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
PPO Copay Plan
In-Network
Out-Of-Network
Plan Year Deductible
Employee Only
Family
$1,000
$2,000
$3,000
$6,000
Coinsurance
20%
50%
Out-Of-Pocket Maximum
$12,000
Preventive Care
100% covered
Not covered
Physician Services
$20 copay
50%*
Hospital Services Inpatients & Outpatient Care
20%*
Emergency Services
$300 copay
Urgent Care Services
$30 copay
Chiropractic Services
$15 copay
Mental health/Chemical Dependency
Inpatient
Outpatient
Retail 30 Day Supply
Mail Order 90 day Supply
Prescription Drug Deductible (per person)
$50
Prescription Drug Coverage
Generic
Preferred brand
Non-preferred brand
Specialty
$50 copay
Not Available
*After Deductible
If you prefer talking with a HealthEZ representative, call 1-855-290-1415