Plan Details

Not all coverage is the right coverage.

Your healthcare coverage is important to us. 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. This summary will help you understand your plan and its coverage.

Questions about your benefits?

service@healthez.com

Register your myHealthEZ account

>>Click here

Summary Of Medical Benefits

Basic Medical Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual

Family

 

$500

$1,000

 

$2,000

$4,000

Out-Of-Pocket Maximum

Individual

Family

 

$1,000

$2,000

 

None

None

Preventive Care

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Vsit

 

$7 Copay

$30 Copay

$30 Copay

 

50%*

50%*

50%*

Urgent Care Services

$30 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Emergency Services**

Emergency Room - First 2 Visits Per Year

Emergency Room - After First 2 Visits Per Year

Emergency Medical Transportation

 

$250 Copay

20%*

20%*

 

50%*

50%*

50%*

Mental health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$30 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Formulary

Non-Formulary (Requires Precertification)

Specialty

Retail 30 Day Supply

$10 Copay

$35 Copay

$35 Copay

20% Coinsurance up to $200 Max

Mail Order 90 day Supply

$20 Copay

$70 Copay

$70 Copay

20% Coinsurance up to $200 Max

NOTE: * Coinsurance After Deductible

**Covered as in-network in true emergency

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

 

 

 

 

 

 


If you prefer talking with a HealthEZ representative, call 1-855-520-4323