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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

$1,000 PPO Plan

In-Network

Out-Of-Network

Deductible

Employee Only

Family

 

$1,000

$2,000

 

$2,000

$4,000

Out-Of-Pocket Maximum

Employee Only

Family

 

$2,500

$5,000

 

$6,000

$12,000

Preventive Care

No Charge

30%*

Office Visits

Primary & Specialist Services (Ages 0 - 18)

Primary & Specialist (Ages 19+)

Chiropractic Visit

 

No Charge

$30 Copay

$30 Copay

 

30%*

30%*

30%*

Urgent Care Services

Ages 0-18

Ages 19+

 

No Charge

$30 Copay

 

$30 Copay

$30 Copay

Complex Imaging: MRI/CT/PET Scans

$100 Copay

30%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

30%*

30%*

Outpatient Procedures

Facility Fee

 

10%*

10%*

 

30%*

30%*

Emergency Room

Emergency Medical Transportation

$200 Copay

10%*

$200 Copay

10%*

Mental Health / Chemical Dependency

Inpatient

Outpatient (Ages 0 - 18)

Outpatient (Ages 19+)

 

10%*

No Charge

$30 Copay

 

30%*

30%*

30%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$10 Copay

25% Coinsurance up to $50

50% Coinsurance up to $80

$100 Copay

Mail Order 90 day Supply

$20 Copay

25% Coinsurance up to $100

50% Coinsurance up to $160

Not Available

Note: * Coinsurance after deductible

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

 

 

 

 

$2.500 PPO Plan

In-Network

Out-Of-Network

Deductible

Employee Only

Family

 

$2,500

$5,000

 

$3,500

$7,000

Out-Of-Pocket Maximum

Employee Only

Family

 

$3,500

$7,000

 

$6,000

$12,000

Preventive Care

No Charge

30%*

Office Visits

Primary & Specialist Services (Ages 0 - 18)

Primary & Specialist (Ages 19+)

Chiropractic Visit

 

100% Covered

$30 Copay

$30 Copay

 

30%*

30%*

30%*

Urgent Care Services

Ages 0-18

Ages 19+

 

No Charge

$30 Copay

 

$30 Copay

$30 Copay

Complex Imaging: MRI/CT/PET Scans

$100 Copay

30%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

30%*

30%*

Outpatient Procedures

Facility Fee

 

20%*

20%*

 

30%*

30%*

Emergency Room

Emergency Medical Transportation

$200 Copay

20%*

$200 Copay

20%*

Mental Health / Chemical Dependency

Inpatient

Outpatient (Ages 0 - 18)

Outpatient (Ages 19+)

 

20%*

100% Covered

$30 Copay

 

30%*

30%*

30%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$10 Copay

25% Coinsurance up to $50

50% Coinsurance up to $80

$100 Copay

Mail Order 90 day Supply

$20 Copay

25% Coinsurance up to $100

50% Coinsurance up to $160

Not Available

Note: * Coinsurance after deductible

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

 

 

 

 

$3,500 HSA Eligible Plan

In-Network

Out-Of-Network

Deductible

Employee Only

Family

 

$3,500

$7,000

 

$5,000

$10,000

Out-Of-Pocket Maximum

Employee Only

Family

 

$7,000

$14,000

 

$10,000

$20,000

Preventive Care

No Charge

50%*

Office Visits

Primary & Specialist Services (Ages 0 - 18)

Primary & Specialist (Ages 19+)

Chiropractic Visit

 

20%*

20%*

20%*

 

50%*

50%*

50%*

Urgent Care Services

Ages 0-18

Ages 19+

 

20%*

20%*

 

50%*

50%*

Complex Imaging: MRI/CT/PET Scans

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

 

20%*

20%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

20%*

20%*

50%*

50%*

Mental Health / Chemical Dependency

Inpatient

Outpatient (Ages 0 - 18)

Outpatient (Ages 19+)

 

20%*

20%*

20%*

 

50%*

50%*

50%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$12 Copay*

$45 Copay*

$90 Copay*

20%*

Mail Order 90 day Supply

$24 Copay*

$90 Copay*

$180 Copay*

Not Available

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 1-855-697-2027