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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

$2,500 Copay Plan

In-Network

Out-Of-Network

Embedded Deductible

Individual

Family

 

$2,500

$5,000

 

$5,000

$10,000

Out-Of-Pocket Maximum

Individual

Family

 

$5,000

$10,000

 

$10,000

$20,000

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$55 Copay

$55 Copay

 

50%*

50%*

50%*

Urgent Care Services

$100 Copay

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 Services

Emergency Room**

Emergency Medical Transportation**

 

$300 Copay

20%*

 

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$55 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred brand

Non-Preferred brand

Specialty

Retail 30 Day Supply

$10 Copay

$35 Copay

20% Coinsurance

50% Coinsurance

Mail Order 90 day Supply

$20 Copay

$70 Copay

20% Coinsurance

Not Available

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

$85 Copay

No Charge

No Charge

No Charge

 

No Charge

$85 Copay

No Charge

No Charge

No Charge

NOTE: * Coinsurance After Deductible

**True emergencies covered at in-network level

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

 

 

 

 

 

 

$3,300 HSA Plan

In-Network

Out-Of-Network

Embedded Deductible

Individual

Family

 

$3,300

$6,000

 

$5,000

$10,000

Out-Of-Pocket Maximum

Individual

Family

 

$6,000

$12,000

 

$10,000

$20,000

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 Services

Emergency Room**

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%*

20%*

50%*

Mail Order 90 day Supply

20%*

20%*

20%

Not Available

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapy

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

$85 Copay Applies Until Deductible is met, then 100% covered

No Charge

No Charge

No Charge

 

No Charge

$85 Copay Applies Until Deductible is met, then 100% covered

No Charge

No Charge

No Charge

NOTE: * Coinsurance After Deductible

**True emergencies covered at in-network level

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

 

 

 

 

 

 


If you prefer talking with a HealthEZ representative, call 1-888-806-3296