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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

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 - Retail

Preferred Generic

Non Preferred Generic

Preferred Brand

Non-Preferred Brand

Specialty

Prescription Drug Coverage - Mail Order

Preferred Generic

Non Preferred Generic

Preferred Brand

Specialty

30 Day Supply

$12 Copay

$12 Copay

$50 Copay

$90 Copay

30% up to $750

30 Day Supply

$12 Copay

$12 Copay

$50 Copay

$90 Copay

90 Day Supply (3x30-day)

$36 Copay

$36 Copay

$150 Copay

$270 Copay

Not Available

90 Day Supply (2.5x30-day)

$30 Copay

$30 Copay

$125 Copay

$225 Copay

HSA 1

In-Network

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$3,400

$3,400

$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