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
Copay Plan
In-Network
Out-Of-Network
Deductible
Individual
Family
$500
$1,000
$3,000
$6,000
Out-Of-Pocket Maximum
$10,000
$20,000
Preventive Care
No Charge
40%*
Office Visits
Primary Office Visit
Specialist Office Visit
Chiropractic Visit
$20 Copay
Complex Imaging: MRI/CT/PET Scans
20%*
Emergency Services
Emergency Room
Emergency Medical Transportation
$250 Copay
Mental Health / Chemical Dependency
Inpatient
Office Viist
Prescription Drug Coverage
Generic
Preferred brand
Non-preferred brand
Specialty
Retail 30 Day Supply
$15 Copay
$35 Copay
$65 Copay
$200 Copay
Mail Order 90 day Supply
$30 Copay
$70 Copay
$130 Copay
Not available
NOTE: * Coinsurance after deductible
Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions
If you prefer talking with a HealthEZ representative, call 844-801-1911