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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

Calendar Year Deductible

Employee Only

Family

 

$1,000

$2,000

 

$2,000

$4,000

Coinsurance

10%

30%

Out-Of-Pocket Maximum

Employee Only

Family

 

$2,500

$5,000

 

$6,000

$12,000

Preventive Care

100% Covered

30%*

Office Visits

Primary & Specialist Services (Ages 0 - 18)

Primary & Specialist (Ages 19+)

 

100% Covered

$30 Copay

 

30%*

30%*

Hospital Services

10%*

30%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$200 Copay

10%*

 

$200 Copay

10%*

Urgent Care Services

Urgent Care Services (Ages 0 - 18)

Urgent Care Services (Ages 19+)

 

100% Covered

$30 Copay

 

$30 Copay

$30 Copay

Chiropractic Services

$30 Copay

30%*

Mental Health / Chemical Dependency

Inpatient

Outpatient (Ages 0 - 18)

Outpatient (Ages 19+)

 

10%*

100% Covered

$30 Copay

 

30%*

30%*

30%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

$10 Copay

25% Coinsurance up to $50

50% Coinsurance up to $80

$100 Copay

 

$20 Copay

25% Coinsurance up to $100

50% Coinsurance up to $160

Not Available

* After deductible

 

 

**Covered as in-network in true-emergency

 

 

$2,500 PPO Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$2,500

$5,000

 

$3,500

$7,000

Coinsurance

20%

30%

Out-Of-Pocket Maximum

Employee Only

Family

 

$3,500

$7,000

 

$6,000

$12,000

Preventive Care

100% Covered

30%*

Office Visits

Primary & Specialist Services (Ages 0 - 18)

Primary & Specialist Services (Ages 19+)

 

100% Covered

$30 Copay

 

30%*

30%*

Hospital Services

20%*

30%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$200 Copay

20%*

 

$200 Copay

20%*

Urgent Care Services

Urgent Care Services (Ages 0 - 18)

Urgent Care Services (Ages 19+)

 

100% Covered

$30 Copay

 

$30 Copay

$30 Copay

Chiropractic Services

$30 Copay

30%*

Mental Health / Chemical Dependency

Inpatient

Outpatient (Ages 0 - 18)

Outpatient (Ages 19+)

 

20%*

100% Covered

$30 Copay

 

30%*

30%*

30%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Formulary

Non-Formulary

Specialty

 

$10 Copay

25% Coinsurance up to $50

50% Coinsurance up to $80

$100 Copay

 

$20 Copay

25% Coinsurance up to $100

50% Coinsurance up to $160

Not Available

* After deductible

 

 

**Covered as in-network in true-emergency

 

 

$3,500 HSA Eligible Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$3,500

$7,000

 

$5,000

$10,000

Coinsurance

20%

50%

Out-of-Pocket Maximum

Employee only

Family

 

$7,000

$14,000

 

$10,000

$20,000

Preventive Care

100% Covered

50%*

Office Visits

Primary & Specialist Services (ages0-18)

Primary & Specialist Services (ages 19+)

 

20%*

20%*

 

50%*

50%*

Hospital Services

20%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

20%*

20%*

 

50%*

50%*

Urgent Care Services

Urgent Care Services (ages 0-18)

Urgent Care Services (ages 19+)

 

20%*

20%*

 

50%*

50%*

Chiropractic Services

20%*

50%*

Mental Health/Chemical Dependency

Inpatient

Outpatient (ages 0-18)

Outpatient (ages 19+)

 

20%*

20%*

20%*

 

50%*

50%*

50%*

Retail 30 Day Supply

Mail Order 90 Day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

$12 Copay*

$45 Copay*

$90 Copay*

20%*

 

$24 Copay*

$90 Copay*

$180 Copay*

Not available

*After Deductible

 

 

**Covered as in-network in true-emergency

 

 


If you prefer talking with a HealthEZ representative, call 1-855-697-2027