Plan Details

Plan Details

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.


Summary of Medical Benefits

Reference Based Pricing Plan 1

Reference Based Pricing

Deductible

Individual

Family

 

$1,000

$2,000

Out-of-Pocket Maximum

Individual

Family

 

$2,000

$4,000

Preventative Care

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$40 Copay

$20 Copay

Urgent Care Services

$75 Copay

Complex Imaging: MRI/CT/PET Scans

20%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$375 Copay

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

$20 Copay

Teledoc Services

General Consultations

Dermatology

Mental Health- Therapist

Mental Health- Psychiatrist, initial evaluation

Mental Health- Psychiatrist, ongoing session

 

No Charge

No Charge

No Charge

No Charge

No Charge

NOTE: * Coinsurance After Deductible

** Referenced Based Pricing applies unless a network is utilized

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

 

 

 

Summary of Pharmacy Benefits

Retail 30 Day Supply

Mail Order 90 Day Supply

Prescription Drug Coverage

Generic

Preferred Brand

Non-preferred Brand

Specialty

 

$10 Copay

$35 Copay

$70 Copay

Not Covered

 

$10 Copay

$88 Copay

$175 Copay

Not Covered


If you prefer talking with a HealthEZ representative, call 888-592-6267