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.

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Summary Of Medical Benefits

US Medical HSA Plan

In-Network

Out-Of-Network

In-Network

Out-of-Network

Calendar Year Deductible

Employee Only

Family

 

$3,000

$6,000

 

$6,000

$12,000

Coinsurance

20%*

50%*

Out-Of-Pocket Maximum

Employee Only

Family

 

$6,000

$12,000

 

$12,000

$24,000

Preventive Care

100% Covered

50%*

Office Visits

Primary Services

Specialist Services

 

20%*

20%*

 

50%*

50%*

Hospital Services

20%*

50%*

Emergency Services

Emergency Room

Emergency Medical Transportation

 

20%*

20%*

 

50%*

50%*

Urgent Care Services

20%*

50%*

Chiropractic Services

20%*

50%*

Mental Health / Chemical Dependency

Inpatient

Outpatient

 

20%*

20%*

 

50%*

50%*

Retail 30 Day Supply

Mail Order 90 day Supply

Prescription Drug Coverage

Generic

Preferred brand

Non-preferred brand

Specialty

 

20%*

20%*

20%*

20%*

 

20%*

20%*

20%*

Not Available

* After deductible

 

 


If you prefer talking with a HealthEZ representative, call 877-321-3167