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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

$2,000 PPO Plan

Tier 1: Missouri Health Cooperative

Tier 2: Freedom Select Network/HealthLink

Out-of-Network

Calendar Year Deductible

Individual

Individual under Family

Family

 

$500

$500

$1,000

 

$2,000

$2,000

$6,000

 

$3,000

$3,000

$9,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$1,000

$1,000

$2,000

 

$6,000

$6,000

$17,000

 

$12,000

$12,000

$36,000

Preventative Services

No Charge

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$5 Copay

$10 Copay

50%*

 

$40 Copay

$60 Copay

50%*

 

50%*

50%*

50%*

Urgent Care Services

$10 Copay

$100 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

10%*

30%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

30%*

30%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

30%*

30%*

 

50%*

50%*

Emergency Room Care

Facility Fee

Physician Fee

Emergency Medical Transportation**

 

$100 Copay

10%*

10%*

 

$300 Copay

30%*

30%*

 

50%*

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

$5 Copay

 

30%*

$40 Copay

 

50%*

50%*

NOTE: * Coinsurance After Deductible

** Covered as in-network in true-emergency

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

 

 

 

 

 

 

 

 

 

$4,500 PPO Plan

Tier 1: Missouri Health Cooperative

Tier 2: Freedom Select Network/HealthLink

Out-of-Network

Calendar Year Deductible

Individual

Individual under Family

Family

 

$1,000

$1,000

$2,000

 

$4,500

$4,500

$9,000

 

$9,000

$9,000

$18,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$2,000

$2,000

$4,000

 

$7,000

$7,000

$14,000

 

$14,500

$14,500

$36,000

Preventative Services

No Charge

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$5 Copay

$10 Copay

50%*

 

$40 Copay

$60 Copay

50%*

 

50%*

50%*

50%*

Urgent Care Services

$10 Copay

$100 Copay

50%*

Complex Imaging: MRI/CT/PET Scans

10%*

30%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

30%*

30%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

30%*

30%*

 

50%*

50%*

Emergency Room Care

Facility Fee

Physician Fee

Emergency Medical Transportation**

 

$100 Copay

10%*

10%*

 

$300 Copay

30%*

30%*

 

50%*

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

$5 Copay

 

30%*

$40 Copay

 

50%*

50%*

NOTE: * Coinsurance After Deductible

** Covered as in-network in true-emergency

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

 

 

 

 

 

 

 

 

 

HSA Plan 1

In-Network

Out-of-Network

Calendar Year Deductible

Individual

Individual under Family

Family

 

$6,000

$6,000

$12,000

 

$12,000

$12,000

$24,000

Embedded Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$6,000

$6,000

$12,000

 

$14,000

$14,000

$28,000

Preventative Services

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

30%*

30%*

30%*

Urgent Care Services

0%*

30%*

Complex Imaging: MRI/CT/PET Scans

0%*

30%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

30%*

30%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

30%*

30%*

Emergency Room Services**

Emergency Medical Transportation**

0%*

0%*

30%*

30%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

30%*

30%*

NOTE: * Coinsurance After Deductible

** Covered as in-network in true-emergency

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

 

 

 

 

 

 

If you prefer talking with a HealthEZ representative, call 844-620-8676