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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

PPO 6500 (Copay 1)

In-Network

Out-of-Network

Plan Year Accumulation

Embedded Deductible

Individual

Individual under Family

Family

 

 

$6,500

$6,500

$13,000

 

 

$19,500

$19,500

$39,000

Coinsurance

45%

55%

Embedded Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$8,550

$8,550

$17,100

 

$25,650

$25,650

$51,300

Recuro Telemedicine Services

100% Covered

100% Covered

Preventive Care

100% Covered

55% Coinsurance

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

$20 Copay

$70 Copay

$20 Copay

 

55%* After Deductible

55%* After Deductible

55%* After Deductible

Urgent Care Services

$100 Copay

55%* After Deductible

Emergency Services

Emergency Room

Emergency Medical Transportation

 

45%* After Deductible

45%* After Deductible

 

45%* After Deductible

45%* After Deductible

Hospital Services

Inpatient Hospital Facility

Outpatient Surgery

 

45%* After Deductible

45%* After Deductible

 

55%* After Deductible

55%* After Deductible

Complex Imaging: MRI/CT/PET Scans

45%* After Deductible

55%* After Deductible

Mental Health/Chemical Dependency

Inpatient

Outpatient

 

45%* After Deductible

$20 Copay

 

55%* After Deductible

55%* After Deductible

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$10 Copay

$45 Copay

$90 Copay

25% Coinsurance

Mail Order 90 Day Supply

$25 Copay

$112.50 Copay

$225 Copay

Not Available

* Coinsurance

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

 

 

 

 

PPO 7000 (Copay 2)

In-Network

Out-of-Network

Plan Year Accumulation

Embedded Deductible

Individual

Individual under Family

Family

 

 

$7,000

$7,000

$14,000

 

 

$21,000

$21,000

$42,000

Coinsurance

45%

55%

Embedded Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$8,550

$8,550

$17,100

 

$25,650

$25,650

$51,300

Recuro Telemedicine Services

100% Covered

100% Covered

Preventive Care

100% Covered

55% Coinsurance

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

$40 Copay

$65 Copay

$65 Copay

 

55%* After Deductible

55%* After Deductible

55%* After Deductible

Urgent Care Services

$100 Copay

55%* After Deductible

Emergency Services

Emergency Room

Emergency Medical Transportation

 

$500 Copay

45%* After Deductible

 

$500 Copay

45%* After Deductible

Hospital Services

Inpatient Hospital Facility

Outpatient Surgery

 

$500 Copay

50%* After Deductible

 

55%* After Deductible

55%* After Deductible

Complex Imaging: MRI/CT/PET Scans

$500 Copay

55%* After Deductible

Mental Health/Chemical Dependency

Inpatient

Outpatient

 

45%* After Deductible

$40 Copay

 

55%* After Deductible

55%* After Deductible

Prescription Drug Coverage

Prescription Deductible

Individual

Family

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

 

$250

$500

$10 Copay

$45 Copay

$90 Copay

25% Coinsurance

Mail Order 90 Day Supply

 

$250

$500

$25 Copay

$112.50 Copay

$225 Copay

Not Available

* Coinsurance

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

 

 

 

 

PPO 5000 (Copay 3)

In-Network

Out-of-Network

Plan Year Accumulation

Embedded Deductible

Individual

Individual under Family

Family

 

 

$5,000

$5,000

$10,000

 

 

$15,000

$15,000

$30,000

Coinsurance

30%

50%

Embedded Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$6,500

$6,500

$13,000

 

$19,500

$19,500

$39,000

Recuro Telemedicine Services

100% Covered

100% Covered

Preventive Care

100% Covered

50% Coinsurance

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

$35 Copay

$50 Copay

$50 Copay

 

50%* After Deductible

50%* After Deductible

50%* After Deductible

Urgent Care Services

$100 Copay

50%* After Deductible

Emergency Services

Emergency Room

Emergency Medical Transportation

 

$500 Copay

30%* After Deductible

 

$500 Copay

30%* After Deductible

Hospital Services

Inpatient Hospital Facility

Outpatient Surgery

 

30%* After Deductible

30%* After Deductible

 

50%* After Deductible

50%* After Deductible

Complex Imaging: MRI/CT/PET Scans

$500 Copay

50%* After Deductible

Mental Health/Chemical Dependency

Inpatient

Outpatient

 

30%* After Deductible

$35 Copay

 

50%* After Deductible

50%* After Deductible

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$10 Copay

$45 Copay

$90 Copay

25% Coinsurance

Mail Order 90 Day Supply

$25 Copay

$112.50 Copay

$225 Copay

Not Available

* Coinsurance

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

 

 

 

 

If you prefer talking with a HealthEZ representative, call 855-255-7060