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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

RBP Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$3,500

$7,000

 

$3,500

$7,000

Out-of-Pocket Maximum

Individual

Family

 

$4,500

$9,000

 

$4,500

$9,000

Preventive Care Services

No Charge

No Charge

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

10%*

10%*

10%*

 

10%*

10%*

10%*

Urgent Care Services

10%*

10%*

Complex Imaging: MRI/CT/PET Scans

10%*

10%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

10%*

10%*

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

10%*

10%*

Emergency Room

Emergency Medical Transportation

10%*

10%*

10%*

10%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

10%*

10%*

 

10%*

10%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty

Retail 30 Day Supply

10%*

10%*

30%*

10%*

Mail Order 90 Day Supply

10%*

10%*

30%*

Not Covered

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 844-855-0621