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

HSA Plan 1

In-Network

Out-of-Network

Embedded Deductible

Individual

Individual under Family

Family

 

$5,000

$5,000

$10,000

 

N/A

N/A

N/A

Embedded Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$5,000

$5,000

$10,000

 

N/A

N/A

N/A

Preventative Care Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractor Visit

 

0%*

0%*

0%*

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

0%*

Not Covered

Complex Imaging: MRI/CT/PET Scans

0%*

Not Covered

Hospital Services

Inpatient

Outpatient

 

0%*

0%*

 

Not Covered

Not Covered

Emergency Services**

Emergency Room Care

Emergency Medical Transportation

 

0%*

0%*

 

Not Covered

Not Covered

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

Not Covered

Not Covered

Teledoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

No Charge

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

No Charge

* Coinsurance After Deductible

** Covered as in-network in true-emergency

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

 

 

 

 

 

 

Copay Plan 1

In-Network

Out-of-Network

Embedded Deductible

Individual

Individual under Family

Family

 

$1,000

$1,000

$2,000

 

$2,000

$2,000

$4,000

Embedded Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$4,000

$4,000

$8,000

 

$8,500

$8,500

$17,000

Preventative Care Services

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractor Visit

 

$30 Copay

$50 Copay

$30 Copay

 

30%*

30%*

30%*

Urgent Care Services

$50 Copay

30%*

Complex Imaging: MRI/CT/PET Scans

$50 Copay

30%*

Hospital Services

Inpatient

Outpatient

 

20%*

20%*

 

30%*

30%*

Emergency Services**

Emergency Room Care

Emergency Medical Transportation

 

$200 Copay

$200 Copay

 

30%*

30%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$30 Copay

 

30%*

30%*

Teledoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

No Charge

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

No Charge

* Coinsurance After Deductible

** Covered as in-network in true-emergency

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

 

 

 

 

 

 

Copay Plan 2

In-Network

Out-of-Network

Embedded Deductible

Individual

Individual under Family

Family

 

$2,500

$2,500

$5,000

 

N/A

N/A

N/A

Embedded Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$7,150

$7,150

$14,300

 

N/A

N/A

N/A

Preventative Care Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractor Visit

 

$30 Copay

$50 Copay

$30 Copay

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

$50 Copay

Not Covered

Complex Imaging: MRI/CT/PET Scans

$150 Copay

Not Covered

Hospital Services

Inpatient

Outpatient

 

20%*

20%*

 

Not Covered

Not Covered

Emergency Services**

Emergency Room Care

Emergency Medical Transportation

 

$300 Copay

20%*

 

Not Covered

Not Covered

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$30 Copay

 

Not Covered

Not Covered

Teledoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

No Charge

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

No Charge

* Coinsurance After Deductible

** Covered as in-network in true-emergency

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

 

 

 

 

 

 

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