Compare Plans

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

PPO Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$0

N/A

 

N/A

N/A

Out-of-Pocket Maximum

Individual

Family

 

$6,600

N/A

 

N/A

N/A

Preventive Care Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$20 Copay

$20 Copay

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

$20 Copay

Not Covered

Complex Imaging: MRI/CT/PET Scans

No Charge

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

$250 Copay

No Charge

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

$200 Copay

No Charge

 

Not Covered

Not Covered

Emergency Room

Facility Fee

Physician Fee

Emergency Medical Transportation

 

$100 Copay

No Charge

No Charge

 

$100 Copay

No Charge

No Charge

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

$250 Copay

$20 Copay

 

Not Covered

Not Covered

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$5 Copay

$20 Copay

$60 Copay

$60 Copay

Mail Order 90 Day Supply

$5 Copay

$60 Copay

$180 Copay

$180 Copay

NOTE: * Coinsurance After Deductible

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

 

 

 

 

OAP Plan

Tier 1 - In Network

Tier 2 - In Network

Out-of-Network

Deductible

Individual

Family

 

$0

N/A

 

$300

N/A

 

$500

N/A

Out-of-Pocket Maximum

Individual

Family

 

$9,200

N/A

 

$1,000

N/A

 

$2,000

N/A

Preventive Care Services

No Charge

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$20 Copay

$20 Copay

 

10%*

10%*

$20 Copay, then 10%*

 

20%*

20%*

$20 Copay, then 20%*

Urgent Care Services

$20 Copay

10%*

20%*

Complex Imaging: MRI/CT/PET Scans

No Charge

10%*

20%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

$250 Copay

No Charge

 

$300 Copay, then 10%*

10%*

 

$400 Copay, then 20%*

20%*

Outpatient Procedures

Facility Fee

Physician Fee

 

$200 Copay

No Charge

 

$200 Copay, then 10%*

10%*

 

$200 Copay, then 20%*

20%*

Emergency Services

Facility Fee

Physician Fee

Medical Transportation

 

$100 Copay

No Charge

20%*

 

$100 Copay, then 10%*

10%*

20%*

 

$100 Copay, then 10%*

10%*

20%*

Mental Health/Chemical Dependency

Inpatient - Facility Fee

Inpatient - Physican Fee

Office Visit

 

$250 Copay

No Charge

$20 Copay

 

$300 Copay, then 10%*

10%*

10%*

 

$400 Copay, then 20%*

20%*

10%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Preferred Pharmacy Retail 30 Day Supply

$5 Copay

$20 Copay

$60 Copay

$60 Copay

Mail Order 90 Day Supply

$5 Copay

$60 Copay

$180 Copay

$180 Copay

Non-Preferred Pharmacy Retail 30 Day Supply

$10 Copay

$35 Copay

$60 Copay

$60 Copay

NOTE: * Coinsurance After Deductible

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

 

 

 

 

 

 

If you prefer talking with a HealthEZ representative, call 844-281-5223