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

Family

 

$7,000

$14,000

 

$21,000

$42,000

Out-Of-Pocket Maximum

Individual

Family

 

$7,000

$14,000

 

$22,000

$44,000

Preventative Care

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

50%*

50%*

50%*

Urgent Care Services

0%*

50%*

Complex Imaging: MRI/CT/PET Scans

0%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

50%*

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

50%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

0%*

0%*

 

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

50%*

50%*

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

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

$85 Copay applies until Deductible is met, then No Charge

No Charge

No Charge

No Charge

 

No Charge

$85 Copay applies until Deductible is met, then No Charge

No Charge

No Charge

No Charge

NOTE: * Coinsurance After Deductible

**Covered as in-network in true emergency

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

 

 

 

 

 

 

HSA Plan 2

In-Network

Out-Of-Network

Deductible

Individual

Family

 

$5,000

$10,000

 

$15,000

$30,000

Out-Of-Pocket Maximum

Individual

Family

 

$6,650

$13,300

 

$21,450

$42,900

Preventative Care

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

20%*

20%*

20%*

 

50%*

50%*

50%*

Urgent Care Services

20%*

50%*

Complex Imaging: MRI/CT/PET Scans

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

20%*

20%*

 

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

50%*

50%*

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

No Charge

No Charge

$85 Copay applies until Deductible is met, then No Charge

No Charge

No Charge

No Charge

No Charge

No Charge

$85 Copay applies until Deductible is met, then No Charge

No Charge

No Charge

No Charge

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

20%*

20%*

20%*

20%*

Mail Order 90 Day Supply

20%*

20%*

20%*

Not Available

NOTE: * Coinsurance After Deductible

**Covered as in-network in true emergency

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

 

 

 

 

 

 

Copay Plan 1

In-Network

Out-Of-Network

Deductible

Individual

Family

 

$1,500

$3,000

 

$4,500

$9,000

Out-Of-Pocket Maximum

Individual

Family

 

$7,150

$14,300

 

$21,450

$42,900

Preventative Care

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$40 Copay

$40 Copay

 

50%*

50%*

50%*

Urgent Care Services

$75 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$500 Copay

20%*

 

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$40 Copay

 

50%*

50%*

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

$85 Copay

No Charge

No Charge

No Charge

 

No Charge

$85 Copay

No Charge

No Charge

No Charge

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay

$45 Copay

$90 Copay

25% Coinsurance

Mail Order 90 Day Supply

$20 Copay

$90 Copay

$180 Copay

Not Available

NOTE: * Coinsurance After Deductible

**Covered as in-network in true emergency

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

 

 

 

 

 

 

Copay Plan 2

In-Network

Out-Of-Network

Deductible

Individual

Family

 

$3,500

$7,000

 

$10,500

$21,000

Out-Of-Pocket Maximum

Individual

Family

 

$7,150

$14,300

 

$21,450

$42,900

Preventative Care

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$35 Copay

$50 Copay

$50 Copay

 

50%*

50%*

50%*

Urgent Care Services

$75 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$500 Copay

20%*

 

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$50 Copay

 

50%*

50%*

Teladoc Benefits

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

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay

$45 Copay

$90 Copay

25% Coinsurance

Mail Order 90 Day Supply

$20 Copay

$90 Copay

$180 Copay

Not Available

NOTE: * Coinsurance After Deductible

**Covered as in-network in true emergency

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

 

 

 

 

 

 


If you prefer talking with a HealthEZ representative, call 1-844-281-5222