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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

Copay Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$1,500

$3,000

 

$4,500

$9,000

Coinsurance

20%

50%

Out-Of-Pocket Maximum

Employee Only

Family

 

$4,500

$9,000

 

$13,500

$27,000

Preventive Care

100% Covered

40%*

Office Visits

Primary Services

Specialist Services

Convenience Clinic

 

$35 Copay

$35 Copay

$35 Copay

 

40%*

40%*

40%*

Hospital Services

Inpatient services

Outpatient Procedures

-Free Standing

-Hospital Based

 

20%*

 

20%*

40%*

 

40%*

 

40%*

50%*

Emergency Services

Emergency Room - True Emergency

Emergency Room - Non Emergency

Emergency Medical Transportation

 

20%*

50%*

20%*

 

20%*

50%*

40%*

Urgent Care Services

$65 Copay

40%*

Chiropractic Services

$35 Copay

40%*

Mental health/Chemical Dependency

Inpatient

Outpatient

 

20%*

$35 Copay

 

40%*

40%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Formulary

Non-Formulary

Specialty

 

$20 Copay

$80 Copay

$150 Copay

30% Coinsurance

 

$40 Copay

$160 Copay

$300 Copay

Not Available

*After Deductible

 

 

HSA Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$3,000

$6,000

 

$6,000

$12,000

Coinsurance

20%

40%

Out-Of-Pocket Maximum

Employee Only

Family

 

$4,000

$8,000

 

$8,000

$16,000

Preventive Care

100% Covered

40%*

Office Visits

Primary Services

Specialist Services

Convenience Clinic

 

20%*

20%*

20%*

 

40%*

40%*

40%*

Hospital Services

Inpatient Services

Outpatient Hospital Procedures

-Free Standing

-Hospital Based

 

20%*

 

20%*

40%*

 

40%*

 

40%*

50%*

Emergency Services

Emergency Room- True Emergency

Emergency Room- Non Emergency

Emergency Medical Transportation

 

20%*

50%*

20%*

 

40%*

50%*

40%*

Urgent Care Services

20%*

40%*

Chiropractic Services

20%*

40%*

Mental health/Chemical Dependency

Inpatient

Outpatient

 

20%*

20%*

 

40%*

40%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

20%*

20%*

20%*

20%*

 

20%*

20%*

20%*

Not Available

*After Deductible

 

 

High Value Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$3,200

$6,400

 

$6,400

$12,800

Coinsurance

20%

40%

Out-Of-Pocket Maximum

Employee Only

Family

 

$5,000

$10,000

 

$10,000

$20,000

Preventive Care

100% Covered

40%*

Office Visits

Primary Services

Specialist Services

Convenience Clinic

 

20%*

20%*

20%*

 

40%*

40%*

40%*

Hospital Charges

Inpatient Services

Outpatient Hospital Procedures

 

20%*

40%*

 

40%*

50%*

Emergency Services

Emergency Room Care

Emergency Room Care – Not True Emergency

Emergency Medical Transportation

 

20%*

50%*

20%*

 

40%*

50%*

40%*

Urgent Care Services

20%*

40%*

Chiropractic Services

20%*

40%*

Mental health/Chemical Dependency

Inpatient

Outpatient

 

20%*

20%*

 

40%*

40%*

Retail 30 Day Supply

Mail Order 90 Day Supply (CVS Pharmacy Retail or CVS Mail Order)

Prescription Drug Coverage Preventive

Generic

Formulary

Non-Formulary

Specialty

 

$10 Copay

$125 Copay

$250 Copay

Not Covered

 

$0 Copay

$250 Copay

$500 Copay

Not Covered

Prescription Drug Coverage Non-Preventive

Generic

Brand Formulary

Brand Non-Formulary

Specialty Drugs

 

80%*

80%*

80%*

Not Covered

 

80%*

80%*

80%*

Not Covered

*After Deductible

 

 


If you prefer talking with a HealthEZ representative, call 1-800-948-5988