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

HSA Plan 1

In-Network

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$1,500

$3,000

$3,000

 

Not Covered

Not Covered

Not Covered

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$5,000

$5,000

$10,000

 

Not Covered

Not Covered

Not Covered

Preventative Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

10%*

10%*

10%*

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

10%*

Not Covered

Complex Imaging: MRI/CT/PET Scans

10%*

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

Not Covered

Not Covered

Emergency Room Services

Emergency Medical Transportation

10%*

10%*

10%*

10%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

10%*

 

Not Covered

Not Covered

Teledoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

No Charge

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

No Charge

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay*

$35 Copay*

$75 Copay*

$75 Copay*

Mail Order 90 Day Supply

$30 Copay*

$70 Copay*

150 Copay*

Not Available

* Copay or Coinsurance after deductible

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

 

 

 

 

HSA Plan 2

In-Network

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$7,000

$7,000

$14,000

 

Not Covered

Not Covered

Not Covered

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$7,000

$7,000

$14,000

 

Not Covered

Not Covered

Not Covered

Preventative Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

0%*

Not Covered

Complex Imaging: MRI/CT/PET Scans

0%*

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

Not Covered

Not Covered

Emergency Room Services

Emergency Medical Transportation

0%*

0%*

0%*

0%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

Not Covered

Not Covered

Teledoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

No Charge

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

No Charge

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

0%*

0%*

0%*

0%*

Mail Order 90 Day Supply

0%*

0%*

0%*

Not Available

* Coinsurance after deductible

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

 

 

 

 

Copay Plan 1

In-Network

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$1,250

$1,250

$2,500

 

Not Covered

Not Covered

Not Covered

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$5,000

$5,000

$10,000

 

Not Covered

Not Covered

Not Covered

Preventative Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$40 Copay

$25 Copay

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

$65 Copay

Not Covered

Complex Imaging: MRI/CT/PET Scans

$100 Copay

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

Not Covered

Not Covered

Emergency Room Services

Emergency Medical Transportation

$500 Copay

20%*

$500 Copay

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

No Charge

No Charge

 

Not Covered

Not Covered

Teledoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

No Charge

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

No Charge

Individual Prescription Deductible

$100

 

Family Prescription Deductible

$200

 

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay

$50 Copay*

$80 Copay*

$80 Copay*

Mail Order 90 Day Supply

$25 Copay

$125 Copay*

$200 Copay*

Not Available

* Coinsurance after deductible

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

 

 

 

 

Copay Plan 2

In-Network

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$3,000

$3,000

$6,000

 

Not Covered

Not Covered

Not Covered

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$7,150

$7,150

$14,300

 

Not Covered

Not Covered

Not Covered

Preventative Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$40 Copay

$70 Copay

$40 Copay

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

$75 Copay

Not Covered

Complex Imaging: MRI/CT/PET Scans

$100 Copay

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

30%*

30%*

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

30%*

30%*

 

Not Covered

Not Covered

Emergency Room Services

Emergency Medical Transportation

$150 Copay

30%*

$150 Copay

30%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

No Charge

No Charge

 

Not Covered

Not Covered

Teledoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

No Charge

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

No Charge

Individual Prescription Deductible

$250

 

Family Prescription Deductible

$500

 

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay

$50 Copay*

$80 Copay*

$80 Copay*

Mail Order 90 Day Supply

$25 Copay

$125 Copay*

$200 Copay*

Not Available

* Coinsurance after deductible

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

 

 

 

 

If you prefer talking with a HealthEZ representative, call 888-806-3226