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. If you prefer talking with a HealthEZ representative, call 844-855-0621.
service@healthez.com
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Summary Of Medical Benefits
PPO (Copay 1) Plan
In-Network
Out-Of-Network
Calendar Year Deductible
Individual
Individual under Family
Family
$750
$1,500
Out-of-Network
$1,000
$2,000
Coinsurance
20%
30%
Out-Of-Pocket Maximum
$4,000
$8,000
Preventive Care
100% Covered
30%*
Office Visits
Primary Services
Specialist Services
Chiropractic Services
$40 Copay
$70 Copay
Hospital Services
20%*
Emergency Services**
Emergency Room
Emergency Medical Transportation
$200 Copay
Urgent Care Services
Mental Health / Chemical Dependency
Inpatient
Outpatient
First 12 visits are no charge, then $70 Copay
Prescription Drug Coverage
Generic
Preferred brand
Non-preferred brand
Specialty
Retail 30 Day Supply
$15 Copay
$35 Copay
$75 Copay
$15 / $35 / $75 Copay
Mail Order 90 day Supply
$37.50
$87.50
$187.50
Not Available
* After deductible
Note: Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions.
** True emergencies covered at in-network level
HDHP (HSA 1) Plan
$3,000
$6,000
10%
$9,000
10%*
$15 Copay*
$35 Copay*
$75 Copay*
$15 / $35 / $75 Copay*
$37.50*
$87.50*
$187.50*
If you prefer talking with a HealthEZ representative, call 844-855-0621