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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

Copay $500/$1,000 Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual Coverage

Family Coverage

 

$500

$1,000

 

$1,000

$2,000

Out-Of-Pocket Maximum

Individual Coverage

Family Coverage

 

$1,500

$3,000

 

$3,000

$6,000

Preventive Care

No Charge

40%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$25 Copay

$25 Copay

 

40%*

40%*

40%*

Urgent Care Services

$25 Copay

40%*

Complex Imaging: MRI/CT/PET Scans

20%*

40%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

40%*

40%*

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

40%*

40%*

Emergency Services

Emergency Room

Emergency Medical Transportation**

 

$250 Copay

20%*

 

40%*

40%*

Mental Health & Substance Abuse Services

Inpatient

Office Visit

 

20%*

$25 Copay

 

40%*

40%*

* Coinsurance After deductible

** True emergencies are covered at in-network level

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

 

 

 

 

 

 

Copay $1,750/$3,500 HRA/VEBA Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual Coverage

Individual Under Family Coverage

Family Coverage

 

$1,750

$1,750

$3,500

 

$3,500

$3,500

$7,000

Out-Of-Pocket Maximum

Individual Coverage

Individual Under Family Coverage

Family Coverage

 

$2,500

$2,500

$5,000

 

$5,000

$5,000

$10,000

Preventive Care

No Charge

40%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$25 Copay

$25 Copay

 

40%*

40%*

40%*

Urgent Care Services

$25 Copay

40%*

Complex Imaging: MRI/CT/PET Scans

20%*

40%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

40%*

40%*

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

40%*

40%*

Emergency Services

Emergency Room

Emergency Medical Transportation**

 

$250 Copay

20%*

 

40%*

40%*

Mental Health & Substance Abuse Services

Inpatient

Office Visit

 

20%*

$25 Copay

 

40%*

40%*

* Coinsurance After deductible

** True emergencies are covered at in-network level

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

 

 

 

 

 

 

$1,650/$4,500 HSA Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual Coverage

Individual Under Family Coverage

Family Coverage

 

$1,650

$4,500

$4,500

 

$5,000

$10,000

$10,000

Out-Of-Pocket Maximum

Individual Coverage

Individual Under Family Coverage

Family Coverage

 

$3,200

$9,000

$9,000

 

$8,000

$16,000

$16,000

Preventive Care

No Charge

40%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

20%*

20%*

20%*

 

40%*

40%*

40%*

Urgent Care Services

20%*

40%*

Complex Imaging: MRI/CT/PET Scans

20%*

40%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

40%*

40%*

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

40%*

40%*

Emergency Services

Emergency Room

Emergency Medical Transportation**

 

20%*

20%*

 

40%*

40%*

Mental Health & Substance Abuse Services

Inpatient

Office Visit

 

20%*

20%*

 

40%*

40%*

* Coinsurance After deductible

** True emergencies are covered at in-network level

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

 

 

 

 

 

 

$1,650/$4,500 HRA/VEBA Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual Coverage

Individual Under Family Coverage

Family Coverage

 

$1,650

$4,500

$4,500

 

$5,000

$10,000

$10,000

Out-Of-Pocket Maximum

Individual Coverage

Individual Under Family Coverage

Family Coverage

 

$3,200

$9,000

$9,000

 

$8,000

$16,000

$16,000

Preventive Care

No Charge

40%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

20%*

20%*

20%*

 

40%*

40%*

40%*

Urgent Care Services

20%*

40%*

Complex Imaging: MRI/CT/PET Scans

20%*

40%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

40%*

40%*

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

40%*

40%*

Emergency Services

Emergency Room

Emergency Medical Transportation**

 

20%*

20%*

 

40%*

40%*

Mental Health & Substance Abuse Services

Inpatient

Office Visit

 

20%*

20%*

 

40%*

40%*

* Coinsurance After deductible

** True emergencies are covered at in-network level

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

 

 

 

 

 

 

$4,500/$7,000 HSA Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual Coverage

Individual Under Family Coverage

Family Coverage

 

$4,500

$4,500

$7,000

 

$6,000

$6,000

$12,000

Out-Of-Pocket Maximum

Individual Coverage

Individual Under Family Coverage

Family Coverage

 

$4,500

$4,500

$7,000

 

$8,000

$8,000

$16,000

Preventive Care

No Charge

40%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

20%*

20%*

20%*

Urgent Care Services

0%*

20%*

Complex Imaging: MRI/CT/PET Scans

0%*

20%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

20%*

20%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

20%*

20%*

Emergency Services

Emergency Room

Emergency Medical Transportation**

 

0%*

0%*

 

20%*

20%*

Mental Health & Substance Abuse Services

Inpatient

Office Visit

 

0%*

0%*

 

20%*

20%*

* Coinsurance After deductible

** True emergencies are covered at in-network level

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

 

 

 

 

 

 

$4,500/$7,000 HRA/VEBA Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual Coverage

Individual Under Family Coverage

Family Coverage

 

$4,500

$4,500

$7,000

 

$6,000

$6,000

$12,000

Out-Of-Pocket Maximum

Individual Coverage

Individual Under Family Coverage

Family Coverage

 

$4,500

$4,500

$7,000

 

$8,000

$8,000

$16,000

Preventive Care

No Charge

40%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

20%*

20%*

20%*

Urgent Care Services

0%*

20%*

Complex Imaging: MRI/CT/PET Scans

0%*

20%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

20%*

20%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

20%*

20%*

Emergency Services

Emergency Room

Emergency Medical Transportation**

 

0%*

0%*

 

20%*

20%*

Mental Health & Substance Abuse Services

Inpatient

Office Visit

 

0%*

0%*

 

20%*

20%*

* Coinsurance After deductible

** True emergencies are covered at in-network level

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

 

 

 

 

 

 


If you prefer talking with a HealthEZ representative, call 888-284-7196