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

$5,500 HSA Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$5,500

$11,000

 

$11,000

$22,000

Out-of-Pocket Maximum

Individual

Family

 

$8,300

$16,600

 

$16,600

$33,200

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

25%*

25%*

25%*

 

50%*

50%*

50%*

Urgent Care Services

25%*

25%*

Complex Imaging: MRI/CT/PET Scans

25%*

25%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

25%*

25%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

25%*

25%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

25%*

25%*

25%*

25%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

25%*

25%*

 

50%*

50%*

Prescription Drug Coverage

Expanded Preventive - Generic

Expanded Preventive - Preferred Brand

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

No Charge

No Charge

25%*

25%*

25%*

Not Covered

Mail Order 90 Day Supply

No Charge

No Charge

25%*

25%*

25%*

Not Covered

NOTE: * Coinsurance After Deductible

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

 

 

 

 

$3,300 HSA Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$3,300

$6,600

 

$6,600

$13,200

Out-of-Pocket Maximum

Individual

Family

 

$6,600

$13,200

 

$13,200

$26,400

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

25%*

25%*

25%*

 

50%*

50%*

50%*

Urgent Care Services

25%*

25%*

Complex Imaging: MRI/CT/PET Scans

25%*

25%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

25%*

25%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

25%*

25%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

25%*

25%*

25%*

25%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

25%*

25%*

 

50%*

50%*

Prescription Drug Coverage

Expanded Preventive - Generic

Expanded Preventive - Preferred Brand

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

No Charge

No Charge

25%*

25%*

25%*

Not Covered

Mail Order 90 Day Supply

No Charge

No Charge

25%*

25%*

25%*

Not Covered

NOTE: * Coinsurance After Deductible

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

 

 

 

 

$2,500 HSA Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$2,500

$5,000

 

$5,000

$10,000

Out-of-Pocket Maximum

Individual

Family

 

$5,000

$10,000

 

$10,000

$20,000

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

25%*

25%*

25%*

 

50%*

50%*

50%*

Urgent Care Services

25%*

25%*

Complex Imaging: MRI/CT/PET Scans

25%*

25%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

25%*

25%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

25%*

25%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

25%*

25%*

25%*

25%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

25%*

25%*

 

50%*

50%*

Prescription Drug Coverage

Expanded Preventive - Generic

Expanded Preventive - Preferred Brand

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

No Charge

No Charge

25%*

25%*

25%*

Not Covered

Mail Order 90 Day Supply

No Charge

No Charge

25%*

25%*

25%*

Not Covered

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 844-302-7772