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

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 Services

No Charge

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

Not Covered

Not Covered

Not Covered

 

Not Covered

Not Covered

Not Covered

Urgent Care Services

Not Covered

Not Covered

Complex Imaging: MRI/CT/PET Scans

Not Covered

Not Covered

Inpatient Hospital Care

Facility Fee

Physician Fee

 

Not Covered

Not Covered

 

Not Covered

Not Covered

Outpatient Procedures

Facility Fee

Physician Fee

 

Not Covered

Not Covered

 

Not Covered

Not Covered

Emergency Room

Emergency Medical Transportation

Not Covered

Not Covered

Not Covered

Not Covered

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

Not Covered

Not Covered

 

Not Covered

Not Covered

Prescription Drug Coverage

Preventive Prescriptions

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

No Charge

Not Covered

Not Covered

Not Covered

Not Covered

Mail Order 90 Day Supply

No Charge

Not Covered

Not Covered

Not Covered

Not Covered

Teladoc Benefits

General Consultations

 

No Charge

 

No Charge

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