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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

$3,000 PPO Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$3,000

$6,000

 

$7,500

$15,000

Out-of-Pocket Maximum

Individual

Family

 

$6,000

$12,000

 

$17,500

$35,000

Preventive Care Services

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$35 Copay

$70 Copay

$35 Copay

 

30%*

30%*

30%*

Urgent Care Services

$50 Copay

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%*

0%*

0%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

$35 Copay

 

30%*

30%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$20 Copay

$50 Copay

$100 Copay

$200 Copay

Mail Order 90 Day Supply

$50 Copay

$125 Copay

$250 Copay

Not Covered

NOTE: * Coinsurance After Deductible

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

 

 

 

 

In-Network

Out-of-Network

Deductible

Individual

Family

 

$3,500

$7,000

 

$6,500

$13,000

Out-of-Pocket Maximum

Individual

Family

 

$4,500

$9,000

 

$9,000

$18,000

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%*

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

$20 Copay after Deductible

$50 Copay after Deductible

$100 Copay after Deductible

$200 Copay after Deductible

Mail Order 90 Day Supply

$50 Copay after Deductible

$125 Copay after Deductible

$250 Copay after Deductible

Not Covered

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 844-475-2820