Compare Plans

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

$500 Copay Plan

In-Network

Out-of-Network

Deductible

Individual

Individual Under Family

Family

 

$500

$500

$1,000

 

$1,000

$1,000

$2,000

Out-of-Pocket Maximum

Individual

Individual Under Family

Family

 

$7,900

$7,900

$15,800

 

$15,800

$15,800

$31,600

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$30 Copay

$60 Copay

$60 Copay

 

50%*

50%*

50%*

Urgent Care Services

$30 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Emergency Room

Facility Fee

Physician Fee

Emergency Medical Transportation**

 

$1,000 Copay

No Charge

20%*

 

$1,000 Copay

No Charge

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$60 Copay

 

50%*

50%*

* Coinsurance after deductible

** Covered as in-network in true-emergency

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

 

 

 

 

 

 

$2,000 Copay Plan

In-Network

Out-of-Network

Deductible

Individual

Individual Under Family

Family

 

$2,000

$2,000

$4,000

 

$4,000

$4,000

$8,000

Out-of-Pocket Maximum

Individual

Individual Under Family

Family

 

$5,000

$5,000

$10,000

 

$10,000

$10,000

$20,000

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$50 Copay

$50 Copay

 

50%*

50%*

50%*

Urgent Care Services

$50 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Emergency Room

Facility Fee

Physician Fee

Emergency Medical Transportation**

 

$500 Copay

No Charge

20%*

 

$500 Copay

No Charge

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$50 Copay

 

50%*

50%*

* Coinsurance after deductible

** Covered as in-network in true-emergency

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

 

 

 

 

 

 

$5,500 Copay Plan

In-Network

Out-of-Network

Deductible

Individual

Individual Under Family

Family

 

$5,500

$5,500

$11,000

 

$11,000

$11,000

$22,000

Out-of-Pocket Maximum

Individual

Individual Under Family

Family

 

$8,550

$8,550

$17,100

 

$17,100

$17,100

$34,200

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$50 Copay

$75 Copay

$75 Copay

 

50%*

50%*

50%*

Urgent Care Services

$75 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

30%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

30%*

30%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

30%*

30%*

 

50%*

50%*

Emergency Room

Facility Fee

Physician Fee

Emergency Medical Transportation**

 

$1,000 Copay

No Charge

30%*

 

$1,000 Copay

No Charge

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

30%*

$75 Copay

 

50%*

50%*

* Coinsurance after deductible

** Covered as in-network in true-emergency

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

 

 

 

 

 

 

If you prefer talking with a HealthEZ representative, call 877-241-6293