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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.


Summary of Medical Benefits

Minimum Essential Coverage Plan

In-Network

Out-of-Network

Calendar Year Deductible

Individual

Family

 

N/A

N/A

 

N/A

N/A

Out-of-Pocket Maximum

Individual

Family

 

N/A

N/A

 

N/A

N/A

Preventive Care Services

No Charge

No Coverage

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

No Coverage

No Coverage

No Coverage

 

No Coverage

No Coverage

No Coverage

Urgent Care Services

No Coverage

No Coverage

Inpatient Hospital Care

No Coverage

No Coverage

Outpatient Procedures

No Coverage

No Coverage

Emergency Room Services

Emergency Medical Transportation

No Coverage

No Coverage

No Coverage

No Coverage

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

No Coverage

No Coverage

 

No Coverage

No Coverage

Prescription Drug Coverage

Preventative

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

No Charge

No Coverage

No Coverage

No Coverage

No Coverage

Mail Order 90 Day Supply

No Charge

No Coverage

No Coverage

No Coverage

No Coverage

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

 

 

Minimum Essential Coverage Plus Plan

In-Network

Out-of-Network

Calendar Year Deductible

Individual

Family

 

N/A

N/A

 

N/A

N/A

Out-of-Pocket Maximum

Individual

Family

 

N/A

N/A

 

N/A

N/A

Preventive Care Services

No Charge

No Coverage

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$50 Copay

No Coverage

 

No Coverage

No Coverage

No Coverage

Urgent Care Services

$75 Copay

No Coverage

Inpatient Hospital Care

No Coverage

No Coverage

Outpatient Procedures

No Coverage

No Coverage

Emergency Room Services

Emergency Medical Transportation

No Coverage

No Coverage

No Coverage

No Coverage

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

No Coverage

$50 Copay

 

No Coverage

No Coverage

Labs/X-Rays/Diagnostic Services

Office Visit Lab

Outpatient Lab

Outpatient X-Ray

Outpatient Major Diagnostic

 

No Charge

$50 Copay

$100 Copay

No Coverage

 

No Coverage

No Coverage

No Coverage

No Coverage

Prescription Drug Coverage

Preventative

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

No Charge

$10 Copay

No Coverage

No Coverage

No Coverage

Mail Order 90 Day Supply

No Charge

No Coverage

No Coverage

No Coverage

No Coverage

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

 

 


If you prefer talking with a HealthEZ representative, call 844-302-7774