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

Copay Plan 1

APPO Elite Network

APPO Network (Tier 2)

Out of Network

Calendar Year Accumulation

Medical Deductible

Individual

Family

 

 

$1,500

$4,500

 

 

$2,500

$6,000

 

 

$7,500

$15,000

Coinsurance

15%

25%

50%

Out-of-Pocket Max

Individual

Family

 

$3,000

$6,000

 

$4,500

$8,000

 

$15,000

$30,000

Preventive Care

100% Covered

100% Covered

50% After Deductible

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

$35 Copay

$35 Copay

$35 Copay

 

$50 Copay

$50 Copay

$50 Copay

 

50% After Deductible

50% After Deductible

50% After Deductible

Hospital Services

15% After Deductible

25% After Deductible

50% After Deductible

Emergency Services*

Emergency Room

Emergency Medical Transportation

 

15% After Deductible

15% After Deductible

 

25% After Deductible

25% After Deductible

 

50% After Deductible

50% After Deductible

Urgent Care Services

$35 Copay

$75 Copay

50% After Deductible

Mental Health/Chemical Dependency

Inpatient

Outpatient

 

15% After Deductible

$35 Copay

 

25% After Deductible

$50 Copay

 

50% After Deductible

50% After Deductible

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Not Applicable

 

Not Applicable

Not Applicable

Not Applicable

Not Applicable

Retail (Per 30 Day Supply)/Mail Order (Per 90 Day Supply)

 

$10 Copay / $20 Copay

$50 Copay / $100 Copay

$90 Copay / $180 Copay

20% Coinsurance up to $200

Not Applicable

 

Not Applicable

Not Applicable

Not Applicable

Not Applicable

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

* Covered as in-network in true-emergency

** Combined with Medical Deductible

 

 

 

 

 

 

 

 

 

HSA Plan 1

APPO Elite Network

APPO Network (Tier 2)

Out of Network

Calendar Year Accumulation

Medical Deductible

Individual

Family

 

 

$3,000

$6,000

 

 

$4,500

$9,000

 

 

$7,500

$15,000

Coinsurance

0%

0%

50%

Out-of-Pocket Max

Individual

Family

 

$3,000

$6,000

 

$4,500

$9,000

 

$15,000

$30,000

Preventive Care

100% Covered

100% Covered

50% After Deductible

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

0% After Deductible

0% After Deductible

0% After Deductible

 

0% After Deductible

0% After Deductible

0% After Deductible

 

50% After Deductible

50% After Deductible

50% After Deductible

Hospital Services

0% After Deductible

0% After Deductible

50% After Deductible

Emergency Services*

Emergency Room

Emergency Medical Transportation

 

0% After Deductible

0% After Deductible

 

0% After Deductible

0% After Deductible

 

50% After Deductible

50% After Deductible

Urgent Care Services

0% After Deductible

0% After Deductible

50% After Deductible

Mental Health/Chemical Dependency

Inpatient

Outpatient

 

0% After Deductible

0% After Deductible

 

0% After Deductible

0% After Deductible

 

50% After Deductible

50% After Deductible

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

Not Applicable

Not Applicable

Not Applicable

Not Applicable

Not Applicable

Retail (Per 30 Day Supply)/Mail Order (Per 90 Day Supply)

0% After Deductible

0% After Deductible

0% After Deductible

0% After Deductible

Not Applicable

Not Applicable

Not Applicable

Not Applicable

Not Applicable

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

* Covered as in-network in true-emergency

** Combined with Medical Deductible

 

 

 

 

 

 

 

 

 

If you prefer talking with a HealthEZ representative, call 866-490-6177