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.


Summary of Medical Benefits

Minimum Essential Coverage Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

N/a

N/a

 

N/a

N/a

Preventative Care- Children

Assessments & Screenings

Immunizations

Supplements

 

100% Covered

100% Covered

100% Covered

 

No Coverage

No Coverage

No Coverage

Preventive Care - Women

Breastfeeding Support

Contraception

Screenings

Folic Acid Supplements

Routine Prenatal Visits

Well-Woman Visits

 

100% Covered

100% Covered

100% Covered

100% Covered

100% Covered

100% Covered

 

No Coverage

No Coverage

No Coverage

No Coverage

No Coverage

No Coverage

Preventive Care - Adults

Assesments & Screenings

Immunizations

 

100% Covered

100% Covered

 

No Coverage

No Coverage

Office Visits

Primary Services

Specialis Services

Urgent Care

 

No Coverage

No Coverage

No Coverage

 

No Coverage

No Coverage

No Coverage

Urgent Care Services

No Coverage

No Coverage

Emergency Services

No Coverage

No Coverage

Hospital Services

No Coverage

No Coverage

Prescription Drug Coverage

Preventive

Non-Preventive Generic

Non-Preventive Preferred brand

Non-Preventive Non-preferred brand

Non-Preventive Specialty

Retail 30 Day Supply

100% Covered

No Coverage

No Coverage

No Coverage

No Coverage

Mail Order 90 Day Supply

No Coverage

No Coverage

No Coverage

No Coverage

No Coverage


If you prefer talking with a HealthEZ representative, call 844-302-7774