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.

Questions about your benefits?

service@healthez.com

Register your myHealthEZ account

>>Click here


Summary of Medical Benefits

Base Plan

Katy Trail Community Health

Tier 2: HealthLink/FNS/FirstHealth

Out-of-Network

Calendar Year Deductible

Individual

Individual Under Family

Family

 

$0

$0

$0

 

$5,000

$5,000

$10,000

 

$5,000

$5,000

$10,000

Out-of-Pocket Maximum

Individual

Individual Under Family

Family

 

$0

$0

$0

 

$6,500

$6,500

$13,000

 

$13,000

$13,000

$26,000

Preventive Care Services

No Charge

No Charge

40%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

No Charge

No Charge

Not Available

 

$40 Copay

$80 Copay

$80 Copay

 

40%*

40%*

40%*

Urgent Care Services

Not Available

$40 Copay

$80 Copay

Complex Imaging: MRI/CT/PET Scans

Not Available

$400 Copay

40%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

Not Available

Not Available

 

20%*

20%*

 

40%*

40%*

Outpatient Procedures

Facility Fee

Physician Fee

 

Not Available

Not Available

 

20%*

20%*

 

40%*

40%*

Emergency Room

Facility Fee

Physician Fee

Medical Transportation

 

Not Available

Not Avaialbe

Not Available

 

$100 Copay, then 20% Coinsurance

20% Coinsurance

20%*

 

$100 Copay, then 20% Coinsurance

20% Coinsurance

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

Not Available

No Charge

 

20%*

$80 Copay

 

40%*

40%*

NOTE: * Coinsurance after deductible

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

 

 

 

 

 

 

Buy Up Plan

Katy Trail Community Health

Tier 2: HealthLink/FNS/FirstHealth

Out-of-Network

Calendar Year Deductible

Individual

Individual Under Family

Family

 

$0

$0

$0

 

$1,000

$1,000

$2,000

 

$1,000

$1,000

$2,000

Out-of-Pocket Maximum

Individual

Individual Under Family

Family

 

$0

$0

$0

 

$4,000

$4,000

$8,000

 

$8,000

$8,000

$16,000

Preventive Care Services

No Charge

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

No Charge

No Charge

Not Available

 

$30 Copay

$60 Copay

$60 Copay

 

50%*

50%*

50%*

Urgent Care Services

Not Available

$30 Copay

$60 Copay

Complex Imaging: MRI/CT/PET Scans

Not Available

$400 Copay

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

Not Available

Not Available

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

Not Available

Not Available

 

20%*

20%*

 

50%*

50%*

Emergency Room

Facility Fee

Physician Fee

Medical Transportation

 

Not Available

Not Avaialbe

Not Available

 

$100 Copay, then 20% Coinsurance

20% Coinsurance

20%*

 

$100 Copay, then 20% Coinsurance

20% Coinsurance

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

Not Available

No Charge

 

0%*

$60 Copay

 

20%*

50%*

NOTE: * Coinsurance after deductible

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

 

 

 

 

 

 

If you prefer talking with a HealthEZ representative, call 844-617-1890