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

$6,000 Elite HSA Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$6,000

$12,000

 

N/A

N/A

Out-of-Pocket Maximum

Individual

Family

 

$6,000

$12,000

 

N/A

N/A

Preventive Care Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

0%*

Not Covered

Complex Imaging: MRI/CT/PET Scans

0%*

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

Not Covered

Not Covered

Emergency Room

Emergency Medical Transportation

0%*

0%*

0%*

0%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

Not Covered

Not Covered

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$0 Copay After Deductible

$0 Copay After Deductible

$0 Copay After Deductible

Not Covered

Mail Order 90 Day Supply

$0 Copay After Deductible

$0 Copay After Deductible

$0 Copay After Deductible

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Therapist

Psychiatrist, Initial Evaluation

Psychiatrist, Ongoing Session

 

$30 Copay

$30 Copay

$30 Copay

$30 Copay

$30 Copay

 

 

 

 

 

 

NOTE: * Coinsurance After Deductible

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

 

 

 

 

$5,000 Elite HRA Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$5,000

$10,000

 

N/A

N/A

Out-of-Pocket Maximum

Individual

Family

 

$5,000

$10,000

 

N/A

N/A

Preventive Care Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

0%*

Not Covered

Complex Imaging: MRI/CT/PET Scans

0%*

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

Not Covered

Not Covered

Emergency Room

Emergency Medical Transportation

0%*

0%*

0%*

0%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

Not Covered

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Therapist

Psychiatrist, initial evaluation

Psychiatrist, ongoing session

 

$30 Copay

$30 Copay

$30 Copay

$30 Copay

$30 Copay

 

 

 

 

 

 

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay

$45 Copay

$80 Copay

Not Covered

Mail Order 90 Day Supply

$37.50 Copay

$112.50 Copay

$200 Copay

Not Covered

NOTE: * Coinsurance After Deductible

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

 

 

 

 

$6,000 America’s PPO HSA Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$6,000

$12,000

 

$6,000

$12,000

Out-of-Pocket Maximum

Individual

Family

 

$6,000

$12,000

 

$6,000

$12,000

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

 

0%*

 

 

50%*

 

Teladoc Benefits

General Consultations

Dermatology

Therapist

Psychiatrist, Initial Evaluation

Psychiatrist, Ongoing Session

 

$30 Copay

$30 Copay

$30 Copay

$30 Copay

$30 Copay

 

 

 

 

 

 

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$0 Copay after Deductible

$0 Copay after Deductible

$0 Copay after Deductible

Not Covered

Mail Order 90 Day Supply

$0 Copay after Deductible

$0 Copay after Deductible

$0 Copay after Deductible

Not Covered

NOTE: * Coinsurance After Deductible

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

 

 

 

 

$5,000 America’s PPO HRA Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$5,000

$10,000

 

$7,500

$15,000

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

 

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%*

Teladoc Benefits

General Consultations

Dermatology

Therapist

Psychiatrist, Initial Evaluation

Psychiatrist, Ongoing Session

 

$30 Copay

$30 Copay

$30 Copay

$30 Copay

$30 Copay

 

 

 

 

 

 

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay

$45 Copay

$80 Copay

Not Covered

Mail Order 90 Day Supply

$37.50 Copay

$112.50 Copay

$200 Copay

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 866-490-6174