Plan Details

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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

Tier 1 In-Network

Tier 2 In-Network

Out of Network

Deductible

Individual Coverage

Family Coverage

 

$3,000

$6,000

 

$4,500

$9,000

 

$9,000

$18,000

Out-of-Pocket Maximum

Individual Coverage

Family Coverage

 

$5,500

$11,000

 

$7,000

$14,000

 

$14,500

$29,000

Preventive Care Services

No Charge

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$40 Copay

$40 Copay

 

$40 Copay

$60 Copay

$60 Copay

 

50%*

50%*

50%*

Urgent Care Services

$50 Copay

$100 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

10%*

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

20%*

20%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

$150 Copay

10%*

$300 Copay

20%*

$300 Copay

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

$20 Copay

 

20%*

$40 Copay

 

50%*

50%*

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 844-449-5537