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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.

Summary Of Medical Benefits

HSA 4 Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Individual Under Family

Family

 

$1,600

$3,200

$3,200

 

$3,000

$6,000

$6,000

Out-Of-Pocket Maximum

Employee Only

Individual Under Family

Family

 

$3,000

$3,200

$6,000

 

$6,000

$6,000

$12,000

Preventive Care

100% Covered

30%*

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

10%*

10%*

10%*

 

30%*

30%*

30%*

Urgent Care Services

10%*

30%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

10%*

10%*

 

10%*

10%*

Hospital Services

Inpatient Hospital Facility

Outpatient Services

 

10%*

10%*

 

30%*

30%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

10%*

10%*

 

30%*

30%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$10 Copay*

$25 Copay*

$50 Copay*

$10/$25/$50 Copay*

Mail Order 90 day Supply

$25 Copay*

$62.50 Copay*

$125 Copay*

Not Available

* After deductible

 

 

** True emergencies covered at in-network level

 

 


Summary of Medical Benefits

Copay 2 Plan

In-Network

Out-of-Network

Calendar Year Deductible

Individual

Individual Under Family

Family

 

$500

$500

$1,000

 

$500

$500

$1,000

Coinsurance

10%

30%

Out-of-Pocket Maximum

Individual

Individual Under Family

Family

 

$3,000

$3,000

$6,000

 

$7,000

$7,000

$14,000

Preventive Care

100% Covered

30%*

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

$20 Copay

$30 Copay

$30 Copay

 

30%*

30%*

30%*

Urgent Care Services

$75 Copay

30%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$150 Copay

10%*

 

$150 Copay

10%*

Hospital Services

Inpatient Hospital Facility

Outpatient Services

 

$250 Copay, then 10%*

10%*

 

$250 Copay, then 30%*

30%*

Mental Health/Chemical Dependency

Inpatient

Outpatient

 

$250 Copay, then 10%*

$20 Copay

 

$250 Copay, then 30%*

30%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$10 Copay

$30 Copay

$60 Copay

$10/$30/$60 Copay

Mail Order 90 Day Supply

$25 Copay

$75 Copay

$150 Copay

Not Available

* After deductible

 

 

** True emergencies covered at in-network level

 

 


If you prefer talking with a HealthEZ representative, call 844-660-2446