*

$15 Copay

 

30%*

30%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

$10 Copay

$25 Copay

$45 Copay

30% Coinsurance up to $250

 

$25 Copay

$75 Copay

$135 Copay

50% Coinsurance up to $250

* Coinsurance after deductible

 

 

HDHP (HSA 1) Plan

In-Network

Out-Of-Network

Embedded Year Deductible

Individual

Family

 

$3,300

$6,600

 

$8,100

$16,200

Coinsurance

0%

30%

Embedded Out-Of-Pocket Maximum

Individual

Family

 

$5,000

$10,000

 

$15,000

$30,000

Preventive Care

100% Covered

30%*

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

0%*

0%*

0%*

 

30%*

30%*

30%*

Hospital Services

0%*

30%*

Emergency Services

Emergency Room

Emergency Medical Transportation

 

0%*

0%*

 

0%*

0%*

Urgent Care Services

0%*

30%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

0%*

0%*

 

30%*

30%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

$10 Copay*

$40Copay*

$60 Copay*

30% Coinsurance* up to $250

 

$25 Copay*

$120 Copay*

$180 Copay*

30% Coinsurance* up to $250

* Coinsurance after deductible

 

 


If you prefer talking with a HealthEZ representative, call 1-844-609-7790