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
HSA Plan
In-Network
Out-Of-Network
Calendar Year Deductible
Employee Only
Family
$4,000
$8,000
$16,000
Coinsurance
0%
50%
Out-Of-Pocket Maximum
$5,500
$11,000
$22,000
Preventive Care
100% Covered
50%*
Office Visits
Primary Services
Specialist Services
0%*
Hospital Services
Emergency Services**
Emergency Room
Emergency Medical Transportation
Urgent Care Services
Chiropractic Services
Mental Health / Chemical Dependency
Inpatient
Outpatient
Retail 30 Day Supply
Mail Order 90 day Supply
Prescription Drug Coverage
Generic
Preferred brand
Non-preferred brand
Specialty
$15 Copay*
$50 Copay*
$70 Copay*
$350 Copay*
$30 Copay*
$100 Copay*
$140 Copay*
Not Available
*After deductible
**Covered as in-network in true-emergency
If you prefer talking with a HealthEZ representative, call 1-844-302-7790