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

Copay Plan 1

In-Network

Out-of-Network

Calendar Year Deductible

Individual

Individual under Family

Family

 

$250

$250

$500

 

$2,000

$2,000

$4,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$2,000

$2,000

$4,000

 

$6,000

$6,000

$12,000

Preventative Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$25 Copay

$25 Copay

 

50%*

50%*

50%*

Urgent Care Services

$50 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

$250 Copay

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

50%*

50%*

Emergency Room Services**

Emergency Medical Transportation**

$150 Copay

10%*

$150 Copay

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

$25 Copay

 

50%*

50%*

Teladoc Services

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

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

 

 

 

 

Copay Plan 2

In-Network

Out-of-Network

Calendar Year Deductible

Individual

Individual under Family

Family

 

$1,500

$1,500

$3,000

 

$4,500

$4,500

$9,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$5,000

$5,000

$10,000

 

$9,000

$9,000

$18,000

Preventative Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$30 Copay

$50 Copay

20%*

 

50%*

50%*

50%*

Urgent Care Services

$75 Copay

50%*

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**

$300 Copay

20%*

$300 Copay

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$50 Copay

 

50%*

50%*

Teladoc Services

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

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

 

 

 

 

Copay Plan 3

In-Network

Out-of-Network

Calendar Year Deductible

Individual

Individual under Family

Family

 

$3,500

$3,500

$7,000

 

$10,000

$10,000

$20,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$6,500

$6,500

$13,000

 

$15,000

$15,000

$30,000

Preventative Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$35 Copay

$65 Copay

20%*

 

50%*

50%*

50%*

Urgent Care Services

$75 Copay

50%*

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**

$300 Copay

20%*

$300 Copay

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$65 Copay

 

50%*

50%*

Teladoc Services

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

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

 

 

 

 

HSA Plan 1

In-Network

Out-of-Network

Calendar Year Deductible

Individual

Individual under Family

Family

 

$3,000

$3,300

$6,000

 

$6,000

$6,000

$12,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$4,500

$4,500

$9,000

 

$10,000

$10,000

$20,000

Preventative Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

20%*

20%*

20%*

 

50%*

50%*

50%*

Urgent Care Services

20%*

50%*

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%*

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

20%*

 

50%*

50%*

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$25 Copay

$25 Copay

$25 Copay

$25 Copay

$25 Copay

 

$25 Copay

$25 Copay

$25 Copay

$25 Copay

$25 Copay

* Coinsurance after deductible

 

 

** Covered as in-network in true-emergency

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

 

 

 

 

HSA Plan 2

In-Network

Out-of-Network

Calendar Year Deductible

Individual

Individual under Family

Family

 

$6,000

$6,000

$12,000

 

$12,000

$12,000

$24,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$6,000

$6,000

$12,000

 

$18,000

$18,000

$36,000

Preventative Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

50%*

50%*

50%*

Urgent Care Services

0%*

50%*

Complex Imaging: MRI/CT/PET Scans

0%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

50%*

50%*

Emergency Room Services**

Emergency Medical Transportation**

0%*

0%*

0%*

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

50%*

50%*

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$25 Copay

$25 Copay

$25 Copay

$25 Copay

$25 Copay

 

$25 Copay

$25 Copay

$25 Copay

$25 Copay

$25 Copay

* Coinsurance after deductible

 

 

** Covered as in-network in true-emergency

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

 

 

 

 

MEC Plus Plan

In-Network

Out-of-Network

Calendar Year Deductible

Individual

Family

 

N/A

N/A

 

N/A

N/A

Out-of-Pocket Maximum

Individual

Family

 

N/A

N/A

 

N/A

N/A

Preventative Services

No Charge

No Coverage

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$50 Copay

No Coverage

 

No Coverage

No Coverage

No Coverage

Urgent Care Services

$75 Copay

No Coverage

Complex Imaging: MRI/CT/PET Scans

No Coverage

No Coverage

Inpatient Hospital Care

Facility Fee

Physician Fee

 

No Coverage

No Coverage

 

No Coverage

No Coverage

Outpatient Procedures

Facility Fee

Physician Fee

 

No Coverage

No Coverage

 

No Coverage

No Coverage

Emergency Room Services

Emergency Medical Transportation

No Coverage

No Coverage

No Coverage

No Coverage

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

No Coverage

$50 Copay

 

No Coverage

No Coverage

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

$55 Copay

$85 Copay

$90 Copay

$220 Copay

$100 Copay

 

$55 Copay

$85 Copay

$90 Copay

$220 Copay

$100 Copay

* Coinsurance after deductible

 

 

** Covered as in-network in true-emergency

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

 

 

 

 

If you prefer talking with a HealthEZ representative, call 844-613-5259