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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

In-Network

Out-of-Network

Calendar Year Accumulation

Embedded Deductible

Employee Only

Family

 

 

$500

$1,500

 

 

$3,000

$9,000

Coinsurance

25%

50%

Embedded Out-of-Pocket Maximum

Employee Only

Family

 

$3,000

$6,000

 

$9,000

$18,000

WellVia Telemedicine Services

100% Covered

100% Covered

Preventative Care

100% Covered

Not Covered

Office Visits

Primary Care

Specialist Servcies

Walk In Clinics

Chiropractic Services

 

$25 Copay

$25 Copay

$25 Copay

$25 Copay

 

Deductible, then 50%*

Deductible, then 50%*

Deductible, then 50%*

Deductible, then 50%*

Urgent Care Services

$25 Copay

Deductible, then 50%*

Emergency Services

Emergency Room

Emergency Medical Transportation

 

Deductible, then 25%*

Deductible, then 25%*

 

Deductible, then 25%*

Deductible, then 25%*

Hospital Services

Inpatient Hospital Facility

Outpatient Surgery

 

Deductible, then 25%*

Deductible, then 25%*

 

Deductible, then 50%*

Deductible, then 50%*

Diagnostic Testing and Imaging

Labs

X-Rays

CT/PET/MRI

 

No Charge

No Charge

Deductible, then 25%*

 

Deductible, then 50%*

Deductible, then 50%*

Deductible, then 50%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

Deductible, then 25%*

$25 Copay

 

Deductible, then 50%*

Deductible, then 50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Generic and Preferred Specialty

Non Preferred Specialty

Retail 30 Day Supply

 

$15 Copay

$50 Copay

Deductible, then 50%*

Deductible, then 25%*

Deductible, then 25%*

Mail Order 90 Day Supply

 

$35 Copay

$125 Copay

Deductible, then 50%*

Not Available

Not Available

* Coinsurance

 

 

Copay Plan 2

In Network Benefits

Out of Network Benefits

Calendar Year Accumulation

Embedded Deductible

Employee Only

Family

 

 

$1,000

$3,000

 

 

$3,000

$9,000

Coinsurance

25%

50%

Embedded Out-of-Pocket Maximum

Employee Only

Family

 

$3,500

$7,000

 

$9,000

$18,000

WellVia Telemedicine Services

100% Covered

100% Covered

Preventative Care

100% Covered

Not Covered

Office Visits

Primary Care

Specialist Servcies

Walk In Clinics

Chiropractic Services

 

$25 Copay

$25 Copay

$25 Copay

$25 Copay

 

Deductible, then 50%*

Deductible, then 50%*

Deductible, then 50%*

Deductible, then 50%*

Urgent Care Services

$25 Copay

Deductible, then 50%*

Emergency Services

Emergency Room

Emergency Medical Transportation

 

Deductible, then 25%*

Deductible, then 25%*

 

Deductible, then 25%*

Deductible, then 25%*

Hospital Services

Inpatient Hospital Facility

Outpatient Surgery

 

Deductible, then 25%*

Deductible, then 25%*

 

Deductible, then 50%*

Deductible, then 50%*

Diagnostic Testing and Imaging

Labs

X-Rays

CT/PET/MRI

 

No Charge

No Charge

Deductible, then 25%*

 

Deductible, then 50%*

Deductible, then 50%*

Deductible, then 50%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

Deductible, then 25%*

$25 Copay

 

Deductible, then 50%*

Deductible, then 50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Generic and Preferred Specialty

Non-Preferred Specialty

Retail 30 Day Supply

 

$15 Copay

$50 Copay

Deductible, then 50%*

Deductible, then 25%*

Deductible, then 25%*

Mail Order 90 Day Supply

 

$35 Copay

$125 Copay

Deductible, then 50%*

Not Available

Not Available

* Coinsurance

 

 

Copay Plan 3

In Network Benefits

Out of Network Benefits

Calendar Year Accumulation

Embedded Deductible

Employee Only

Family

 

 

$3,000

$3,500

 

 

$6,000

$18,000

Coinsurance

25%

50%*

Embedded Out-of-Pocket Maximum

Employee Only

Family

 

$6,000

$12,000

 

$12,000

$24,000

WellVia Telemedicine Services

100% Covered

100% Covered

Preventative Care

100% Covered

Not Covered

Office Visits

Primary Care

Specialist Servcies

Walk In Clinics

Chiropractic Services

 

$45 Copay

$45 Copay

$45 Copay

$45 Copay

 

Deductible, then 50%*

Deductible, then 50%*

Deductible, then 50%*

Deductible, then 50%*

Urgent Care Services

$45 Copay

Deductible, then 50%*

Emergency Services

Emergency Room

Emergency Medical Transportation

 

Deductible, then 25%*

Deductible, then 25%*

 

Deductible, then 25%*

Deductible, then 25%*

Hospital Services

Inpatient Hospital Facility

Outpatient Surgery

 

Deductible, then 25%*

Deductible, then 25%*

 

Deductible, then 50%*

Deductible, then 50%*

Diagnostic Testing and Imaging

Labs

X-Rays

CT/PET/MRI

 

No Charge

No Charge

Deductible, then 25%*

 

Deductible, then 50%*

Deductible, then 50%*

Deductible, then 50%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

Deductible, then 25%*

$45 Copay

 

Deductible, then 50%*

Deductible, then 50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Generic and Preferred Specialty

Non-Preferred Specialty

Retail 30 Day Supply

 

$15 Copay

$50 Copay

Deductible, then 50%*

Deductible, then 25%*

Deductible, then 25%*

Mail Order 90 Day Supply

 

$35 Copay

$125 Copay

Deductible, then 50%*

Not Available

Not Available

* Coinsurance

 

 

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