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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.

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 Hospital Procedures

 

20%*

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

 

$2,800

$5,600

 

$5,600

$11,200

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

 

20%*

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

 

$3,000

$6,000

 

$6,000

$12,000

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

Non-Preventive Rx

Generic

Brand Formulary

Brand Non-Formulary

Specialty Drugs

 

 

$10 Copay

$125 Copay

$250 Copay

No Covered

 

80%*

80%*

80%*

Not Covered

 

 

$0 Copay

$250 Copay

$500 Copay

Not Covered

 

80%*

80%*

80%*

Not Covered

*After Deductible

 

 


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