Plan Details

Summary of Medical Benefits

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

MEC Plus Plan

In-Network

Out-Of-Network

Calendar Year Deductible

Individual

Family

 

N/A

N/A

 

N/A

N/A

Out-of-Pocket Maximum

Individual

Family

 

N/A

N/A

 

N/A

N/A

Preventive Care

No Charge

No Coverage

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$50 Copay

$75 Copay

 

No Coverage

No Coverage

No Coverage

Urgent Care Services

$50 Copay

No Coverage

Complex Imaging: MRI/CT/PET Scans

$200 Copay

No Coverage

Hospital Inpatient & Outpatient Services

No Coverage

No Coverage

Emergency Services

No Coverage

No Coverage

Mental Health

Inpatient

Office Visit

 

No Coverage

$75 Copay

 

No Coverage

No Coverage

Teladoc Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, initial evaluation

Mental Health - Psychiatrist, ongoing session

 

No Charge

$85 Copay

$90 Copay

$220 Copay

$100 Copay

 

No Charge

$85 Copay

$90 Copay

$220 Copay

$100 Copay

Prescription Drug Coverage

Preventive

Generic

Preferred brand

Brand Non-Formulary

Specialty Drugs

Retail 30 Day Supply

No Charge

$10 Copay

100% Copay

No Coverage

No Coverage

Mail Order 90 Day Supply

No Charge

No Coverage

100% Copay

No Coverage

No Coverage


If you prefer talking with a HealthEZ representative, call 888-701-2975