Plan Details

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 1

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$7,000

$14,000

 

$10,000

$20,000

Coinsurance

0%

50%

Out-Of-Pocket Maximum

Employee Only

Family

 

$7,000

$14,000

 

$30,000

$60,000

WellVia Telemedicine

100% Covered

100% Covered

Preventive Care

100% Covered

Well Child: No Charge Adult: Deductible, then 50%*

Office Visits

Primary Services

Specialist Services

Walk In Clinics

Chiropractic Services

 

Deductible, then 100% Covered

Deductible, then 100% Covered

Deductible, then 100% Covered

Deductible, then 100% Covered

 

Deductible, then 50%*

Deductible, then 50%*

Deductible, then 50%*

Deductible, then 50%*

Urgent Care Services

Deductible, then 100% Covered

Deductible, then 50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

Deductible, then 100% Covered

Deductible, then 100% Covered

 

Deductible, then 100% Covered

Deductible, then 100% Covered

Hospital Services

Inpatient Hospital Facility

Outpatient Surgery

 

Deductible, then 100% Covered

Deductible, then 100% Covered

 

Deductible, then 50%*

Deductible, then 50%*

Diagnostic Testing and Imaging

Labs

X-Rays

CT/PET/MRI

 

Deductible, then 100% Covered

Deductible, then 100% Covered

Deductible, then 100% Covered

 

Deductible, then 50%*

Deductible, then 50%*

Deductible, then 50%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

Deductible, then 100% Covered

Deductible, then 100% Covered

 

Deductible, then 50%*

Deductible, then 50%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

Deductible, then 100% Covered

Deductible, then 100% Covered

Deductible, then 100% Covered

Deductible, then 100% Covered

 

Deductible, then 100% Covered

Deductible, then 100% Covered

Deductible, then 100% Covered

Not Available

*Coinsurance

 

 


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