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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

Silver Copay Base Plan

In-Network

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$5,000

$5,000

$10,000

 

$10,000

$10,000

$20,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$7,000

$7,000

$13,000

 

$13,000

$13,000

$26,000

Preventative Services

No Charge

40%

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$50 Copay

$50 Copay

 

40%

40%

40%

Urgent Care Services

$50 Copay

40%

Complex Imaging: MRI/CT/PET Scans

20%*

40%

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

40%

40%

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

40%

40%

Emergency Room Services

Emergency Medical Transportation

$500 Copay, then 20%* (Copay waived if admitted)

20%*

40%

40%

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$50 Copay

 

40%

40%

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay

$40 Copay

20%*

$500 Copay after Deductible

Mail Order 90 Day Supply

$20 Copay

$80 Copay

20%*

(Only available in 30-day supply)

NOTE: * Coinsurance After Deductible

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

 

 

 

 

Gold HDHP Buy Up Plan

In-Network

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$1,700

$3,400

$3,400

 

$3,400

$3,400

$6,800

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$3,500

$3,500

$7,000

 

$7,000

$7,000

$14,000

Preventative Services

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

30%*

30%*

30%*

Urgent Care Services

0%*

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 Services

Emergency Medical Transportation

$250 Copay After Deductible

0%*

30%*

30%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

30%*

30%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay After Deductible

$30 Copay After Deductible

$50 Copay After Deductible

75%* up to $150 max per fill

Mail Order 90 Day Supply

$10 Copay After Deductible

$75 Copay After Deductible

$100 Copay After Deductible

Not Available

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 1-844-302-7779