Plan Details

Not all coverage is the right coverage.

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 Enhanced Schedule of Benefits

In-Network

Out-of-Network

Deductible

Individual

Individual Under Family

Family

 

n/a

n/a

n/a

 

n/a

n/a

n/a

Out-of-Pocket Maximum

Individual

Individual Under Family

Family

 

n/a

n/a

n/a

 

n/a

n/a

n/a

Preventive Care Services

No Charge

Not Covered

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$50 Copay

$50 Copay

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

$75 Copay

Not Covered

Complex Imaging: MRI/CT/PET Scans

$500 Copay

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

$1,000 benefit per year, then Not Covered

$1,000 benefit per year, then Not Covered

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

$1,000 benefit per year, then Not Covered

$1,000 benefit per year, then Not Covered

 

Not Covered

Not Covered

Emergency Room

Ground Amublance

$500 Copay

$500 Copay

Not Covered

Not Covered

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

$1,000 benefit per day, then Not Covered

$50 Copay

 

Not Covered

Not Covered

Prescription Drug Coverage

Preventive

Generic

Preferred brand

Brand Non-Formulary

Specialty Drugs

Retail 30 Day Supply

No Charge

$25 Copay

$50 Copay

Not Covered

Not Covered

Mail Order 90 Day Supply

No Charge

$50 Copay

$100 Copay

Not Covered

Not Covered

Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions

 

 

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