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

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

Preventative Services

No Charge

No Coverage

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

No Coverage

No Coverage

No Coverage

 

No Coverage

No Coverage

No Coverage

Urgent Care Services

No Coverage

No Coverage

Complex Imaging: MRI/CT/PET Scans

No Coverage

No Coverage

Inpatient Hospital Care

Facility Fee

Physician Fee

 

No Coverage

No Coverage

 

No Coverage

No Coverage

Outpatient Procedures

Facility Fee

Physician Fee

 

No Coverage

No Coverage

 

No Coverage

No Coverage

Emergency Room Services

Emergency Medical Transportation

No Coverage

No Coverage

No Coverage

No Coverage

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

No Coverage

No Coverage

 

No Coverage

No Coverage

Prescription Drug Coverage

Preventative

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

No Charge

No Coverage

No Coverage

No Coverage

No Coverage

Mail Order 90 Day Supply

No Charge

No Coverage

No Coverage

No Coverage

No Coverage

If you prefer talking with a HealthEZ representative, call 1-844-302-7774