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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

Copay Plan 1 (Bronze)

In-Network

Out-of-Network

Deductible

Individual

Individual Under Family

Family

 

$5,000

$5,000

$10,000

 

$10,000

$10,000

$20,000

Out-of-Pocket Maximum

Individual

Individual Under Family

Family

 

$6,550

$6,550

$13,100

 

$10,000

$10,000

$20,000

Preventative Care

No Charge

20%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$35 Copay

$25 Copay

 

20%*

20%*

20%*

Urgent Care Services

$50 Copay

20%*

Complex Imaging: MRI/CT/PET

$200 Copay

20%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

20%*

20%*

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

20%*

20%*

Emergency Room

Emergency Medical Transportation

10%*

10%*

20%*

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

$25 Copay

 

20%*

20%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay

$30 Copay

$75 Copay

50% Coinsurance

Mail Order 90 Day Supply

$25 Copay

$75 Copay

$187.50 Copay

Not Available

Recuro Benefits

General Consultation

 

No Charge

 

No Charge

NOTE: * Coinsurance after deductible

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

 

 

 

 

Copay Plan 2 (Platinum)

In-Network

Out-of-Network

Deductible

Individual

Individual Under Family

Family

 

$0

$0

$0

 

$500

$1,500

$1,500

Out-of-Pocket Maximum

Individual

Individual Under Family

Family

 

$1,500

$1,500

$3,000

 

$3,000

$3,000

$6,000

Preventative Care

No Charge

40%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

No Charge

$10 Copay

$10 Copay

 

40%*

40%*

40%*

Urgent Care Services

$20 Copay

40%*

Complex Imaging: MRI/CT/PET

$50 Copay

40%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

$750 Copay

No Charge

 

40%*

40%*

Outpatient Procedures

Facility Fee

Physician Fee

 

$150 Copay

$750 Copay

 

40%*

40%*

Emergency Room

Emergency Medical Transportation

$500 Copay

No Charge

$500 Copay

No Charge

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

No Charge

$10 Copay

 

40%*

40%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay

$30 Copay

$75 Copay

50% Coinsurance

Mail Order 90 Day Supply

$25 Copay

$75 Copay

$187.50 Copay

Not Available

Recuro 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

 

 

 

 

Copay Plan 3 (Gold)

In-Network

Out-of-Network

Deductible

Individual

Individual Under Family

Family

 

$1,000

$1,000

$3,000

 

$3,000

$3,000

$6,000

Out-of-Pocket Maximum

Individual

Individual Under Family

Family

 

$3,500

$3,500

$7,000

 

$7,000

$7,000

$14,000

Preventative Care

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$10 Copay

$25 Copay

$25 Copay

 

50%*

50%*

50%*

Urgent Care Services

$20 Copay

50%*

Complex Imaging: MRI/CT/PET

$100 Copay*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

$100 Copay*

20%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

$500 Copay*

20%*

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$25 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay

$30 Copay

$75 Copay

50% Coinsurance

Mail Order 90 Day Supply

$25 Copay

$75 Copay

$187.50 Copay

Not Available

Recuro Benefits

General Consutlation

 

No Charge

 

No Charge

NOTE: * Coinsurance after deductible

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

 

 

 

 

Copay Plan 4 (Silver)

In-Network

Out-of-Network

Deductible

Individual

Individual Under Family

Family

 

$3,000

$3,000

$9,000

 

$6,000

$6,000

$18,000

Out-of-Pocket Maximum

Individual

Individual Under Family

Family

 

$6,350

$6,350

$12,700

 

$15,000

$15,000

$30,000

Preventative Care

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$10 Copay

$25 Copay

$10 Copay

 

50%*

50%*

50%*

Urgent Care Services

$50 Copay

50%*

Complex Imaging: MRI/CT/PET

$200 Copay*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

$300 Copay*

20%*

 

50%*

50%*

Emergency Room

Emergency Medical Transportation

$500 Copay*

20%*

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$10 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$10 Copay

$30 Copay

$75 Copay

50% Coinsurance

Mail Order 90 Day Supply

$25 Copay

$75 Copay

$187.50 Copay

Not Available

Recuro 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 855-255-7060