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
HSA Plan
In-Network
Out-Of-Network
Calendar Year Deductible
Individual
Individual under Family
Family
$3,300
$6,400
$12,800
Out-Of-Pocket Maximum
$10,000
$20,000
Preventive Care
No Chage
20%*
Office Visits
Primary Office Visit
Specialist Office Visit
Chiropractic Visit
0%*
Urgent Care Services
Complex Imaging: MRI/CT/PET Scans
Hospital Services Inpatient & Outpatient
Emergency Services**
Emergency Room
Emergency Medical Transportation
20%**
Chiropractic Services
Mental Health / Chemical Dependency
Inpatient
Outpatient
Prescription Drug Coverage
Generic
Preferred brand
Non-preferred brand
Specialty
Retail 30 Day Supply
Mail Order 90 day Supply
Not Available
NOTE: * After deductible
** True emergencies covered at in-network level
Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions
If you prefer talking with a HealthEZ representative, call 1-866-768-9685