Plan Details

Plan Details

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

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$2,000

$4,000

 

$10,000

$20,000

Coinsurance

20%

50%

Out-Of-Pocket Maximum

Employee Only

Family

 

$6,000

$12,000

 

$20,000

$40,000

Preventive Care

No Charge

50%*

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

$25 Copay

$50 Copay

$50 Copay

 

50%*

50%*

50%*

Urgent Care Services

$75 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

20%*

50%*

Inpatient Hospital Care

Outpatient Procedures

20%*

20%*

50%*

50%*

Emergency Room

Emergency Medical Transportation**

$500 Copay

20%*

$500 Copay

50%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

20%*

$50 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$20 Copay

$40 Copay

$60 Copay

$250 Copay

Mail Order 90 day Supply

$60 Copay

$120 Copay

$180 Copay

Not Available

Teledoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$50 Copay

$50 Copay

$50 Copay

$50 Copay

$50 Copay

 

$50 Copay

$50 Copay

$50 Copay

$50 Copay

$50 Copay

* After deductible

 

 

** True emergencies covered at in-network level

 

 

Dental Plan

In-Network

Out-Of-Network

Deductible

Individual Coverage

Family Coverage

 

$50

$150

 

N/A

N/A

Annual Maximum per Individual

$1,000

N/A

Preventive/Diagnostic Care

No Charge

No Coverage

Basic Services

20%*

No Coverage

Major Services

50%*

No Coverage

Prosthetics

50%*

No Coverage

Orthodontics

50%* - $1,000 Lifetime Max

No Coverage


If you prefer talking with a HealthEZ representative, call 888-701-2994