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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

$3,000 PPO Plan

Tier 1

Tier 2

Out of Network

Deductible

Individual

Family

 

$1,000

$2,000

 

$3,000

$6,000

 

$6,000

$12,000

Out-of-Pocket Maximum

Individual

Family

 

$6,250

$12,500

 

$6,250

$12,500

 

$12,500

$25,000

Preventive Care Services

No Charge

No Charge

50%*

Office Visits

Primary Office Visit


Specialist Office Visit

Chiropractic Visit

 

ACCH: No Charge,

MO COOP: $5 Copay

$10 Copay

$10 Copay

 

$25 Copay

 

$45 Copay

$45 Copay

 

50%*

 

50%*

50%*

Urgent Care Services

$10 Copay

$50 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

10%*

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

20%*

20%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

$100 Copay

20%*

$350 Copay

20%*

50%*

50%*

Mental Health & Chemical Dependency


Inpatient


Office Visit

 


0%*


ACCH: No Charge

MO COOP: $5 Copay

 

 

20%*

 

$25 Copay

 

 

 

50%*

 

50%*

 

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Domestic 30 Day/90 Day Supply

No Charge

No Charge

No Charge

$150 Copay/Not Covered

Non-Domestic 30 Day

$5 Copay

$20 Copay

$40 Copay

$150 Copay

Non-Domestic 90 Day

$12.50 Copay

$50 Copay

$100 Copay

Not Covered

Teladoc Benefits

General Consultations

 

No Charge

 

No Charge

 

No Charge

NOTE: * Coinsurance After Deductible

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

 

 

 

 

 

 

$1,500 PPO Plan

Tier 1

Tier 2

Out of Network

Deductible

Individual

Family

 

$500

$1,000

 

$1,500

$3,000

 

$3,000

$6,000

Out-of-Pocket Maximum

Individual

Family

 

$6,250

$12,500

 

$6,250

$12,500

 

$12,500

$25,000

Preventive Care Services

No Charge

No Charge

50%*

Office Visits

Primary Office Visit


Specialist Office Visit

Chiropractic Visit

 

ACCH: No Charge,

MO COOP: $5 Copay

$10 Copay

$10 Copay

 

$25 Copay

 

$30 Copay

$30 Copay

 

50%*

 

50%*

50%*

Urgent Care Services

$10 Copay

$50 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

10%*

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

20%*

20%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

$100 Copay

20%*

$350 Copay

20%*

50%*

50%*

Mental Health & Chemical Dependency


Inpatient


Office Visit

 


0%*


ACCH: No Charge

MO COOP: $5 Copay

 

 

20%*

 

$25 Copay

 

 

 

50%*

 

50%*

 

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Domestic 30 Day/90 Day Supply

No Charge

No Charge

No Charge

$150 Copay/Not Covered

Non-Domestic 30 Day

$5 Copay

$20 Copay

$40 Copay

$150 Copay

Non-Domestic 90 Day

$12.50 Copay

$50 Copay

$100 Copay

Not Covered

Teladoc Benefits

General Consultations

 

No Charge

 

No Charge

 

No Charge

NOTE: * Coinsurance After Deductible

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

 

 

 

 

 

 

$5,000 HSA Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$5,000

$10,000

 

$10,000

$20,000

Out-of-Pocket Maximum

Individual

Family

 

$5,000

$10,000

 

$20,000

$40,000

Preventive Care 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

Emergency Medical Transportation

0%*

0%*

0%*

0%*

Mental Health & Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

0%*

0%*

0%*

0%*

Mail Order 90 Day Supply

0%*

0%*

0%*

Not Covered

Teladoc Benefits

General Consultations

 

No Charge

 

No Charge

NOTE: * Coinsurance After Deductible

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

 

 

 

 

If you prefer talking with a HealthEZ representative, call 844-302-7771