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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

HSA Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual Coverage

Individual Under Coverage with Dependent

Family

 

$1,600

$3,200

$3,200

 

N/A

N/A

N/A

Coinsurance

20%

Not Covered

Out-Of-Pocket Maximum

Individual Coverage

Individual Under Coverage with Dependent

Family

 

$2,500

$3,200

$8,050

 

N/A

N/A

N/A

Preventive Care

100% Covered

Not Covered

Office Visits

Primary Services

Specialist Services

 

20%*

20%*

 

Not Covered

Not Covered

Hospital Services Inpatients & Outpatient Care

20%*

Not Covered

Emergency Services

20%*

Not Covered

Urgent Care Services

20%*

Not Covered

Chiropractic Services

20%*

Not Covered

Mental health/Chemical Dependency

Inpatient

Outpatient

 

20%*

20%*

 

Not Covered

Not Covered

 

 

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

Retail 30 Day Supply

No Charge

No Charge

No Charge

No Charge

No Charge

Mail Order 90 day Supply

No Charge

No Charge

No Charge

No Charge

No Charge

Prescription Drug Coverage

Generic

Formulary

Non-Formulary

Specialty

 

20%*

20%*

20%*

Not Covered

 

20%*

20%*

20%*

Not Covered

*After Deductible

 

 

Copay Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual Coverage

Family

 

$500

$1,500

 

N/A

N/A

Coinsurance

20%

N/A

Out-Of-Pocket Maximum

Individual Coverage

Family

 

$5,000

$10,000

 

N/A

N/A

Preventive Care

100% Covered

Not Covered

Office Visits

Primary Services

Specialist Services

 

$25 Copay

$40 Copay

 

Not Covered

Not Covered

Hospital Services Inpatients & Outpatient Care

20%*

Not Covered

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$350 Copay*

20%*

 

Not Covered

Not Covered

Urgent Care Services

$40 Copay

Not Covered

Chiropractic Services

$25 Copay

Not Covered

Mental health/Chemical Dependency

Inpatient

Outpatient

 

20%*

$25 Copay

 

Not Covered

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

 

No Charge

No Charge

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

No Charge

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

$10 Copay

25% Coinsurance

50% Coinsurance

$1,000 Copay

 

$10 Copay

25% Coinsurance

50% Coinsurance

Not Covered

*After Deductible

 

 

**Covered as in-network in true emergency

 

 


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