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.
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Summary of Medical Benefits
$2,000 Plan
In-Network
Out-of-Network
Deductible
Individual
Family
$2,000
$4,000
$8,000
Out-of-Pocket Maximum
$7,000
$14,000
$28,000
Preventive Care Services
No Charge
Not Covered
Office Visits
Primary Office Visit
Specialist Office Visit
Chiropractic Visit
$30 Copay
$60 Copay
40%*
Urgent Care Services
$75 Copay
Complex Imaging: MRI/CT/PET Scans
20%*
Inpatient Hospital Care
Facility Fee
Physician Fee
Outpatient Procedures
Emergency Room
Emergency Medical Transportation
$500 Copay
Mental Health/Chemical Dependency
Inpatient
Office Visit
Prescription Drug Coverage
Generic
Preferred Brand
Non-Preferred Brand
Specialty
Retail 30 Day Supply
$25 Copay
$50 Copay
$100 Copay
Mail Order 90 Day Supply
$65 Copay
$125 Copay
Not Available
Teladoc Services
General Consultations
Dermatology
Therapist
Psychiatrist - Initial Evaluation
Psychiatrist - Ongoing Evaluation
NOTE: * Coinsurance After Deductible
Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions
$4,000 Plan
$16,000
$9,000
If you prefer talking with a HealthEZ representative, call 888-592-6344