Compare Plans
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
Plan 1
In-Network
Out-of-Network
Deductible
Individual
Individual Under Family
Family
$1,600
$4,800
Out-Of-Pocket Maximum
Preventive Care Services
No Charge
No Charge up to $500 per Deductible Year, then 45% Coinsurance After Deductible
Office Visits
Primary Office Visit
Specialist Office Visit
Chiropractic Visit
$35 Copay
45% Coinsurance After Deductible
Urgent Care Services
Complex Imaging: MRI/CT/PET Scans
KIS Imaging
Non-KIS Imaging
20% Coinsurance After Deductible
Not Covered
Inpatient Hospital Care
Facility Fee
Physician Fee
$500 Copay per confinement, then 20% Coinsurance After Deductible
Outpatient Procedures
$500 Copay, then 20% Coinsurance After Deductible
Emergency Room
Emergency Medical Transportation
Mental Health/Chemical Dependency
Inpatient
Office Visit
Prescription Drug Coverage
Generic
Preferred brand
Non-preferred brand
Specialty
$20 Copay
$25 Copay
$20/$25/$35 Copay
Not available
Over-the-Counter COVID-19 Tests
2 per year, per individual
*Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions
Plan 2
$800
$2,400
$7,200
$30 Copay
15% Coinsurance After Deductible
$500 Copay per confinement, then 15% Coinsurance After Deductible
$500 Copay, then 15% Coinsurance After Deductible
$8 Copay
$15 Copay
$8/$15/$25 Copay
Plan 3
$300
$900
$600
$1,800
$1,500
$4,500
10% Coinsurance After Deductible
$500 Copay per confinement, then 10% Coinsurance After Deductible
$500 Copay, then 10% Coinsurance After Deductible
$5 Copay
$18 Copay
$5/$8/$18Copay
If you prefer talking with a HealthEZ representative, call 844-804-8121