Compare Plans

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

PPO Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual

Family

 

$3,500

$7,000

 

$7,000

$14,000

Out-Of-Pocket Maximum

Individual

Family

 

$6,250

$12,500

 

$21,000

$42,000

Preventive Care

No Charge

50%*

Office Visit

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$30 Copay

$60 Copay

$30 Copay

 

50%*

50%*

50%*

Urgent Care Services

$75 Copay

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

30%*

30%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

30%*

30%*

 

50%*

50%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$250 Copay

30%*

 

50%*

50%*

Mental Health / Chemical Dependency

Inpatient

Office Visit

 

30%*

$60 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$15 Copay

$50 Copay

$100 Copay

$250 Copay

Mail Order 90 day Supply

$30 Copay

$100 Copay

$200 Copay

Not Available

NOTE: * Coinsurance After Deductible

**True emergencies covered at in-network level

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

 

 

 

 

 

 

MVP Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual

Family

 

None

None

 

$500

$1,000

Out-Of-Pocket Maximum

Individual

Family

 

$1,850

$12,700

 

Unlimited

Unlimited

Preventive Care

No Charge

40%*

Office Visit

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$15 Copay

$25 Copay

20%*

 

40%*

40%*

40%*

Urgent Care Services

$50 Copay

40%*

Complex Imaging: MRI/CT/PET Scans

$400 Copay

40%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

Not Covered

Not Covered

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

Not Covered

Not Covered

 

Not Covered

Not Covered

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$400 Copay

Not Covered

 

50%*

Not Covered

Mental Health / Chemical Dependency

Inpatient

Office Visit

 

Not Covered

$25 Copay

 

Not Covered

50%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$25 Copay

$60 Copay

$125 Copay

Not Covered

Mail Order 90 day Supply

$50 Copay

$120 Copay

$250 Copay

Not Covered

NOTE: * Coinsurance After Deductible

**True emergencies covered at in-network level

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

 

 

 

 

 

 

RBP Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual

Family

 

$5,500

$11,000

 

$11,000

$22,000

Out-Of-Pocket Maximum

Individual

Family

 

$7,000

$14,000

 

$20,000

$40,000

Preventive Care

No Charge

50%*

Office Visit

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$50 Copay

$100 Copay

0%*

 

50%*

50%*

50%*

Urgent Care Services

$100 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

0%*

0%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

0%*

0%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

0%*

0%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

0%*

0%*

 

0%*

0%*

Mental Health / Chemical Dependency

Inpatient

Office Visit

 

0%*

$100 Copay

 

0%*

50%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

$15 Copay

$50 Copay

$100 Copay

$250 Copay

Mail Order 90 day Supply

$30 Copay

$100 Copay

$200 Copay

Not Covered

NOTE: * Coinsurance After Deductible

**True emergencies covered at in-network level

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

 

 

 

 

 

 


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