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

MEC Plan

In-Network

Out-of-Network

Deductible

Employee only

Family

 

N/A

N/A

 

N/A

N/A

Out-of-Pocket Maximum

Employee only

Family

 

N/A

N/A

 

N/A

N/A

Preventive Care

100% Covered

No Coverage

Teladoc Services

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

100% Covered

No Coverage

No Coverage

No Coverage

No Coverage

 

100% Covered

No Coverage

No Coverage

No Coverage

No Coverage

Office Visits

Primary Services

Specialist Services

Chiropractic Services

 

No Coverage

No Coverage

No Coverage

 

No Coverage

No Coverage

No Coverage

Urgent Care Services

No Coverage

No Coverage

Emergency Services

Emergency Room

Emergency Medical Transportation

 

No Coverage

No Coverage

 

No Coverage

No Coverage

Hospital Services

Inpatient Care

Outpatient Surgery

 

No Coverage

No Coverage

 

No Coverage

No Coverage

Labs & Scans

Office Visit Lab

Outpatient Lab

Outpatient X-Ray

Outpatient Major Diagnostic

 

No Coverage

No Coverage

No Coverage

No Coverage

 

No Coverage

No Coverage

No Coverage

No Coverage

Mental Health/Chemical Dependency

Inpatient

Outpatient

 

No Coverage

No Coverage

 

No Coverage

No Coverage

Summary of Pharmacy Benefits

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

100% Covered

No Coverage

No Coverage

No Coverage

No Coverage

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