Plan Details

Plan Details

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.


Summary of Medical Benefits

Copay Plan

In-Network

Out-of-Network

Calendar Year Deductible

Individual

Individual Under Family

Family

 

$0

$0

$0

 

$500

$500

$1,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$1,000

$1,000

$2,500

 

$2,500

$2,500

$6,000

Preventative Care Services

No Charge

30%*

Office Visit

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$20 Copay

$20

 

30%*

30%*

30%*

Urgent Care Services

$25 Copay

$25 Copay

Complex Imaging: MRI/CT/PET Scans

$100 Copay per Scan

$100 Copay per Scan, then 30%*

Inpatient Hospital Services

Facility Charges

Physician Charges

 

$200 Copay

No Charge

 

$200 Copay, then 30%*

30%*

Outpatient Procedures

Facility Charges

Physician Charges

 

$100 Copay

No Charge

 

$100 Copay, then 30%*

30%*

Emergency Room Services

Emergency Medical Transportation

$50 Copay

No Charge

$50 Copay

No Charge

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

$200 Copay

$20 Copay

 

$200 Copay, then 30%*

30%*

* Coinsurance After Deductible

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

 

 

 

 

Dental Plan

In-Network

Deductible

Individual

Family

 

$50

$150

Deductible Year Maximum Benefit Per Person (Excluding Orthodontia)

Lifetime Maximum Benefit for Orthodontia (Coverage for participants up to age 19)

​​$2,500​

​​$2,500​

Class I-Diagnostic and Preventive Procedures

No Charge

Class II-Basic Procedures

10% Coinsurance After Deductible

Class III – Major Procedures

40% Coinsurance After Deductible

Class IV - Orthodontia

50% Coinsurance After Deductible


If you prefer talking with a HealthEZ representative, call 888-588-6521