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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

$1,500 Copay Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Employee Only

Family

 

$1,500

$3,000

 

$3,000

$6,000

Out-Of-Pocket Maximum

Employee Only

Family

 

$4,000

$8,000

 

$8,000

$16,000

Preventive Care

100% Covered

50%*

Office Visits

Primary Services

Specialist Services

 

$30 Copay

$30 Copay

 

50%*

50%*

Hospital Services- Inpatient & Outpatient Care

0%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$300 Copay

0%*

 

50%*

50%*

Urgent Care Services

$100 Copay

50%*

Chiropractic Services

$30 Copay

50%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

0%*

$30 Copay

 

50%*

50%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

$15 Copay

$35 Copay

$75 Copay

$250 Copay

 

$38 Copay

$88 Copay

$188 Copay

Not Available

*After Deductible

 

 

**Covered as in-network in true emergency

 

 

BuyUp Plan RBP

In-Network

Out-Of-Network

Embedded Deductible

Individual Coverage

Family Coverage

Reference Based Pricing

$1,500

$3,000

N/A

 

 

Embedded Out-of-Pocket Maximum

Individual Coverage

Family Coverage

Reference Based Pricing

$4,000

$8,000

N/A

 

 

Preventive Care Services

No Charge

 

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$30 Copay

$30 Copay

$30 Copay

 

 

 

 

Urgent Care Services

$100 Copay

 

Complex Imaging: MRI/CT/PET Scans

0%*

 

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

 

 

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

 

 

Emergency Room Services

Emergency Medical Transportation

$300 Copay

0%*

 

 

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

$30 Copay

 

 

 

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay

$35 Copay

$75 Copay

$250 Copay

Mail Order 90 Day Supply

$38 Copay

$88 Copay

$188 Copay

Not Available

* Coinsurance after deductible

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

 

 

 

 

Base Plan RBP

In-Network

Out-Of-Network

Embedded Deductible

Individual Coverage

Family Coverage

Reference Based Pricing

$3,000

$6,000

N/A

 

 

Embedded Out-of-Pocket Maximum

Individual Coverage

Family Coverage

Reference Based Pricing

$5,500

$11,000

N/A

 

 

Preventive Care Services

No Charge

 

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$30 Copay

$30 Copay

$30 Copay

 

 

 

 

Urgent Care Services

$100 Copay

 

Complex Imaging: MRI/CT/PET Scans

0%*

 

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

 

 

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

 

 

Emergency Room Services

Emergency Medical Transportation

$300 Copay

0%*

 

 

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

$30 Copay

 

 

 

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

$15 Copay

$35 Copay

$75 Copay

$250 Copay

Mail Order 90 Day Supply

$38 Copay

$88 Copay

$188 Copay

Not Available

* Coinsurance after deductible

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

 

 

 

 


If you prefer talking with a HealthEZ representative, call 1-888-592-6344