Compare Plans

Not all coverage is the right coverage.

The healthcare coverage you need is probably very different than the coverage some of your co-workers need. 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. That’s why HealthEZ provides multiple coverage options, so you’re never caught paying too much money, or worse, having too little coverage.

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Summary of Medical Benefits

Core Health Plan

Reference Based Pricing

Deductible

Individual

Family

 

$9,000

$18,000

Out-of-Pocket Maximum

Individual

Family

 

$9,000

$18,000

Preventive Care

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

No Charge

No Charge

20%*

Urgent Care Services

No Charge

Complex Imaging: MR/CT/PET Scans

0%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

Emergency Room

Emergency Medical Transportation

$250 Copay (Copay waived if admitted)

0%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

No Charge

Prescription Drug Service

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail (per 30 day supply)/Mail Order (per 90-day supply)

No Charge

$75 Copay/$150 Copay

$100 Copay/$250 Copay

Not Covered

NOTE: *Coinsurance after deductible

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

 

 

Select Health Plan

Reference Based Pricing

Deductible

Individual

Family

 

$5,000

$10,000

Out-of-Pocket Maximum

Individual

Family

 

$5,000

$10,000

Preventive Care

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

No Charge

No Charge

20%*

Urgent Care Services

No Charge

Complex Imaging: MR/CT/PET Scans

0%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

Emergency Room

Emergency Medical Transportation

$250 Copay (Copay waived if admitted)

0%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

No Charge

Prescription Drug Service

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail (per 30 day supply)/Mail Order (per 90-day supply)

No Charge

$75 Copay/$150 Copay

$100 Copay/$250 Copay

Not Covered

NOTE: *Coinsurance after deductible

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

 

 

Elite Health Plan

Reference Based Pricing

Deductible

Individual

Family

 

$1,000

$2,000

Out-of-Pocket Maximum

Individual

Family

 

$1,000

$2,000

Preventive Care

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

No Charge

No Charge

20%*

Urgent Care Services

No Charge

Complex Imaging: MR/CT/PET Scans

0%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

Emergency Room

Emergency Medical Transportation

$250 Copay (Copay waived if admitted)

0%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

No Charge

Prescription Drug Service

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail (per 30 day supply)/Mail Order (per 90-day supply)

No Charge

$75 Copay/$150 Copay

$100 Copay/$250 Copay

Not Covered

NOTE: *Coinsurance after deductible

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

 

 

Premier Health Plan

Reference Based Pricing

Deductible

Individual

Family

 

$3,000

$6,000

Out-of-Pocket Maximum

Individual

Family

 

$3,000

$6,000

Preventive Care

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

No Charge

No Charge

20%*

Urgent Care Services

No Charge

Complex Imaging: MR/CT/PET Scans

0%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

Emergency Room

Emergency Medical Transportation

$250 Copay (Copay waived if admitted)

0%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

No Charge

Prescription Drug Service

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail (per 30 day supply)/Mail Order (per 90-day supply)

No Charge

$75 Copay/$150 Copay

$100 Copay/$250 Copay

Not Covered

NOTE: *Coinsurance after deductible

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

 

 

Deluxe Platinum Plan

Reference Based Pricing

Deductible

Individual

Family

 

$100

$200

Out-of-Pocket Maximum

Individual

Family

 

$3,000

$6,000

Preventive Care

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$30 Copay

20%*

Urgent Care Services

$40 Copay

Complex Imaging: MR/CT/PET Scans

$150 Copay

Inpatient Hospital Care

Facility Fee - Days 1-5

Facility Fee - After day 5

Physician Fee

 

$150 Copay/Day

No Charge

0%*

Outpatient Procedures

Facility Fee

Physician Fee

 

$150 Copay/Procedure

0%*

Emergency Room

Facility Fee

Physician Fee

Emergency Medical Transportation

 

$150 Copay

$40 Copay

20%*

Mental Health/Chemical Dependency

Inpatient Facility Fee - Days 1-5

Inpatient Facility Fee - After day 5

Office Visit

 

$150 Copay/Day

No Charge

$30 Copay

Prescription Drug Service

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail (per 30 day supply)/Mail Order (per 90-day supply)

No Charge

$30 Copay/$75 Copay

$60 Copay/$150 Copay

Not Covered

NOTE: *Coinsurance after deductible

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

 

 

Freedom Platinum Plan

Reference Based Pricing

Deductible

Individual

Family

 

$100

$200

Out-of-Pocket Maximum

Individual

Family

 

$3,000

$6,000

Preventive Care

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$30 Copay

20%*

Urgent Care Services

$40 Copay

Complex Imaging: MR/CT/PET Scans

$150 Copay

Inpatient Hospital Care

Facility Fee - Days 1-5

Facility Fee - After day 5

Physician Fee

 

$150 Copay/Day

No Charge

0%*

Outpatient Procedures

Facility Fee

Physician Fee

 

$150 Copay/Procedure

0%*

Emergency Room

Facility Fee

Physician Fee

Emergency Medical Transportation

 

$150 Copay

$40 Copay

20%*

Mental Health/Chemical Dependency

Inpatient Facility Fee - Days 1-5

Inpatient Facility Fee - After day 5

Office Visit

 

$150 Copay/Day

No Charge

$30 Copay

Prescription Drug Service

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail (per 30 day supply)/Mail Order (per 90-day supply)

$10 Copay/$25 Copay

Not Covered

Not Covered

Not Covered

NOTE: *Coinsurance after deductible

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

 

 

Choice Gold Plan

Reference Based Pricing

Deductible

Individual

Family

 

$500

$1,000

Out-of-Pocket Maximum

Individual

Family

 

$5,000

$10,000

Preventive Care

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$35 Copay

$50 Copay

20%*

Urgent Care Services

$50 Copay

Complex Imaging: MR/CT/PET Scans

$200 Copay

Inpatient Hospital Care

Facility Fee - Days 1-5

Facility Fee - After day 5

Physician Fee

 

$200 Copay/Day

No Charge

0%*

Outpatient Procedures

Facility Fee

Physician Fee

 

$200 Copay/Procedure

0%*

Emergency Room

Facility Fee

Physician Fee

Emergency Medical Transportation

 

$200 Copay

$50 Copay

20%*

Mental Health/Chemical Dependency

Inpatient Facility Fee - Days 1-5

Inpatient Facility Fee - After day 5

Office Visit

 

$200 Copay/Day

No Charge

$30 Copay

Prescription Drug Service

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail (per 30 day supply)/Mail Order (per 90-day supply)

$15 Copay/$37.50 Copay

$40 Copay/$100 Copay

$60 Copay/$150 Copay

Not Covered

NOTE: *Coinsurance after deductible

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

 

 

Freedom Gold Plan

Reference Based Pricing

Deductible

Individual

Family

 

$500

$1,000

Out-of-Pocket Maximum

Individual

Family

 

$5,000

$10,000

Preventive Care

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$35 Copay

$50 Copay

20%*

Urgent Care Services

$50 Copay

Complex Imaging: MR/CT/PET Scans

$200 Copay

Inpatient Hospital Care

Facility Fee - Days 1-5

Facility Fee - After day 5

Physician Fee

 

$200 Copay/Day

No Charge

0%*

Outpatient Procedures

Facility Fee

Physician Fee

 

$200 Copay/Procedure

0%*

Emergency Room

Facility Fee

Physician Fee

Emergency Medical Transportation

 

$200 Copay

$50 Copay

20%*

Mental Health/Chemical Dependency

Inpatient Facility Fee - Days 1-5

Inpatient Facility Fee - After day 5

Office Visit

 

$200 Copay/Day

No Charge

$30 Copay

Prescription Drug Service

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail (per 30 day supply)/Mail Order (per 90-day supply)

$10 Copay/$25 Copay

Not Covered

Not Covered

Not Covered

NOTE: *Coinsurance after deductible

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

 

 

Basic Gold Plan

Reference Based Pricing

Deductible

Individual

Family

 

$1,000

$2,000

Out-of-Pocket Maximum

Individual

Family

 

$6,000

$12,000

Preventive Care

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$40 Copay

$60 Copay

20%*

Urgent Care Services

$60 Copay

Complex Imaging: MR/CT/PET Scans

$250 Copay

Inpatient Hospital Care

Facility Fee - Days 1-5

Facility Fee - After day 5

Physician Fee

 

$250 Copay/Day

No Charge

0%*

Outpatient Procedures

Facility Fee

Physician Fee

 

$250 Copay/Procedure

0%*

Emergency Room

Facility Fee

Physician Fee

Emergency Medical Transportation

 

$250 Copay

$60 Copay

20%*

Mental Health/Chemical Dependency

Inpatient Facility Fee - Days 1-5

Inpatient Facility Fee - After day 5

Office Visit

 

$250 Copay/Day

No Charge

$60 Copay

Prescription Drug Service

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail (per 30 day supply)/Mail Order (per 90-day supply)

$15 Copay/$37.50 Copay

$50 Copay/$125 Copay

$100 Copay/$250 Copay

Not Covered

NOTE: *Coinsurance after deductible

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

 

 

Preferred Silver Plan

Reference Based Pricing

Deductible

Individual

Family

 

$3,000

$6,000

Out-of-Pocket Maximum

Individual

Family

 

$7,900

$15,800

Preventive Care

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$40 Copay

$60 Copay

20%*

Urgent Care Services

$60 Copay

Complex Imaging: MR/CT/PET Scans

$300 Copay

Inpatient Hospital Care

Facility Fee - Days 1-5

Facility Fee - After day 5

Physician Fee

 

$300 Copay/Day

No Charge

0%*

Outpatient Procedures

Facility Fee

Physician Fee

 

$300 Copay/Procedure

0%*

Emergency Room

Facility Fee

Physician Fee

Emergency Medical Transportation

 

$300 Copay

$60 Copay

20%*

Mental Health/Chemical Dependency

Inpatient Facility Fee - Days 1-5

Inpatient Facility Fee - After day 5

Office Visit

 

$300 Copay/Day

No Charge

$60 Copay

Prescription Drug Service

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail (per 30 day supply)/Mail Order (per 90-day supply)

$15 Copay/$37.50 Copay

$60 Copay/$150 Copay

$100 Copay/$250 Copay

Not Covered

NOTE: *Coinsurance after deductible

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

 

 

Freedom Silver Plan

Reference Based Pricing

Deductible

Individual

Family

 

$3,000

$6,000

Out-of-Pocket Maximum

Individual

Family

 

$7,900

$15,800

Preventive Care

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$40 Copay

$60 Copay

20%*

Urgent Care Services

$60 Copay

Complex Imaging: MR/CT/PET Scans

$300 Copay

Inpatient Hospital Care

Facility Fee - Days 1-5

Facility Fee - After day 5

Physician Fee

 

$300 Copay/Day

No Charge

0%*

Outpatient Procedures

Facility Fee

Physician Fee

 

$300 Copay/Procedure

0%*

Emergency Room

Facility Fee

Physician Fee

Emergency Medical Transportation

 

$300 Copay

$60 Copay

20%*

Mental Health/Chemical Dependency

Inpatient Facility Fee - Days 1-5

Inpatient Facility Fee - After day 5

Office Visit

 

$300 Copay/Day

No Charge

$60 Copay

Prescription Drug Service

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail (per 30 day supply)/Mail Order (per 90-day supply)

$10 Copay/$25 Copay

Not Covered

Not Covered

Not Covered

NOTE: *Coinsurance after deductible

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

 

 

Enhanced Silver Plan

Reference Based Pricing

Deductible

Individual

Family

 

$3,000

$6,000

Out-of-Pocket Maximum

Individual

Family

 

$7,900

$15,800

Preventive Care

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$40 Copay

$65 Copay

20%*

Urgent Care Services

$65 Copay

Complex Imaging: MR/CT/PET Scans

$400 Copay

Inpatient Hospital Care

Facility Fee - Days 1-5

Facility Fee - After day 5

Physician Fee

 

$400 Copay/Day

No Charge

0%*

Outpatient Procedures

Facility Fee

Physician Fee

 

$400 Copay/Procedure

0%*

Emergency Room

Facility Fee

Physician Fee

Emergency Medical Transportation

 

$400 Copay

$60 Copay

20%*

Mental Health/Chemical Dependency

Inpatient Facility Fee - Days 1-5

Inpatient Facility Fee - After day 5

Office Visit

 

$400 Copay/Day

No Charge

$65 Copay

Prescription Drug Service

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail (per 30 day supply)/Mail Order (per 90-day supply)

$15 Copay/$37.50 Copay

$75 Copay/$187.50 Copay

$100 Copay/$250 Copay

Not Covered

NOTE: *Coinsurance after deductible

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

 

 

Classic Silver Plan

Reference Based Pricing

Deductible

Individual

Family

 

$4,000

$8,000

Out-of-Pocket Maximum

Individual

Family

 

$8,150

$16,300

Preventive Care

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$40 Copay

$70 Copay

20%*

Urgent Care Services

$70 Copay

Complex Imaging: MR/CT/PET Scans

$450 Copay

Inpatient Hospital Care

Facility Fee - Days 1-5

Facility Fee - After day 5

Physician Fee

 

$450 Copay/Day

No Charge

0%*

Outpatient Procedures

Facility Fee

Physician Fee

 

$450 Copay/Procedure

0%*

Emergency Room

Facility Fee

Physician Fee

Emergency Medical Transportation

 

$450 Copay

$60 Copay

20%*

Mental Health/Chemical Dependency

Inpatient Facility Fee - Days 1-5

Inpatient Facility Fee - After day 5

Office Visit

 

$450 Copay/Day

No Charge

$65 Copay

Prescription Drug Service

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail (per 30 day supply)/Mail Order (per 90-day supply)

$15 Copay/$37.50 Copay

$75 Copay/$187.50 Copay

$100 Copay/$250 Copay

Not Covered

NOTE: *Coinsurance after deductible

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

 

 

Saver HSA Plan

Reference Based Pricing

Deductible

Individual

Family

 

$6,450

$12,900

Out-of-Pocket Maximum

Individual

Family

 

$6,450

$12,900

Preventive Care

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

Urgent Care Services

0%*

Complex Imaging: MR/CT/PET Scans

0%*

Inpatient Hospital Care

Facility Fee - Days 1-5

Facility Fee - After day 5

Physician Fee

 

0%*

No Charge

0%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

Emergency Room

Emergency Medical Transportation

0%*

20%*

Mental Health/Chemical Dependency

Inpatient Facility Fee - Days 1-5

Inpatient Facility Fee - After day 5

Office Visit

 

0%*

No Charge

0%*

Prescription Drug Service

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail (per 30 day supply)/Mail Order (per 90-day supply)

0%*

0%*

0%*

Not Covered

NOTE: *Coinsurance after deductible

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

 

 

Freedom Bronze Plan

Reference Based Pricing

Deductible

Individual

Family

 

$8,550

$17,100

Out-of-Pocket Maximum

Individual

Family

 

$8,550

$17,100

Preventive Care

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$35 Copay

$50 Copay

0%*

Urgent Care Services

0%*

Complex Imaging: MR/CT/PET Scans

0%*

Inpatient Hospital Care

Facility Fee - Days 1-5

Facility Fee - After day 5

Physician Fee

 

0%*

No Charge

0%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

Emergency Room

Emergency Medical Transportation

0%*

0%*

Mental Health/Chemical Dependency

Inpatient Facility Fee - Days 1-5

Inpatient Facility Fee - After day 5

Office Visit

 

0%*

No Charge

0%*

Prescription Drug Service

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail (per 30 day supply)/Mail Order (per 90-day supply)

$10 Copay/$25 Copay

Not Covered

Not Covered

Not Covered

NOTE: *Coinsurance after deductible

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

 

 

Value Essential Plan

Reference Based Pricing

Deductible

Individual

Family

 

Not Applicable

Not Applicable

Out-of-Pocket Maximum

Individual

Family

 

Not Applicable

Not Applicable

Preventive Care

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$50 Copay

$50 Copay

Urgent Care Services

$75 Copay

Complex Imaging: MR/CT/PET Scans

$200 Copay

Inpatient Hospital Care

Facility Fee - Days 1-5

Physician Fee

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

Not Covered

Not Covered

Emergency Room

Emergency Medical Transportation

$350 Copay

Not Covered

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

Not Covered

Not Covered

Prescription Drug Service

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail (per 30 day supply)/Mail Order (per 90-day supply)

$10 Copay/$20 Copay

100% Copay

100% Copay

Not Covered

NOTE: *Coinsurance after deductible

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

 

 

If you prefer talking with a HealthEZ representative, call 1-844-839-6740