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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

$500 Copay

In-Network

Out-of-Network

Deductible

Individual

Family

 

$500

$1,500

 

$750

$2,250

Out-of-Pocket Maximum

Individual

Family

 

$2,500

$5,000

 

$5,000

$10,000

Preventive Care Services

No Charge

40%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$40 Copay

$40 Copay

 

40%*

40%*

40%*

Urgent Care Services

$45 Copay

$45 Copay, then 40%*

Complex Imaging: MRI/CT/PET Scans

$150 Copay

40%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

$600 Copay

20%*

 

40%*

40%*

Outpatient Procedures

Facility Fee

Physician Fee

 

Ambulatory Surgical Center: $100 Copay; Hospital: $200 Copay

20%*

 

40%*

40%*

Emergency Room

Emergency Medical Transportation

$100 Copay

20%*

$100 Copay

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

No Charge

No Charge

 

40%*

40%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay

$50 Copay

$80 Copay

$250 Copay

Mail Order 90 Day Supply

$25 Copay

$125 Copay

$200 Copay

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$10 Copay

$10 Copay

$10 Copay

$10 Copay

$10 Copay

 

$10 Copay

$10 Copay

$10 Copay

$10 Copay

$10 Copay

NOTE: * Coinsurance After Deductible

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

 

 

 

 

$1,500 Copay Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$1,500

$4,500

 

$4,500

$13,500

Out-of-Pocket Maximum

Individual

Family

 

$5,500

$11,000

 

$11,000

$22,000

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$30 Copay

$55 Copay

$55 Copay

 

50%*

50%*

50%*

Urgent Care Services

$60 Copay

$60 Copay, then 50%*

Complex Imaging: MRI/CT/PET Scans

$250 Copay

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

$600 Copay

30%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

Ambulatory Surgical Center: $200 Copay; Hospital: 30%*

20%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

$250

30%*

$250

30%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

No Charge

No Charge

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay

$50 Copay

$80 Copay

$250 Copay

Mail Order 90 Day Supply

$25 Copay

$125 Copay

$200 Copay

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$10 Copay

$10 Copay

$10 Copay

$10 Copay

$10 Copay

 

$10 Copay

$10 Copay

$10 Copay

$10 Copay

$10 Copay

NOTE: * Coinsurance After Deductible

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

 

 

 

 

$2,500 HSA Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$2,500

$5,000

 

$5,000

$10,000

Out-of-Pocket Maximum

Individual

Family

 

$6,850

$11,600

 

$11,600

$23,200

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%*

$45 Copay, then 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

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

$10 Copay*

$50 Copay*

$80 Copay*

$250 Copay*

Mail Order 90 Day Supply

$25 Copay*

$125 Copay*

$200 Copay*

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$10 Copay

$10 Copay

$10 Copay

$10 Copay

$10 Copay

 

$10 Copay

$10 Copay

$10 Copay

$10 Copay

$10 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 888-701-3008