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

HDHP 4 Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$5,000

$10,000

 

$10,000

$20,000

Coinsurance

20%

50%

Out-Of-Pocket Maximum

Employee Only

Family

 

$6,750

$13,500

 

$15,000

$30,000

Preventive Care

100% Covered

50% Coinsurance No Deductible

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

20%*

20%*

20%*

 

50%*

50%*

50%*

Hospital Services

20%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

20%*

20%*

 

20%*

20%*

Urgent Care Services

20%*

50%*

WellVia Telemedicine Services

100% Covered

100% Covered

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

20%*

20%*

 

50%*

50%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

20%*

20%*

50%*

20%*

 

20%*

20%*

50%*

Not Available

* After deductible

 

 

** True emergencies covered at in-network level

 

 

PPO 4 Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$2,000

$4,000

 

$4,000

$8,000

Coinsurance

0%

50%

Out-Of-Pocket Maximum

Employee Only

Family

 

$6,000

$12,000

 

$12,000

$24,000

Preventive Care

100% Covered

50% Coinsurance, No Deductible

Office Visits

Primary Services

Specialist Services

Walk In Clin

Chiropractic Services

 

$20 Copay

$75 Copay

$50 Copay

25%*

 

50%*

50%*

50%*

50%*

Hospital Services

Inpatient Hospital Facility

Outpatient Surgery

 

Deductible, then 100% Covered

Deductible, then $750 Copay

 

50%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$300 Copay*

100% Covered*

 

$300 Copay*

100% Covered*

Urgent Care Services

$50 Copay

50%*

WellVia Telemedicine Services

100% Covered

100% Covered

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

Deductible, then 100% Covered

$75 Copay

 

50%*

50%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

$10 Copay

$25 Copay

50% Coinsurance

$200 Copay

 

$20 Copay

$50 Copay

50% Coinsurance

Not Available

* After deductible

 

 

** True emergencies covered at in-network level

 

 

PPO 5 Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$3,000

$6,000

 

$5,000

$10,000

Coinsurance

0%

50%

Out-Of-Pocket Maximum

Employee Only

Family

 

$6,750

$13,500

 

$15,000

$30,000

Preventive Care

100% Covered

50% Coinsurance No Deductible

Office Visits

Primary Services

Specialist Services

Walk In Clinics

Chiropractic Services

 

$20 Copay

$75 Copay

$50 Copay

25%*

 

50%*

50%*

50%*

50%*

Hospital Services

Inpatient Hospital Facility

Outpatient Surgery

 

Deductible, then 100% Covered

Deductible, then $750 Copay

 

50%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

Deductible, then $300 Copay

Deductible, then 100% Covered

 

Deductible, then $300 Copay

Deductible, then 100% Covered

Urgent Care Services

$50 Copay

50%*

WellVia Telemedicine Services

100% Covered

100% Covered

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

Deductible, then 100% Covered

$75 Copay

 

50%*

50%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

$10 Copay

$25 Copay

50% Coinsurance

$200 Copay

 

$20 Copay

$50 Copay

50% Coinsurance

Not Available

* After deductible

 

 

** True emergencies covered at in-network level

 

 


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