Summary of Medical Benefits
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
Plan Year Deductible
Employee Only
Family
$3,200
$6,000
N/A
Coinsurance
20%
Out-Of-Pocket Maximum
$4,000
$8,000
Preventive Care
100% Covered
No Coverage
Office Visits
Primary Services
Specialist Services
20%*
Hospital Services Inpatients & 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
20% Coinsurance
*After Deductible
**Covered as in-network in true emergency
If you prefer talking with a HealthEZ representative, call 1-855-520-4328