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

$750 Copay Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$750

$1,500

 

$3,000

$6,000

Out-Of-Pocket Maximum

Employee Only

Family

 

$3,000

$5,000

 

$6,000

$12,000

Preventive Care

100% Covered

No Coverage

Office Visits

Primary

Specialist

Chiropractic

 

$30 Copay

$60 Copay

$60 Copay

 

50%*

50%*

50%*

Hospital Services Inpatients & Outpatient Care

10%*

50%*

Emergency Services

Emergency Medical Transportation

$350 Copay

0%*

$350 Copay

0%*

Urgent Care Services

$100 Copay

50%*

Mental health/Chemical Dependency

Inpatient

Outpatient Office Visits

 

10%*

$60 Copay

 

50%*

50%*

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

$20 Copay

$20 Copay

$20 Copay

$20 Copay

$20 Copay

 

$20 Copay

$20 Copay

$20 Copay

$20 Copay

$20 Copay

Prescription Drug Coverage

Generic

Formulary

Non-Formulary

Specialty (Mail order available for a 30 day supply)

Retail 30 Day Supply

$10 Copay

$20 Copay

$40 Copay

25%*

Mail Order 90 day Supply

$20 Copay

$40 Copay

$80 Copay

Not available

*After Deductible

 

 

$1,250 Copay Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$1,250

$2,500

 

$4,000

$8,000

Out-Of-Pocket Maximum

Employee Only

Family

 

$6,000

$11,000

 

$10,000

$20,000

Preventive Care

100% Covered

No Coverage

Office Visits

Primary

Specialist

Chiropractic

 

$40 Copay

$75 Copay

$75 Copay

 

50%*

50%*

50%*

Hospital Services Inpatients & Outpatient Care

20%*

50%*

Emergency Services

Emergency Medical Transportation

$350 Copay

20%*

$350 Copay

20%*

Urgent Care Services

$100 Copay

50%*

Mental health/Chemical Dependency

Inpatient

Outpatient Office Visits

 

20%*

$75 Copay

 

50%*

50%*

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

$30 Copay

$30 Copay

$30 Copay

$30 Copay

$30 Copay

 

$30 Copay

$30 Copay

$30 Copay

$30 Copay

$30 Copay

Prescription Drug Coverage

Generic

Formulary

Non-Formulary

Specialty (Mail order available for a 30 day supply)

Retail 30 Day Supply

$10 Copay

$30 Copay

$60 Copay

25%*

Mail Order 90 day Supply

$20 Copay

$60 Copay

$120 Copay

Not available

*After Deductible

 

 

$1,600 HSA Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$1,600

$3,200

 

$3,200

$6,400

Out-Of-Pocket Maximum

Employee Only

Family

 

$6,000

$9,000

 

$10,000

$20,000

Preventive Care

100% Covered

No Coverage

Office Visits

Primary

Specialist

Chiropractic

 

20%*

20%*

20%*

 

50%*

50%*

50%*

Hospital Services Inpatients & Outpatient Care

20%*

50%*

Emergency Services

Emergency Medical Transportation

20%*

20%*

50%*

50%*

Urgent Care Services

20%*

50%*

Mental health/Chemical Dependency

20%*

50%*

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

$55 Copay until Deductible is met, then 100% Covered

$85 Copay until deductible is met, then 20% coinsurance

$90 Copay until deductible is met, then 20% coinsurance

$220 Copay until deductible is met, then 20% coinsurance

$100 Copay until deductible is met, then 20% coinsurance

 

$55 Copay until Deductible is met, then 100% Covered

$85 Copay until deductible is met, then 20% coinsurance

$90 Copay until deductible is met, then 20% coinsurance

$220 Copay until deductible is met, then 20% coinsurance

$100 Copay until deductible is met, then 20% coinsurance

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty (Available for 30 day mail order)

Retail 30 Day Supply

20%*

20%*

20%*

20%*

Mail Order 90 day Supply

20%*

20%*

20%*

Not available

*After Deductible

 

 

$3,200 HSA Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$3,200

$6,400

 

$6,400

$12,800

Out-Of-Pocket Maximum

Employee Only

Family

 

$6,000

$9,000

 

$10,000

$20,000

Preventive Care

100% Covered

No Coverage

Office Visits

Primary

Specialist

Chiropractic

 

20%*

20%*

20%*

 

50%*

50%*

50%*

Hospital Services Inpatients & Outpatient Care

20%*

50%*

Emergency Services

Emergency Medical Transportation

20%*

20%*

50%*

50%*

Urgent Care Services

20%*

50%*

Mental health/Chemical Dependency

20%*

50%*

HealthiestYou Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

$55 Copay until Deductible is met, then 100% Covered

$85 Copay until deductible is met, then 20% coinsurance

$90 Copay until deductible is met, then 20% coinsurance

$220 Copay until deductible is met, then 20% coinsurance

$100 Copay until deductible is met, then 20% coinsurance

 

$55 Copay until Deductible is met, then 100% Covered

$85 Copay until deductible is met, then 20% coinsurance

$90 Copay until deductible is met, then 20% coinsurance

$220 Copay until deductible is met, then 20% coinsurance

$100 Copay until deductible is met, then 20% coinsurance

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

100% Covered

100% Covered

Diagnostic Services

100% Covered

100% Covered

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 (Up to Age 19)

Orthodontics (Adults)

 

$2,500/person/year

$2,500/person/year

$1,000/person/lifetime

 

$2,500/person/year

$2,500/person/year

$1,000/person/lifetime

Preventive Health Care

100% Covered

100% Covered

Diagnostic Services

100% Covered

100% Covered

Basic Dental Services

10%*

10%*

Major Dental Services

20%*

20%*

Orthodontic Services

20%*

20%*

*After Deductible

 

 


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