Plan Details

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.

Summary Of Medical Benefits

Copay Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual

Individual under Family

Family

 

$500

$500

$1,000

 

$3,000

$3,000

$6,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$1,000

$1,000

$2,500

 

$5,000

$5,000

$12,500

Preventive Care

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$40 Copay

$40 Copay

 

30%*

30%*

30%*

Urgent Care Services

$50 Copay

$50 Copay

Complex Imaging: MRI/CT/PET Scans

KIS Imaging

Non-KIS Imaging

 

No Charge

10%*

 

30%*

30%*

Inpatient Hospital Care

Facility Fee

Physican Fee

 

$250 Copay, then 10%*

10%*

 

$500 Copay, then 30%*

30%*

Outpatient Procedures

Facility Fee

Physician Fee

 

$250 Copay, then 10%*

10%*

 

$500 Copay, then 30%*

30%*

Emergency Services

Medical Transportation

$100 Copay

10%&

$100 Copay

10%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

$250 Copay, then 10%*

$20 Copay

 

$500 Copay, then 30%*

30%*

Telemedicine Services Through Teladoc

General Consultations

Dermatology

Therapist

Psychiatrist, initial evaluation

Psychiatrist, ongoing session

 

No Charge

No Charge

No Charge

No Charge

No Charge

 

No Charge

No Charge

No Charge

No Charge

No Charge

Prescription Drug Coverage

Generic

Preferred Brand

Brand Non-Formulary

Specialty Drugs

Retail 30 Day Supply

$5 Copay

$15 Copay

$35 Copay

$20 Copay

Mail Order 90 Day Supply

$5 Copay

$15 Copay

$35 Copay

$20 Copay

NOTE: * Coinsurance After Deductible

**Covered at in-network benefit level if determined medically necessary.

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

 

 

 

 

 

 

Dental Plan

In-Network

Out-Of-Network

Medical Deductible

Individual

Family

 

$50

$150

 

$50

$150

Maximums

Deductible Year Maximum Benefit Per Person Age 19 and Over (Excluding Orthodontia)

Lifetime Maximum Benefit For Orthodontia (Coverage for participants up to age 26)

 

$2,500

$1,500

 

$2,500

$1,500

Class I-Diagnostic and Preventive Procedures

No Charge

No Charge

Class II-Basic Procedures

15%*

15%*

Class III – Major Procedures

40%*

40%*

Class IV – Orthodontia

50%*

50%*

NOTE: * Coinsurance After Deductible

 

 


If you prefer talking with a HealthEZ representative, call 866-490-6171