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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 Plan

Tier 1 In-Network

Tier 2 In-Network

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$500

$500

$1,000

 

$1,000

$1,000

$2,000

 

$5,000

$5,000

$10,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$1,250

$1,250

$2,500

 

$2,500

$2,500

$5,000

30

$10,000

$10,000

$20,000

Preventative Services

No Charge

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$10 Copay

$10 Copay

$20 Copay

 

$25 Copay

$25 Copay

$50 Copay

 

50%*

50%*

50%*

Urgent Care Services

$10 Copay

$25 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

10%*

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

20%*

20%*

50%*

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

20%*

20%*

 

50%*

50%*

Emergency Room Services

Emergency Medical Transportation

$50 Copay

10%*

$250 Copay

20%*

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

$10 Copay

 

20%*

$25 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay

$70 Copay

$110 Copay

$200 Copay

Mail Order 90 Day Supply

$37.50 Copay

$175 Copay

$275 Copay

Not Available

 

 

 

 

 

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

* Coinsurance after deductible

** Covered as in-network in true-emergency

 

 

 

 

 

 

 

 

 

Copay 2 Plan

Tier 1 In-Network

Tier 2 In-Network

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$1,000

$1,000

$2,000

 

$2,000

$2,000

$4,000

 

$5,000

$5,000

$10,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$2,500

$2,500

$5,000

 

$5,000

$5,000

$10,000

30

$10,000

$10,000

$20,000

Preventative Services

No Charge

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$20 Copay

$20 Copay

 

$50 Copay

$50 Copay

$50 Copay

 

50%*

50%*

50%*

Urgent Care Services

$20 Copay

$50 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

10%*

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

20%*

20%*

50%*

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

20%*

20%*

 

50%*

50%*

Emergency Room Services

Emergency Medical Transportation

$50 Copay

10%*

$250 Copay

20%*

$250 Copay

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

$20 Copay

 

20%*

$50 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay

$70 Copay

$110 Copay

$200 Copay

Mail Order 90 Day Supply

$37.50 Copay

$175 Copay

$275 Copay

Not Available

 

 

 

 

 

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

* Coinsurance after deductible

** Covered as in-network in true-emergency

 

 

 

 

 

 

 

 

 

Copay 3 Plan

Tier 1 In-Network

Tier 2 In-Network

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$3,000

$3,000

$6,000

 

$5,500

$5,500

$11,000

 

$10,000

$10,000

$20,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$3,000

$3,000

$6,000

 

$8,000

$8,000

$16,000

30

$15,000

$15,000

$30,000

Preventative Services

No Charge

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$20 Copay

$20 Copay

 

$50 Copay

$50 Copay

$50 Copay

 

50%*

50%*

50%*

Urgent Care Services

0%*

$50 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

0%*

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

20%*

20%*

50%*

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

20%*

20%*

 

50%*

50%*

Emergency Room Services

Emergency Medical Transportation

$50 Copay

0%*

$250 Copay

20%*

$250 Copay

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

$20 Copay

 

20%*

$50 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay

$70 Copay

$110 Copay

$200 Copay

Mail Order 90 Day Supply

$37.50 Copay

$175 Copay

$275 Copay

Not Available

 

 

 

 

 

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

* Coinsurance after deductible

** Covered as in-network in true-emergency

 

 

 

 

 

 

 

 

 

If you prefer talking with a HealthEZ representative, call 844-204-3762