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

$3,300 HDHP Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual

Individual Under Family

Family

 

$3,300

$3,300

$6,600

 

N/A

N/A

N/A

Out-Of-Pocket Maximum

Individual

Individual Under Family

Family

 

$7,150

$7,150

$14,300

 

N/A

N/A

N/A

Preventive Care

No Charge

N/A

Office Visits

Primary Office Visit

Specialist Office Visit

 

20%*

20%*

 

N/A

N/A

Hospital Services

20%*

N/A

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

20%*

20%*

 

N/A

N/A

Urgent Care Services

20%*

N/A

Chiropractic Services

20%*

N/A

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

20%*

20%*

 

N/A

N/A

Prescription Drug Coverage

Preventive Prescriptions

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail 30 Day Supply

No Charge

20%*

20%*

20%*

20%*

Mail Order 90 Day Supply

No Charge

20%*

20%*

20%*

Not Covered

* Coinsurance After deductible

 

 

** True emergencies covered at in-network level

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

 

 

 

 

$5,500 HDHP Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual

Individual Under Family

Family

 

$5,000

$5,000

$10,000

 

N/A

N/A

N/A

Out-Of-Pocket Maximum

Individual

Individual Under Family

Family

 

$7,150

$7,150

$14,300

 

N/A

N/A

N/A

Preventive Care

No Charge

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

 

20%*

20%*

 

N/A

N/A

Hospital Services

20%*

N/A

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

20%*

20%*

 

N/A

N/A

Urgent Care Services

20%*

N/A

Chiropractic Services

20%*

N/A

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

20%*

20%*

 

N/A

N/A

Prescription Drug Coverage

Preventive Prescriptions

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail 30 Day Supply

No Charge

20%*

20%*

20%*

20%*

Mail Order 90 Day Supply

No Charge

20%*

20%*

20%*

Not Covered

* Coinsurance After deductible

 

 

** True emergencies covered at in-network level

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

 

 

 

 


If you prefer talking with a HealthEZ representative, call 1-888-701-3042