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.
service@healthez.com
>>Click here
Summary of Medical Benefits
$1,000 Deductible Plan
In-Network
Out-of-Network
Deductible
Individual
Family
$1,000
$2,000
$25,000
$50,000
Out-of-Pocket Maximum
$5,000
$10,000
$100,000
Preventive Care Services
No Charge
30%*
Office Visits
Primary Office Visit
Specialist Office Visit
Chiropractic Visit
$15 Copay
$50 Copay
Urgent Care Services
$25 Copay
Complex Imaging: MRI/CT/PET Scans
0%*
Inpatient Hospital Care
Facility Fee
Physician Fee
Outpatient Procedures
Emergency Room
Emergency Medical Transportation
$500 Copay, then 0%* (Copay waived if admitted)
80%*
Mental Health/Chemical Dependency
Inpatient
Office Visit
Prescription Drug Coverage
Generic
Preferred Brand
Non-Preferred Brand
Specialty
Retail 30 Day Supply
$10 Copay
$35 Copay
$60 Copay
25% Coinsurance up to $150
25% Coinsurance up to $250
30% Coinsurance up to $500
Mail Order 90 Day Supply
$87.50 Copay
$150 Copay
Not Covered
Teladoc Benefits
General Consultations
Dermatology
Mental Health - Therapy
Mental Health - Psychiatrist, Initial Evaluation
Mental Health - Psychiatrist, Ongoing Session
NOTE: * Coinsurance After Deductible
Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions
$3,000 Deductible Plan
$3,000
$6,000
$8,000
$16,000
If you prefer talking with a HealthEZ representative, call 844-204-3757