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

$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