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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.


Summary of Medical Benefits

Copay 1

In-Network

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$3,000

$3,000

$9,000

 

$6,000

$6,000

$18,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$5,000

$5,000

$10,000

 

$15,000

$15,000

$30,000

Preventative Services

No Charge

40%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$40 Copay

$40 Copay

$40 Copay

 

40%*

40%*

40%*

Urgent Care Services

$40 Copay

40%*

Complex Imaging: MRI/CT/PET Scans

20%*

40%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

40%*

40%*

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

40%*

40%*

Emergency Room Services

Emergency Medical Transportation

20%*

20%*

40%*

40%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$40 Copay

 

40%*

40%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$12 Copay

$50 Copay

$90 Copay

30% up to $750

Mail Order 90 Day Supply

$24 Copay

$100 Copay

$180 Copay

Not Available

HSA 1

In-Network

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$3,200

$3,200

$6,400

 

$6,400

$6,400

$12,800

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$6,400

$6,400

$12,800

 

$16,500

$16,500

$33,000

Preventative Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

20%*

20%*

20%*

 

50%*

50%*

50%*

Urgent Care Services

20%*

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 Services

Emergency Medical Transportation

20%*

20%*

50%*

50%*

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%*

40%*

20%*

Mail Order 90 Day Supply

20%*

20%*

40%*

Not Available

HSA 2

In-Network

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$5,250

$5,250

$10,000

 

$10,500

$10,500

$21,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$5,950

$5,950

$11,900

 

$17,850

$17,850

$35,700

Preventative Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

20%*

20%*

20%*

 

50%*

50%*

50%*

Urgent Care Services

20%*

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 Services

Emergency Medical Transportation

20%*

20%*

50%*

50%*

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%*

40%*

20%*

Mail Order 90 Day Supply

20%*

20%*

40%*

Not Available

* Coinsurance after deductible

** Covered as in-network in true-emergency

 

 

 

 


If you prefer talking with a HealthEZ representative, call 844-617-1495