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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

PPO Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$1,000

$2,000

 

$2,000

$4,000

Out-of-Pocket Maximum

Individual

Family

 

$3,000

$6,000

 

$6,000

$12,000

Preventive Care Services

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$50 Copay

$50 Copay

 

30%*

30%*

30%*

Urgent Care Services

$50 Copay

$50 Copay

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

$150 Copay (Copay waived if admitted)

20%*

$150 Copay (Copay waived if admitted)

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$25 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay

$35 Copay

$75 Copay

$150 Copay

Mail Order 90 Day Supply

$25 Copay

$88 Copay

$188 Copay

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$0 Copay

$0 Copay

$0 Copay

$0 Copay

$0 Copay

 

$0 Copay

$0 Copay

$0 Copay

$0 Copay

$0 Copay

NOTE: * Coinsurance After Deductible

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

 

 

 

 

HDHP Buy-Up Plan

In-Network

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$2,000

$4,000

$4,000

 

$4,000

$8,000

$8,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$4,000

$8,000

$8,000

 

$8,000

$16,000

$16,000

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

20%*

20%*

20%*

 

50%*

50%*

50%*

Urgent Care Services

20%*

20%*

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

20%*

20%*

20%*

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

20%*

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

0%*

0%*

0%*

0%*

Mail Order 90 Day Supply

0%*

0%*

0%*

Not Covered

Teladoc Benefits

General Consultation

Dermatology

Mental Health - Therapist

Mental Health - Psychologist, Initial Evaluation

Mental Health - Psychologist, Ongoing Session

 

$0 Copay

$0 Copay

$0 Copay

$0 Copay

$0 Copay

 

$0 Copay

$0 Copay

$0 Copay

$0 Copay

$0 Copay

NOTE: * Coinsurance After Deductible

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

 

 

 

 

HDHP Base Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$3,400

$6,800

 

$6,800

$13,600

Out-of-Pocket Maximum

Individual

Family

 

$6,800

$13,600

 

$13,600

$27,200

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

20%*

20%*

20%*

 

50%*

50%*

50%*

Urgent Care Services

20%*

20%*

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

20%*

20%*

20%*

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

20%*

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

20%*

20%*

20%*

20%*

Mail Order 90 Day Supply

20%*

20%*

20%*

Not Covered

Teladoc Benefits

General Consultation

Dermatology

Mental Health - Therapist

Mental Health - Psychologist, Initial Evaluation

Mental Health - Psychologist, Ongoing Session

 

$0 Copay

$0 Copay

$0 Copay

$0 Copay

$0 Copay

 

$0 Copay

$0 Copay

$0 Copay

$0 Copay

$0 Copay

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 844-475-2803