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.

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Summary of Medical Benefits

PPO 10

In-Network

Out-of-Network

Embedded Deductible

Individual Coverage

Family Coverage

 

$4,000

$8,000

 

$5,000

$10,000

Embedded Out-of-Pocket Maximum

Individual Coverage

Family Coverage

 

$7,000

$14,000

 

$15,000

$30,000

Preventive Care Services

No Charge

50% Coinsurance

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

$20 Copay

$50 Copay

20%*

50%*

50%*

50%*

Urgent Care Services

$40 Copay

50% Coinsurance*

Complex Imaging: MRI/CT/PET Scans

30%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

30%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

30%*

30%*

 

50%*

50%*

Emergency Room Services

Emergency Medical Transportation

30%*

No Charge

$300 Copay*

0%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

30%*

$20 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay

$25 Copay

50% Coinsurance

$200 Copay

Mail Order 90 Day Supply

$20 Copay

$50 Copay

50% Coinsurance

Not Covered

* After Deductible

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

 

 

 

 

HDHP 5

In-Network

Out-of-Network

Embedded Deductible

Individual Coverage

Family Coverage

 

$6,900

$13,800

 

$10,000

$20,000

Embedded Out-of-Pocket Maximum

Individual Coverage

Family Coverage

 

$7,000

$14,000

 

$15,000

$30,000

Preventive Care Services

No Charge

50% Coinsurance

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

20%*

20%*

20%*

50%*

50%*

50%*

Urgent Care Services

20%*

50% Coinsurance*

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

20%*

20%*

20%*

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

20%*

 

50%*

50%*

Prescription Drug Coverage

Expanded Preventative - Generic

Expanded Preventative - Preferred Brand

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

20%*

20%*

20%*

20%*

50% Coinsurance

50%*

Mail Order 90 Day Supply

20%*

20%*

20%*

20%*

50% Coinsurance

Not Covered

* After deductible

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

 

 

 

 

If you prefer talking with a HealthEZ representative, call 855-255-7060