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.
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Summary Of Medical Benefits
HSA Plan
In-Network
Out-Of-Network
Calendar Year Deductible
Employee Only
Family
$2,700
$5,400
$5,000
$10,000
Coinsurance
0%
50%
Out-Of-Pocket Maximum
Preventive Care
100% Covered
50%*
Office Visits
Primary Services
Specialist Services
0%*
Hospital Services- Inpatient & Outpatient Care
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
Formulary
Non-Formulary
Specialty
Not Available
*After deductible
**Covered as in-network in true-emergency
If you prefer talking with a HealthEZ representative, call 1-844-281-5215