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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 Copay Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$1,000

$2,000

 

$3,000

$6,000

Out-of-Pocket Maximum

Individual

Family

 

$4,500

$9,000

 

$9,000

$18,000

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$50 Copay

$50 Copay

 

50%*

50%*

50%*

Urgent Care Services

$85 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

$350 Copay

20%*

$350 Copay

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$50 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay

$45 Copay

$70 Copay

30% Coinsurance

up to $150 Copay

Mail Order 90 Day Supply

$20 Copay

$90 Copay

$140 Copay

Not Covered

 

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$0

$50

$0

$0

$0

 

$0

$50

$0

$0

$0

NOTE: * Coinsurance After Deductible

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

 

 

 

 

$3,000 Copay Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$3,000

$6,000

 

$6,000

$12,000

Out-of-Pocket Maximum

Individual

Family

 

$4,500

$9,000

 

$9,000

$18,000

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$30 Copay

$60 Copay

$60 Copay

 

50%*

50%*

50%*

Urgent Care Services

$85 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

0%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

$600 Copay

0%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

$350 Copay

0%*

$350 Copay

0%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

$600 Copay

$60 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay

$45 Copay

$70 Copay

30% Coinsurance

up to $150 Copay

Mail Order 90 Day Supply

$20 Copay

$90 Copay

$140 Copay

Not Covered

 

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$0

$60

$0

$0

$0

 

$0

$60

$0

$0

$0

NOTE: * Coinsurance After Deductible

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

 

 

 

 

$3,400 HSA Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$3,400

$6,800

 

$6,800

$13,600

Out-of-Pocket Maximum

Individual

Family

 

$5,500

$11,000

 

$12,000

$24,000

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

10%*

10%*

10%*

 

50%*

50%*

50%*

Urgent Care Services

10%*

50%*

Complex Imaging: MRI/CT/PET Scans

10%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

10%*

10%*

10%*

10%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

10%*

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay after Deductible

$45 Copay after Deductible

$70 Copay after Deductible

30% Coinsurance after

Deductible, up to $150 Copay

Mail Order 90 Day Supply

$20 Copay after Deductible

$90 Copay after Deductible

$140 Copay after Deductible

Not Covered

 

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

10%*

10%*

10%*

10%*

10%*

 

10%*

10%*

10%*

10%*

10%*

NOTE: * Coinsurance After Deductible

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

 

 

 

 

$6,350 HSA Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$6,350

$12,700

 

$10,000

$20,000

Out-of-Pocket Maximum

Individual

Family

 

$6,850

$13,700

 

$21,000

$42,000

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay after Deductible

0%*

0%*

 

50%*

50%*

50%*

Urgent Care Services

0%*

50%*

Complex Imaging: MRI/CT/PET Scans

0%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

0%*

0%*

0%*

0%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay after Deductible

$45 Copay after Deductible

$70 Copay after Deductible

30% Coinsurance after

Deductible, up to $150 Copay

Mail Order 90 Day Supply

$20 Copay after Deductible

$90 Copay after Deductible

$140 Copay after Deductible

Not Covered

 

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

0%*

0%*

0%*

0%*

0%*

 

0%*

0%*

0%*

0%*

0%*

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 844-302-7784