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

$500 Copay Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$500

$1,000

 

$1,500

$3,000

Coinsurance

10%

50%

Out-Of-Pocket Maximum

Employee Only

Family

 

$1,500

$3,000

 

$3,000

$6,000

Preventive Care

100% Covered

No Coverage

Physician Services

Primary

Specialist

 

$25 Copay

$35 Copay

 

50%*

50%*

Hospital Services Inpatients & Outpatient Care

10%*

50%*

Emergency Services

$150 Copay

$150 copay

Urgent Care Services

$50 Copay

50%

Chiropractic Services

$40 Copay

50%*

Mental health/Chemical Dependency

Inpatient

Outpatient

 

10%*

$35 Copay

 

50%*

50%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty (Mail order available for a 30 day supply

 

$5 Copay

$15 Copay

$30 Copay

25%*

 

$10 Copay

$30 Copay

$60 Copay

Not Available

*After Deductible

 

 

$1,000 Copay Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$1,000

$2,000

 

$3,000

$6,000

Coinsurance

20%

50%

Out-Of-Pocket Maximum

Employee Only

Family

 

$5,000

$10,000

 

$10,000

$20,000

Preventive Care

100% Covered

No Coverage

Physician Services

Primary

Specialist

 

$30 Copay

$40 Copay

 

50%*

50%*

Hospital Services Inpatients & Outpatient Care

20%*

50%*

Emergency Services

$200 Copay

$200 Copay

Urgent Care Services

$75 copay

50%*

Chiropractic Services

$45 Copay

50%*

Mental health/Chemical Dependency

Inpatient

Outpatient Office Visits

 

20%*

$40 Copay

 

50%*

50%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Formulary

Non-Formulary

Specialty (Mail order available for a 30 day supply)

 

$5 Copay

$25 Copay

$45 Copay

25%*

 

$10 Copay

$50 Copay

$90 Copay

Not Available

*After Deductible

 

 

$1,500 HSA Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Individual on Family Plan

Family

 

$1,500

$2,700

$3,000

 

$3,250

$3,250

$6,250

Coinsurance

20%

50%

Out-Of-Pocket Maximum

Employee Only

Family

 

$5,000

$8,000

 

$10,000

$20,000

Preventive Care

100% Covered

No Coverage

Physician Services

20%*

50%*

Hospital Services Inpatients & Outpatient Care

20%*

50%*

Emergency Services

20%*

50%*

Urgent Care Services

20%*

50%*

Chiropractic Services

20%*

50%*

Mental health/Chemical Dependency

20%*

50%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty (Available for 30 day mail order)

 

20%*

20%*

20%*

20%*

 

20%*

20%*

20%*

Not Available

*After Deductible

 

 

$2,700 HSA Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$2,700

$5,300

 

$5,350

$10,650

Coinsurance

20%

50%

Out-Of-Pocket Maximum

Employee Only

Family

 

$5,000

$8,000

 

$10,000

$20,000

Preventive Care

100% Covered

No Coverage

Physician Services

20%*

50%*

Hospital Services Inpatients & Outpatient Care

20%*

50%*

Emergency Services

20%*

50%*

Urgent Care Services

20%*

50%*

Chiropractic Services

20%*

50%*

Mental health/Chemical Dependency

20%*

50%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty (Available for 30 day mail order)

 

20%*

20%*

20%*

20%*

 

20%*

20%*

20%*

Not Available

*After Deductible

 

 

$1,500 Dental Plan Benefit

In-Network

Out-Of-Network

Deductible

Employee Only

Family

 

$50

$150

 

$50

$150

Annual Maximum

Non-Orthodontics

Orthodontics

 

$1,500/person/year

$1,500/person/lifetime

 

$1,500/person/year

$1,500/person/lifetime

Preventive Health Care

No Member Responsibility

No Member Responsibility

Diagnostic Services

No Member Responsibility

No Member Responsibility

Basic Dental Services

20%*

20%*

Major Dental Services

50%*

50%*

Orthodontic Services

50%*

50%*

*After Deductible

 

 

$2,500 Dental Plan Benefit

In-Network

Out-Of-Network

Deductible

Employee Only

Family

 

$50

$150

 

$50

$150

Annual Maximum

Non-Orthodontics

Orthodontics

 

$2,500/person/year

$2,500/person/lifetime

 

$2,500/person/year

$2,500/person/lifetime

Preventive Health Care

No Member Responsibility

No Member Responsibility

Diagnostic Services

No Member Responsibility

No Member Responsibility

Basic Dental Services

10%*

10%*

Major Dental Services

30%*

30%*

Orthodontic Services

20%*

20%*

*After Deductible

 

 

Contact your HR rep to choose your plan.

If you prefer talking with a HealthEZ representative, call 1-844-288-5703