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

ACP Plan

In-Network

Out-Of-Network

Deductible

Employee Only

Family

 

$2,000

$4,000

 

N/A

N/A

Out-of-Pocket Maximum

Employee Only

Family

 

$6,450

$12,900

 

N/A

N/A

Preventive Care

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$35 Copay

$50 Copay

$50 Copay

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

$75 Copay

Not Covered

Complex Imaging: MRI/CT/PET Scans

10%*

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

Not Covered

Not Covered

Emergency Room

Emergency Medical Transportation

10%*

10%*

10%*

10%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

10%*

 

Not Covered

Not Covered

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

0%*

0%*

0%*

0%*

Mail Order 90 Day Supply

0%*

0%*

0%*

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - -Psychiatrist, ongoing session

 

No Charge

$50 Copay

No Charge

No Charge

No Charge

 

No Charge

$50 Copay

No Charge

No Charge

No Charge

NOTE: *Coinsurance after deductible

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

 

 

 

 

PPO Plan

In-Network

Out-Of-Network

Deductible

Employee Only

Family

 

$1,500

$3,000

 

$3,000

$9,000

Out-of-Pocket Maximum

Employee Only

Family

 

$4,500

$13,500

 

$9,000

$27,000

Preventive Care

No Charge

40%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$40 Copay

$40 Copay

 

40%*

40%*

40%*

Urgent Care Services

$75 Copay

40%*

Complex Imaging: MRI/CT/PET Scans

20%*

40%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

40%*

40%*

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

40%*

40%*

Emergency Room

Emergency Medical Transportation

$300 Copay

20%*

$300 Copay

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$40 Copay

 

40%*

40%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

0%*

0%*

0%*

0%*

Mail Order 90 Day Supply

0%*

0%*

0%*

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - -Psychiatrist, ongoing session

 

No Charge

$40 Copay

No Charge

No Charge

No Charge

 

No Charge

$50 Copay

No Charge

No Charge

No Charge

NOTE: *Coinsurance after deductible

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

 

 

 

 

HDHP Plan

In-Network

Out-Of-Network

Deductible

Employee Only

Family

 

$3,400

$9,000

 

$6,000

$18,000

Out-of-Pocket Maximum

Employee Only

Family

 

$3,400

$9,000

 

$12,000

$36,000

Preventive Care

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

30%*

30%*

30%*

Urgent Care Services

0%*

30%*

Complex Imaging: MRI/CT/PET Scans

0%*

30%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

30%*

30%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

30%*

30%*

Emergency Room

Emergency Medical Transportation

0%*

0%*

0%*

0%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

30%*

30%*

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Retail 30 Day Supply

0%*

0%*

0%*

0%*

Mail Order 90 Day Supply

0%*

0%*

0%*

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - -Psychiatrist, ongoing session

 

$55 Copay*, then No Charge

$85 Copay*, then No Charge

$90 Copay*, then No Charge

$220 Copay*, then No Charge

$100 Copay*, then No Charge

 

$55 Copay*, then No Charge

$85 Copay*, then No Charge

$90 Copay*, then No Charge

$220 Copay*, then No Charge

$100 Copay*, then No Charge

NOTE: *Coinsurance after deductible

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

 

 

 

 

MEC Plus Plan

In-Network

Out-Of-Network

Deductible

Employee Only

Family

 

N/A

N/A

 

N/A

N/A

Out-of-Pocket Maximum

Employee Only

Family

 

N/A

N/A

 

N/A

N/A

Preventive Care

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$40 Copay

Not Covered

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

$75 Copay

Not Covered

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 Room

Emergency Medical Transportation

Not Covered

Not Covered

Not Covered

Not Covered

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

Not Covered

Not Covered

 

Not Covered

Not Covered

Office Visit Lab

Outpatient Lab

Outpatient X-Ray

Outpatient Major Diagnostic

Not Covered

Not Covered

Not Covered

Not Covered

Not Covered

Not Covered

Not Covered

Not Covered

Prescription Drug Coverage

Preventive

Non-Preventive Generic

Non-Preventive Preferred brand

Non-Preventive Non-preferred brand

Non-Preventive Specialty

Retail 30 Day Supply

$5 Copay

$40 Copay

Not Covered

Not Covered

Not Covered

Mail Order 90 Day Supply

$12.50 Copay

$100 Copay

Not Covered

Not Covered

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - -Psychiatrist, ongoing session

 

No Charge

$40 Copay

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

No Charge

NOTE: *Coinsurance after deductible

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

 

 

 

 

MEC Preventive Plan

In-Network

Out-Of-Network

Deductible

Employee Only

Family

 

N/A

N/A

 

N/A

N/A

Out-of-Pocket Maximum

Employee Only

Family

 

N/A

N/A

 

N/A

N/A

Preventive Care

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

Not Covered

Not Covered

Not Covered

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

Not Covered

Not Covered

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 Room

Emergency Medical Transportation

Not Covered

Not Covered

Not Covered

Not Covered

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

Not Covered

Not Covered

 

Not Covered

Not Covered

Office Visit Lab

Outpatient Lab

Outpatient X-Ray

Outpatient Major Diagnostic

Not Covered

Not Covered

Not Covered

Not Covered

Not Covered

Not Covered

Not Covered

Not Covered

Prescription Drug Coverage

Preventive

Non-Preventive Generic

Non-Preventive Preferred brand

Non-Preventive Non-preferred brand

Non-Preventive Specialty

Retail 30 Day Supply

No Charge

Not Covered

Not Covered

Not Covered

Not Covered

Mail Order 90 Day Supply

No Charge

Not Covered

Not Covered

Not Covered

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - -Psychiatrist, ongoing session

 

No Charge

$40 Copay

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

No Charge

NOTE: *Coinsurance after deductible

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

 

 

 

 


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