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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

$500 PPO Plan

In-Network

Out-Of-Network

Embedded Deductible

Individual

Family

 

$500

$1,500

 

$1,500

$4,500

Embedded Out-Of-Pocket Maximum

Individual

Family

 

$3,000

$6,000

 

$5,000

$10,000

Preventive Care

100% Covered

50%*

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

$30 Copay

$30 Copay

$30 Copay

 

50%*

50%*

50%*

Hospital Services- Inpatient & Outpatient Care

20%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

20%*

20%*

 

50%*

50%*

Urgent Care Services

$50 Copay

50%*

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

No Charge

$30 Copay

No Charge

No Charge

No Charge

 

No Charge

$30 Copay

No Charge

No Charge

No Charge

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

20%*

$30 Copay

 

50%*

$30 Copay

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$12 Copay

$50 Copay

$90 Copay

20% Coinsurance up to $200

Mail Order 90 day Supply

$24 Copay

$100 Copay

$180 Copay

Not Available

* Coinsurance after deductible

**Covered as in-network in true emergency

 

 

 

 

$1,500 PPO Plan

In-Network

Out-Of-Network

Embedded Deductible

Individual

Family

 

$1,500

$3,000

 

$3,000

$6,000

Embedded Out-Of-Pocket Maximum

Individual

Family

 

$5,000

$10,000

 

$8,000

$16,000

Preventive Care

100% Covered

50%*

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

$30 Copay

$30 Copay

$30 Copay

 

50%*

50%*

50%*

Hospital Services- Inpatient & Outpatient Care

20%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

20%*

20%*

 

50%*

50%*

Urgent Care Services

$50 Copay

50%*

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

No Charge

$30 Copay

No Charge

No Charge

No Charge

 

No Charge

$30 Copay

No Charge

No Charge

No Charge

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

20%*

$30 copay

 

50%*

$30 Copay

Prescription Drug Coverage

Generic

Formulary

Non-Formulary

Specialty

Retail 30 Day Supply

$12 copay

$50 copay

$90 copay

20% Coinsurance up to $200

Mail Order 90 day Supply

$24 copay

$100 copay

$180 copay

Not Available

*After Deductible

**Covered as in-network in true emergency

 

 

 

 

$3,500 HDHP + HSA Plan

In-Network

Out-Of-Network

Embedded Deductible

Individual

Family

 

$3,500

$6,000

 

$6,000

$12,000

Embedded Out-Of-Pocket Maximum

Individual

Family

 

$6,000

$12,000

 

$10,000

$12,000

Preventative Care

100% Covered

50%*

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

20%*

20%*

20%*

 

50%*

50%*

50%*

Hospital Services - Inpatient & Outpatient

20%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

20%*

20%*

 

50%*

50%*

Urgent Care Services

20%*

50%*

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

20%*

20%*

20%*

20%*

20%*

 

20%*

20%*

20%*

20%*

20%*

Mental Health/Chemical Dependency

Inpatient

Outpatient

 

20%*

20%*

 

50%*

20%*

Expanded Preventive Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Retail 30 Day Supply

$12 Copay

$50 Copay

$90 Copay

Mail Order 90 Day Supply

$24 Copay

$100 Copay

$180 Copay

Non-Expanded Preventive Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$12 Copay*

$50 Copay*

$90 Copay*

20% Coinsurance up to $200

Mail Order 90 Day Supply

$24 Copay*

$100 Copay*

$180 Copay*

Not available

*After Deductible

**Covered as in-network in true emergency

 

 

 

 


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