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

HSA Plan 1

In-Network

Out-Of-Network

Deductible

Individual

Family

 

$3,300

$6,600

 

$9,000

$18,000

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

 

$30 Copay After Deductible

$55 Copay After Deductible

$30 Copay After Deductible

 

30%*

30%*

30%*

Urgent Care Services

$55 Copay After Deductible

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 Services**

Emergency Room

Emergency Medical Transportation

 

$250 Copay After Deductible

0%*

 

30%*

30%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

$55 Copay After Deductible

 

30%*

30%*

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

$55 Copay

No Charge

No Charge

No Charge

 

No Charge

$55 Copay

No Charge

No Charge

No Charge

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$10 Copay After Deductible

$40 Copay After Deductible

$70 Copay After Deductible

25%*

Mail Order 90 day Supply

$20 Copay After Deductible

$80 Copay After Deductible

$140 Copay After Deductible

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

 

 

 

 

 

 

Copay Plan 1

In-Network

Out-Of-Network

Deductible

Individual

Family

 

$1,000

$2,000

 

$3,000

$6,000

Out-of-Pocket Maximum

Individual

Family

 

$5,000

$10,000

 

$9,000

$18,000

Preventive Care Services

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$30 Copay

$55 Copay

$30 Copay

 

30%*

30%*

30%*

Urgent Care Services

$55 Copay

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 Services**

Emergency Room

Emergency Medical Transportation

 

$250 Copay

0%*

 

30%*

30%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

$55 Copay

 

30%*

30%*

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

$55 Copay

No Charge

No Charge

No Charge

 

No Charge

$55 Copay

No Charge

No Charge

No Charge

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$10 Copay

$40 Copay

$70 Copay

25%*

Mail Order 90 day Supply

$20 Copay

$80 Copay

$140 Copay

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

 

 

 

 

 

 


If you prefer talking with a HealthEZ representative, call 844-855-0614