Compare Plans

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

Copay Plan

Tier 1: Olmsted Medical Center

Tier 2: America's PPO/Aetna

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$750

$750

$2,250

 

$1,000

$1,000

$3,000

 

$1,000

$1,000

$3,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$3,500

$3,500

$7,000

 

$4,500

$4,500

$9,000

 

$4,500

$4,500

$9,000

Preventative Services

No Charge

No Charge

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$30 Copay

$30 Copay

Not Available

 

$30 Copay, then 20% Coinsurance

$30 Copay, then 20% Coinsurance

20%*

 

40%*

40%*

40%*

Urgent Care Services

$30 Copay

$30 Copay, then 20% Coinsurance

40%*

Complex Imaging: MRI/CT/PET Scans

10%*

20%*

40%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

20%*

20%*

 

40%*

40%*

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

20%*

20%*

 

40%*

40%*

Emergency Room Services

Facility Fee

Physician Fee

Emergency Medical Transportation

 

$50 Copay, then 10% Coinsurance

10%*

10%*

 

$50 Copay After Deductible

20%*

20%*

 

40%*

40%*

40%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

Not Available

$30 Copay

 

20%*

$30 Copay, then 20% Coinsurance

 

40%*

40%*

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.

 

 

 

HDHP w/HRA Plan

Tier 1: Olmsted Medical Center

Tier 2: America's PPO/Aetna

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$1,000

$1,000

$2,000

 

$2,000

$2,000

$4,000

 

$2,000

$2,000

$4,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$4,500

$4,500

$9,000

 

$5,500

$5,500

$11,000

 

$5,500

$5,500

$11,000

Preventative Services

No Charge

No Charge

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

10%*

10%*

Not Available

 

20%*

20%*

20%*

 

40%*

40%*

40%*

Urgent Care Services

10%*

20%*

40%*

Complex Imaging: MRI/CT/PET Scans

10%*

20%*

40%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

20%*

20%*

 

40%*

40%*

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

20%*

20%*

 

40%*

40%*

Emergency Room Services

Facility Fee

Physician Fee

Emergency Medical Transportation

 

10%*

10%*

10%*

 

20%*

20%*

20%*

 

40%*

40%*

40%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

Not Available

10%*

 

20%*

20%*

 

40%*

40%*

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.

 

 

 

QHDHP w/HSA Plan

Tier 1: Olmsted Medical Center

Tier 2: America's PPO/Aetna

Out-of-Network

Deductible

Individual

Individual under Family

Family

 

$3,500

$3,500

$7,000

 

$3,500

$3,500

$7,000

 

$3,500

$3,500

$7,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$5,000

$5,000

$10,000

 

$6,000

$6,000

$12,000

 

$6,000

$6,000

$12,000

Preventative Services

No Charge

No Charge

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

10%*

10%*

Not Available

 

20%*

20%*

20%*

 

40%*

40%*

40%*

Urgent Care Services

10%*

20%*

40%*

Complex Imaging: MRI/CT/PET Scans

10%*

20%*

40%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

20%*

20%*

 

40%*

40%*

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

20%*

20%*

 

40%*

40%*

Emergency Room Services

Facility Fee

Physician Fee

Emergency Medical Transportation

 

10%*

10%*

10%*

 

20%*

20%*

20%*

 

40%*

40%*

40%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

Not Available

10%*

 

20%*

20%*

 

40%*

40%*

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 888-284-7194