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

PPO Plan

In-Network

Out-Of-Network

Deductible

Individual

Family

 

$1,500

$4,500

 

$4,500

$9,000

Out-Of-Pocket Maximum

Individual

Family

 

$3,750

$7,500

 

$13,500

$27,000

Preventive Care

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$50 Copay

$100 Copay

30%*

 

50%*

50%*

50%*

Urgent Care Services

$150 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

30%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

30%*

30%*

 

50%*

50%*

Outpatient Procedure

Facility Fee

Physician Fee

 

30%*

30%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

$250 Copay

30%*

50%*

50%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

30%*

$100 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

$12 copay

$45 copay

$90 copay

20% coinsurance, $200 maximum

 

$24 copay

$90 copay

$180 copay

Not Available

Note: * Coinsurance after deductible

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

 

 

 

 

HSA 1 Plan

In-Network

Out-Of-Network

Deductible

Individual

Individual Under Family Coverage

Family

 

$2,500

$3,400

$5,000

 

$5,000

$5,000

$10,000

Out-Of-Pocket Maximum

Individual

Individual Under Family Coverage

Family

 

$5,000

$5,000

$10,000

 

$10,000

$10,000

$20,000

Preventive Care

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 Procedure

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

20%*

20%*

50%*

50%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

20%*

20%*

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

$12 copay*

$45 copay*

$90 copay*

20%*

 

$24 copay*

$90 copay*

$180 copay*

Not Available

Note: * Coinsurance after deductible

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

 

 

 

 

HSA 2 Plan

In-Network

Out-Of-Network

Deductible

Individual

Family

 

$3,500

$7,000

 

$5,000

$10,000

Out-Of-Pocket Maximum

Individual

Family

 

$7,000

$14,000

 

$10,000

$20,000

Preventive Care

100% Covered

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 Procedure

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

$250 Copay

20%*

50%*

50%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

20%*

20%*

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

$12 copay*

$45 copay*

$90 copay*

20%*

 

$24 copay*

$90 copay*

$180 copay*

Not Available

Note: * Coinsurance after deductible

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

 

 

 

 


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