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

In-Network Tier 1

In-Network Tier 2

Out-of-Network

Calendar Year Deductible

Individual Coverage

Individual Under Family Coverage

Family Coverage

 

$1,000

$1,000

$2,000

 

$2,000

$2,000

$4,000

 

$4,500

$4,500

$9,000

Out-of-Pocket Maximum

Individual Coverage

Individual Under Family Coverage

Family Coverage

 

$3,300

$3,300

$6,600

 

$5,000

$5,000

$10,000

 

$8,000

$8,000

$16,000

Preventive Care

No Charge

No Charge

40%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$20 Copay

$20 Copay

 

$40 Copay

$40 Copay

$40 Copay

 

40%*

40%*

40%*

Infinite Health/REVO Physician Services

$0 Copay

$0 Copay

$0 Copay

Urgent Care Services

$100 Copay

$100 Copay

40%*

Complex Imaging

MRI/CT/PET scans- Free standing Facility

MRI/CT/PET scans- Hospital or outpatient hospital

 

10%*

10%*

 

25%*

25%*

 

40%*

40%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

25%*

25%*

 

40%*

40%*

Outpatient Procedure

Facility Fee

Physician Fee

 

10%*

10%*

 

25%*

25%*

 

40%*

40%*

Emergency Room Services**

Emergency Medical Transportation**

10%*

10%*

25%*

25%*

40%*

40%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

$20 Copay

 

25%*

$40 Copay

 

40%*

40%*

* 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 Plan

In-Network Tier 1

In-Network Tier 2

Out-of-Network

Calendar Year Deductible

Individual Coverage

Individual Under Family Coverage

Family Coverage

 

$3,300

$3,300

$6,600

 

$4,000

$4,000

$8,000

 

$6,400

$6,400

$12,800

Out-of-Pocket Maximum

Individual Coverage

Individual Under Family Coverage

Family Coverage

 

$3,300

$3,300

$6,600

 

$5,000

$5,000

$10,000

 

$8,000

$8,000

$16,000

Preventive Care

No Charge

No Charge

40%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

25%*

25%*

25%*

 

40%*

40%*

40%*

Infinite Health/REVO Physician Services

i-Health Discount Rate; 100% after deductible

i-Health Discount Rate; 100% after deductible

i-Health Discount Rate; 100% after deductible

Urgent Care Services

0%*

25%*

40%*

Complex Imaging

MRI/CT/PET scans- Free standing Facility

MRI/CT/PET scans- Hospital or outpatient hospital

 

0%*

0%*

 

25%*

25%*

 

40%*

40%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

25%*

25%*

 

40%*

40%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

25%*

25%*

 

40%*

40%*

Emergency Room Services**

Emergency Medical Transportation**

0%*

0%*

25%*

25%*

40%*

40%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

25%*

25%*

 

40%*

40%*

* 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 1-800-948-5988