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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

HSA Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual

Family

 

$3,400

$6,000

 

$10,000

$20,000

Coinsurance

0%

50%

Out-Of-Pocket Maximum

Individual

Family

 

$3,400

$6,000

 

$15,000

$30,000

Preventive Care

100% Covered

50%*

Office Visits

Primary Services

Specialist Services

 

0%*

0%*

 

50%*

50%*

Hospital Services

0%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

0%*

0%*

 

50%*

50%*

Urgent Care Services

0%*

50%*

Chiropractic Services

0%*

50%*

Teledoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

$55 Copay, then Covered 100%*

$85 Copay, then Covered 100%*

$90 Copay, then Covered 100%*

$220 Copay, then Covered 100%*

$100 Copay, then Covered 100%*

 

$55 Copay, then Covered 100%*

$85 Copay, then Covered 100%*

$90 Copay, then Covered 100%*

$220 Copay, then Covered 100%*

$100 Copay, then Covered 100%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

0%*

0%*

 

50%*

50%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

0%*

0%*

0%*

0%*

 

50%*

50%*

50%*

Not Available

* After deductible

 

 

** True emergencies covered at in-network level

 

 

Copay Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$3,500

$7,000

 

$10,000

$20,000

Coinsurance

25%

50%

Out-Of-Pocket Maximum

Employee Only

Family

 

$7,000

$14,000

 

$15,000

$30,000

Preventive Care

100% Covered

50%*

Office Visits

Primary Services

Specialist Services

 

$30 Copay

$65 Copay

 

50%*

50%*

Hospital Services

25%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$400 Copay

25%*

 

50%*

50%*

Urgent Care Services

$75 Copay

50%*

Chiropractic Services

$65 Copay

50%*

Teledoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

$30 Copay

$30 Copay

$30 Copay

$30 Copay

$30 Copay

 

$30 Copay

$30 Copay

$30 Copay

$30 Copay

$30 Copay

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

25%*

$65 Copay

 

50%*

50%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Formulary

Non-Formulary

Specialty

 

$10 Copay

$50 Copay

$90 Copay

20% Coinsurance up to $200

 

$20 Copay

$100 Copay

$180 Copay

Not Available

* After deductible

 

 

** True emergencies covered at in-network level

 

 


If you prefer talking with a HealthEZ representative, call 844-204-3765