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

In-Network

Out-Of-Network

Calendar Year Deductible

Individual

Family

 

$2,000

$4,000

 

N/A

N/A

Out-Of-Pocket Maximum

Individual

Family

 

$6,850

$13,700

 

N/A

N/A

Preventive Care

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

20%*

20%*

20%*

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

20%*

Not Covered

Complex Imaging: MRI/CT/PET Scans

20%*

Not Covered

Hospital Services Inpatient & Outpatient

20%*

Not Covered

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

20%*

20%*

 

20%*

20%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

20%*

20%*

 

Not Covered

Not Covered

Teladoc Services

General Consultations

Dermatology

 

$55 Copay

$85 Copay

 

$55 Copay

$85 Copay

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$10 Copay

$40 Copay

$85 Copay

Not Covered

Mail Order 90 day Supply

$20 Copay

$80 Copay

$170 Copay

Not Available

NOTES: * Coinsurance After Deductible

** True emergencies covered at in-network level

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

 

 

 

 

 

 

HSA Plan 1

In-Network

Out-Of-Network

Calendar Year Deductible

Individual

Family

 

$4,000

$8,000

 

N/A

N/A

Out-Of-Pocket Maximum

Individual

Family

 

$4,000

$8,000

 

N/A

N/A

Preventive Care

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

0%*

Not Covered

Complex Imaging: MRI/CT/PET Scans

0%*

Not Covered

Hospital Services Inpatient & Outpatient

0%*

Not Covered

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

0%*

0%*

 

0%*

0%*

Teladoc Services

General Consultations

Dermatology

 

$55 Copay

$85 Copay

 

$55 Copay

$85 Copay

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

0%*

0%*

 

Not Covered

Not Covered

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

0%*

0%*

0%*

Not Covered

Mail Order 90 day Supply

0%*

0%*

0%*

Not Available

NOTE: * Coinsurance After Deductible

** True emergencies covered at in-network level

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

 

 

 

 

 

 


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