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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

Buy Up $500 HRA Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$500

$1,000

 

N/A

N/A

Out-of-Pocket Maximum

Individual

Family

 

$1,500

$3,000

 

N/A

N/A

Preventive Care Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$30 Copay after deductible​

$50 Copay after deductible​

$30 Copay

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

$50 Copay after deductible​

Not Covered

Complex Imaging: MRI/CT/PET Scans

20% Coinsurance After Deductible

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20% Coinsurance After Deductible

20% Coinsurance After Deductible

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

20% Coinsurance After Deductible

20% Coinsurance After Deductible

 

Not Covered

Not Covered

Emergency Room

Emergency Medical Transportation

​​$400 Copay After Deductible (copay waived if admitted)​

​​0% Coinsurance After Deductible​

​​$400 Copay After Deductible (copay waived if admitted)​

​​0% Coinsurance After Deductible​

Mental Health/Chemical Dependency

Inpatient - Facility Charges

Inpatient - Physician Charges

Office Visit

 

​​$30 Copay after deductible​

20% Coinsurance After Deductible

​​$30 Copay after deductible​

 

Not Covered

Not Covered

Not Covered

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty (Generic/Preferred/Non-preferred)

Retail 30 Day Supply

$20 Copay after Deductible

$40 Copay after Deductible

$70 Copay after Deductible

$20/$40/$70 Copay after Deductible

Mail Order 90 Day Supply

$40 Copay after Deductible

$80 Copay after Deductible

$140 Copay after Deductible

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

$20 Copay

$20 Copay

$20 Copay

$20 Copay

 

 

 

 

 

 

NOTE: * Coinsurance After Deductible

Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions

 

 

 

 

Basic $2,500 HRA Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$2,500

$5,000

 

N/A

N/A

Out-of-Pocket Maximum

Individual

Family

 

$3,500

$7,000

 

N/A

N/A

Preventive Care Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$30 Copay after deductible​

$50 Copay after deductible​

$30 Copay

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

$50 Copay after deductible​

Not Covered

Complex Imaging: MRI/CT/PET Scans

20% Coinsurance After Deductible

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20% Coinsurance After Deductible

20% Coinsurance After Deductible

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

20% Coinsurance After Deductible

20% Coinsurance After Deductible

 

Not Covered

Not Covered

Emergency Room

Emergency Medical Transportation

​​$400 Copay After Deductible (copay waived if admitted)​

​​0% Coinsurance After Deductible​

​​$400 Copay After Deductible (copay waived if admitted)​

​​0% Coinsurance After Deductible​

Mental Health/Chemical Dependency

Inpatient - Facility Charges

Inpatient - Physician Charges

Office Visit

 

​​$30 Copay after deductible​

20% Coinsurance After Deductible

​​$30 Copay after deductible​

 

Not Covered

Not Covered

Not Covered

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty (Generic/Preferred/Non-preferred)

Retail 30 Day Supply

$20 Copay after Deductible

$40 Copay after Deductible

$70 Copay after Deductible

$20/$40/$70 Copay after Deductible

Mail Order 90 Day Supply

$40 Copay after Deductible

$80 Copay after Deductible

$140 Copay after Deductible

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

$20 Copay

$20 Copay

$20 Copay

$20 Copay

 

 

 

 

 

 

NOTE: * Coinsurance After Deductible

Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions

 

 

 

 

EPO $3,500 Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$2,500

$5,000

 

N/A

N/A

Out-of-Pocket Maximum

Individual

Family

 

$4,500

$9,000

 

N/A

N/A

Preventive Care Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$30 Copay after deductible​

$50 Copay after deductible​

$30 Copay

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

$50 Copay after deductible​

Not Covered

Complex Imaging: MRI/CT/PET Scans

20% Coinsurance After Deductible

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20% Coinsurance After Deductible

20% Coinsurance After Deductible

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

20% Coinsurance After Deductible

20% Coinsurance After Deductible

 

Not Covered

Not Covered

Emergency Room

Emergency Medical Transportation

​​$400 Copay After Deductible (copay waived if admitted)​

​​0% Coinsurance After Deductible​

​​$400 Copay After Deductible (copay waived if admitted)​

​​0% Coinsurance After Deductible​

Mental Health/Chemical Dependency

Inpatient - Facility Charges

Inpatient - Physician Charges

Office Visit

 

​​$30 Copay after deductible​

30% Coinsurance After Deductible

​​$30 Copay after deductible​

 

Not Covered

Not Covered

Not Covered

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty (Generic/Preferred/Non-preferred)

Retail 30 Day Supply

$20 Copay after Deductible

$40 Copay after Deductible

$70 Copay after Deductible

$20/$40/$70 Copay after Deductible

Mail Order 90 Day Supply

$40 Copay after Deductible

$80 Copay after Deductible

$140 Copay after Deductible

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

$20 Copay

$20 Copay

$20 Copay

$20 Copay

 

 

 

 

 

 

NOTE: * Coinsurance After Deductible

Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions

 

 

 

 

If you prefer talking with a HealthEZ representative, call 844-671-1840​