Compare Plans

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 Plan 1

In-Network

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$500

$500

$1,000

 

N/A

N/A

N/A

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$5,000

$5,000

$10,000

 

N/A

N/A

N/A

Preventative Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$35 Copay

$50 Copay

20%*

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

$50 Copay

Not Covered

Complex Imaging: MRI/CT/PET Scans

$200 Copay

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

$200 Copay per day

0%

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

$200 Copay per procedure

0%

 

Not Covered

Not Covered

Emergency Room Services

Facility

Physician

 

$200 Copay

$50 Copay

 

Not Covered

Not Covered

Emergency Medical Transportation**

20%*

Not Covered

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

Facility- $200 Copay

$50 Copay

 

Not Covered

Not Covered

Teledoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

 

No Charge

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay

$40 Copay

$60 Copay

Not Covered

Mail Order 90 Day Supply

$37.50 Copay

$100 Copay

$150 Copay

Not Covered

* Coinsurance after deductible

** Covered as in-network in true-emergency

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

 

 

 

 

 

 

HSA 1 Plan

In-Network

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$6,450

$6,450

$12,900

 

N/A

N/A

N/A

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$6,450

$6,450

$12,900

 

N/A

N/A

N/A

Preventative Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

0%*

Not Covered

Complex Imaging: MRI/CT/PET Scans

0%*

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%

 

Not Covered

Not Covered

Emergency Room Services

Facility

Physician

 

0%*

0%*

 

Not Covered

Not Covered

Emergency Medical Transportation**

0%*

Not Covered

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

Not Covered

Not Covered

Teledoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

No Charge

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

No Charge

Prescription Drug Coverage

Expanded Preventive Generic

Expanded Preventive Preferred Brand

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

No Charge

No Charge

0%*

0%*

0%*

Not Covered

Mail Order 90 Day Supply

No Charge

No Charge

0%*

0%*

0%*

Not Covered

* Coinsurance after deductible

** Covered as in-network in true-emergency

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

 

 

 

 

 

 

HSA 2 Plan

In-Network

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$4,150

$4,150

$8,300

 

N/A

N/A

N/A

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$4,150

$4,150

$8,300

 

N/A

N/A

N/A

Preventative Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

0%*

Not Covered

Complex Imaging: MRI/CT/PET Scans

0%*

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%

 

Not Covered

Not Covered

Emergency Room Services**

0%*

Not Covered

Emergency Medical Transportation**

0%*

Not Covered

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

Not Covered

Not Covered

Teledoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

No Charge

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

No Charge

Prescription Drug Coverage

Expanded Preventive Generic

Expanded Preventive Preferred Brand

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

No Charge

No Charge

0%*

0%*

0%*

Not Covered

Mail Order 90 Day Supply

No Charge

No Charge

0%*

0%*

0%*

Not Covered

* Coinsurance after deductible

** Covered as in-network in true-emergency

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

 

 

 

 

 

 

If you prefer talking with a HealthEZ representative, call 844-660-2445