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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

Cigna Plan

In-Network

Out-Of-Network

Deductible

Individual

Family

 

$6,500

$13,000

 

N/A

N/A

Out-Of-Pocket Maximum

Indidivual

Family

 

$6,500

$13,000

 

N/A

N/A

Preventive Care Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$40 Copay

$65 Copay

$50 Copay

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

$110 Copay

Not Covered

Complex Imaging: MRI/CT/PET Scans

No Charge

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

Not Covered

Not Covered

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$500 Copay

0%*

 

Not Covered

Not Covered

Mental health/Chemical Dependency

Inpatient

Office Visit

 

0%*

$50 Copay

 

Not Covered

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

No Charge

$75 Copay

No Charge

No Charge

No Charge

 

No Charge

$75 Copay

No Charge

No Charge

No Charge

Prescription Drug Coverage

Generic

Formulary

Non-Formulary

Specialty

Retail 30 Day Supply

$10 Copay

25% Coinsurance

50% Coinsurance

Not Covered

Mail Order 90 day Supply

$10 Copay

25% Coinsurance

50% Coinsurance

Not Covered

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

 

 

 

 

 

 

PHCS Plan

In-Network

Out-Of-Network

Deductible

Individual

Family

 

$6,500

$13,000

 

N/A

N/A

Out-Of-Pocket Maximum

Indidivual

Family

 

$6,500

$13,000

 

N/A

N/A

Preventive Care Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$40 Copay

$65 Copay

$50 Copay

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

$110 Copay

Not Covered

Complex Imaging: MRI/CT/PET Scans

No Charge

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

0%*

0%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

0%*

0%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$500 Copay

0%*

 

$500 Copay

Not Covered

Mental health/Chemical Dependency

Inpatient

Office Visit

 

0%*

$50 Copay

 

0%*

Not Covered

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

No Charge

$75 Copay

No Charge

No Charge

No Charge

 

No Charge

$75 Copay

No Charge

No Charge

No Charge

Prescription Drug Coverage

Generic

Formulary

Non-Formulary

Specialty

Retail 30 Day Supply

$10 Copay

25% Coinsurance

50% Coinsurance

Not Covered

Mail Order 90 day Supply

$10 Copay

25% Coinsurance

50% Coinsurance

Not Covered

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

 

 

 

 

 

 


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