Your healthcare coverage is important to us. 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. This summary will help you understand your plan and its coverage.
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Summary Of Medical Benefits
Copay Plan
In-Network
Out-Of-Network
Calendar Year Deductible
Employee Only
Family
$2,000
$4,000
$3,000
$6,000
Coinsurance
20%
40%
Out-Of-Pocket Maximum
$12,000
$11,000
$22,000
Preventive Care
100% Covered
40%*
Office Visits
Primary Services
Specialist Services
$25 Copay
Hospital Services
20%*
Emergency Services**
Emergency Room
Emergency Medical Transportation
$250 Copay
Urgent Care Services
Chiropractic Services
Mental Health / Chemical Dependency
Inpatient
Outpatient
Retail 30 Day Supply
Mail Order 90 day Supply
Prescription Drug Coverage
Generic
Preferred brand
Non-preferred brand
Specialty
$10 Copay
$35 Copay
$70 Copay
$10/ $35/ $70 Copay
$30 Copay
$105 Copay
$210 Copay
Not Available
* After deductible
** True emergencies covered at in-network level
If you prefer talking with a HealthEZ representative, call 1-844-801-1913