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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

PPO Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$300

$600

 

$450

$900

Out-of-Pocket Maximum

Individual

Family

 

$3,700

$7,800

 

$6,200

$12,500

Preventive Care Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$15 Copay

$25 Copay

$25 Copay

 

50%*

50%*

50%*

Urgent Care Services

$20 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

$100 Copay for Freestanding Imaging; $500 Copay for Outpatient

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

15%*

15%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

Ambulatory Surgery Center: 5%*; Outpatient Hospital: 15%*

Ambulatory Surgery Center: 5%*; Outpatient Hospital: 15%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

$200 Copay

20%*

$200 Copay

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

15%*

OV: No Charge; Bereavement Counseling: 15%*

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Preferred GLP-1 Weight Loss Drugs

Specialty

Retail 30 Day Supply

$5 Copay

$30 Copay

100%*

50%*

30%*

Mail Order 90 Day Supply

No Charge

$60 Copay

100%*

50%*

Not Covered

Teladoc Benefits

General Consultations

 

No Charge

 

No Charge

NOTE: * Coinsurance After Deductible

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

 

 

 

 

EPO Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$300

$600

 

N/A

N/A

Out-of-Pocket Maximum

Individual

Family

 

$2,550

$5,100

 

N/A

N/A

Preventive Care Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$15 Copay

$25 Copay

$25 Copay

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

$20 Copay

Not Covered

Complex Imaging: MRI/CT/PET Scans

$100 Copay for Freestanding Imaging; $500 Copay for Outpatient

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

15%*

15%*

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

Ambulatory Surgery Center: 5%*; Outpatient Hospital: 15%*

Ambulatory Surgery Center: 5%*; Outpatient Hospital: 15%*

 

Not Covered

Not Covered

Emergency Room

Emergency Medical Transportation

$200 Copay

20%*

$200 Copay

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

15%*

OV: No Charge; Bereavement Counseling: 15%*

 

Not Covered

Not Covered

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Preferred GLP-1 Weight Loss Drugs

Specialty

Retail 30 Day Supply

$5 Copay

$30 Copay

100%*

50%*

30%*

Mail Order 90 Day Supply

No Charge

$60 Copay

100%*

50%*

Not Covered

Teladoc Benefits

General Consultations

 

No Charge

 

No Charge

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 888-806-3226