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
Reference Based Pricing Plan
In-Network
Out-Of-Network
Plan Year Deductible
Employee Only
Family
$3,000
$6,000
N/A
Coinsurance
20%
Out-Of-Pocket Maximum
$6,600
$13,200
Preventive Care
100% Covered
Office Visits
Primary Services
Specialist Services
$40 Copay
$60 Copay
Hospital Services
20%*
Emergency Services
Emergency Room
Emergency Medical Transportation
Urgent Care Services
$75 Copay
Chiropractic Services
Mental Health / Chemical Dependency
Inpatient
Outpatient
Retail 30 Day Supply
Mail Order 90 day Supply
Prescription Drug Coverage
Generic
Preferred brand
Non-preferred brand
Specialty
No Charge
$50 Copay
$100 Copay
$150 Copay
Not Available
* After deductible
If you prefer talking with a HealthEZ representative, call 1-844-204-3766