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.


Summary of Medical Benefits

Copay 1 Plan

In-Network

Out-of-Network

Embedded Deductible

Individual

Individual under Family

Family

 

$1,000

$1,000

$3,000

 

$3,000

$3,000

$6,000

Embedded Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$4,000

$4,000

$8,000

 

$8,000

$8,000

$16,000

Preventative Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$40 Copay

20%*

 

50%*

50%*

50%*

Urgent Care Services

$50 copay, then 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 Room Services**

Emergency Medical Transportation**

$150 copay

20%*

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$40 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay

$30 Copay

$45 Copay

Not Covered

Mail Order 90 Day Supply

$30 Copay

$60 Copay

$90 Copay

Not Covered

* 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 2 Plan

In-Network

Out-of-Network

Embedded Deductible

Individual

Individual under Family

Family

 

$3,000

$3,000

$6,000

 

$6,000

$6,000

$12,000

Embedded Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$6,000

$6,000

$12,000

 

$12,000

$12,000

$24,000

Preventative Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$40 Copay

20%*

 

50%*

50%*

50%*

Urgent Care Services

$50 copay, then 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 Room Services**

Emergency Medical Transportation**

$150 copay

20%*

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$40 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay

$30 Copay

$45 Copay

Not Covered

Mail Order 90 Day Supply

$30 Copay

$60 Copay

$90 Copay

Not Covered

* 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 3 Plan

In-Network

Out-of-Network

Embedded Deductible

Individual

Individual under Family

Family

 

$5,000

$5,000

$10,000

 

$10,000

$10,000

$20,000

Embedded Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$7,000

$7,000

$14,000

 

$14,000

$14,000

$28,000

Preventative Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$30 Copay

$50 Copay

20%*

 

50%*

50%*

50%*

Urgent Care Services

$75 copay, then 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 Room Services**

Emergency Medical Transportation**

$300 copay

20%*

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$50 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay

$30 Copay

$45 Copay

Not Covered

Mail Order 90 Day Supply

$30 Copay

$60 Copay

$90 Copay

Not Covered

* 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 844-610-2379