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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

Base Medical Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$6,000

$12,000

 

$10,000

$20,000

Out-of-Pocket Maximum

Individual

Family

 

$6,450

$12,900

 

$20,000

$40,000

Preventive Care Services

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

30%*

30%*

30%*

Urgent Care Services

0%*

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 Room

Emergency Medical Transportation

0%*

0%*

30%*

30%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

30%*

30%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$5 Copay after Deductible

$25 Copay after Deductible

$40 Copay after Deductible

10%*

Mail Order 90 Day Supply

$10 Copay after Deductible

$50 Copay after Deductible

$80 Copay after Deductible

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapy

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$37 Copay

$37 Copay

$37 Copay

$37 Copay

$37 Copay

 

$37 Copay

$37 Copay

$37 Copay

$37 Copay

$37 Copay

NOTE: * Coinsurance After Deductible

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

 

 

 

 

Buy-Up Medical Plan #1

In-Network

Out-of-Network

Deductible

Individual

Family

 

$2,850

$5,700

 

$2,850

$5,700

Out-of-Pocket Maximum

Individual

Family

 

$4,000

$8,000

 

$5,850

$11,700

Preventive Care Services

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

10%*

 

30%*

30%*

30%*

Urgent Care Services

10%*

30%*

Complex Imaging: MRI/CT/PET Scans

10%*

30%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

30%*

30%*

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

30%*

30%*

Emergency Room

Emergency Medical Transportation

10%*

10%*

30%*

30%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

0%*

 

30%*

30%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$5 Copay after Deductible

$25 Copay after Deductible

$40 Copay after Deductible

10%*

Mail Order 90 Day Supply

$10 Copay after Deductible

$50 Copay after Deductible

$80 Copay after Deductible

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapy

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$37 Copay

$37 Copay

$37 Copay

$37 Copay

$37 Copay

 

$37 Copay

$37 Copay

$37 Copay

$37 Copay

$37 Copay

NOTE: * Coinsurance After Deductible

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

 

 

 

 

Buy-Up Medical Plan #2

In-Network

Out-of-Network

Deductible

Individual

Family

 

$1,500

$3,000

 

$3,000

$6,000

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

 

$30 Copay

$45 Copay

10%*

 

30%*

30%*

30%*

Urgent Care Services

$45 Copay

30%*

Complex Imaging: MRI/CT/PET Scans

10%*

30%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

30%*

30%*

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

30%*

30%*

Emergency Room

Emergency Medical Transportation

$150 Copay (Copay waived if admitted)

10%*

30%*

30%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

10%*

 

30%*

30%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$5 Copay

$25 Copay

$40 Copay

10% Coinsurance

Mail Order 90 Day Supply

$10 Copay

$50 Copay

$80 Copay

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapy

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$37 Copay

$37 Copay

$37 Copay

$37 Copay

$37 Copay

 

$37 Copay

$37 Copay

$37 Copay

$37 Copay

$37 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 866-490-6171