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.
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Summary of Medical Benefits
Copay Plan
Tier 1 In-Network
Tier 2 In-Network
Out of Network
Embedded Deductible
Individual Coverage
Individual under Family Coverage
Family Coverage
$500
$1,000
$1,500
$3,000
$4,000
$8,000
Embedded Out-of-Pocket Maximum
$2,500
$5,000
$3,500
$7,000
$6,000
$12,000
Preventive Care Services
No Charge
Office Visits
Primary Office Visit
Specialist Office Visit
Chiropractic Visit
$10 Copay
$20 Copay
Not Available
$30 Copay
$60 Copay
20%*
50%*
Urgent Care Services
$25 Copay
$75 Copay
Complex Imaging: MRI/CT/PET Scans
Inpatient Hospital Care
Facility Fee
Physician Fee
Outpatient Procedures
Emergency Room Services
Emergency Medical Transportation
$300 Copay, then 20%*
Mental Health/Chemical Dependency
Inpatient
Office Visit
If you prefer talking with a HealthEZ representative, call 1-844-671-4963