Everything You Want to Know About EASE Plans – Zupnick Associates

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(by Edward Mimi)

EASE plans provide various designs that meet each employee’s needs. They include the following:

1.  EASE Primary

The plan provides savings for daily coverage like urgent healthcare for copays of $25 and $10 per visit, and unlimited primary healthcare. It covers all wellness benefits and mandated preventive benefits under the Affordable Care Act (ACA) without cost-sharing to offer Minimum Essential Coverage. The coverage is suitable for people who want to reduce their health coverage costs.

The following are EASE Primary plan’s costs:

  •         Deductible: $0 for individuals and families
  •         Out of Pocket Maximum: $0 for individuals and families
  •         Preventive and Wellness Services: $0 Copay
  •         Telemedicine Services: $0
  •         Direct Primary Care (DPC): $10 Copay for a primary doctor and $25 for Urgent Healthcare
  •         Pharmacy Benefits: $0 Copay

 

2.  EASE Essential

The healthcare insurance provides Minimum Essential Coverage like supplemental hospitalization benefits, primary care coverage, wellness, and preventive benefits without cost-sharing. Besides, EASE Essential offers daily coverage. Here are its payments:

  •         Deductible: $0 for individuals and families.
  •         Out of Pocket Maximum: $8,150 for individuals and $16,300 for families.
  •         Preventive and Wellness Services: $0 Copay.
  •         Primary Care Office Visit: $25 Copay for up to six visits per year.
  •         Specialist Office Visit: $50 Copay for six visits per year.
  •         Outpatient Services (Substance Abuse, Behavioral and Mental Health): $50 Copay for six visits per year with a Primary Care Office visit.
  •         Pharmacy Benefits: $0 Copay for preventive generic medicine.
  •         Supplemental Hospital Benefit: $5,000 and it is limited to $1,000 daily for 5 days.

 

3.  EASE Premium

The employer funded plan increases healthcare savings, has many benefits and its coverage resembles that of EASE Primary. It has Minimum Essential Coverage. The following are its costs:

  •         Deductible: $0 for individuals and families.
  •         Out of Pocket Maximum: $8,150 for individuals and $16,300 for families.
  •         Preventive and Wellness Services: $0 Copay
  •         Telemedicine Services: $0
  •         Direct Primary Care (DPC): $10 Copay for a primary doctor and $25 for Urgent healthcare.
  •         Primary Care Office Visit: $35 Copay for an existing doctor and $70 Copay for a new doctor.
  •         Specialist Office Visit: $75 Copay for an existing doctor and $150 Copay for a new doctor.
  •         Laboratory Service and Radiology: $50 Copay per image and panel.
  •         CT/MRI/MRA/Pet Scan: $500 Copay for each image.
  •         Urgent Care: $75 Copay.
  •         Outpatient Services (Substance Abuse, Behavioral and Mental Health): $75 Copay for an existing doctor and $150 Copay for a new doctor.
  •         Pharmacy Benefits: $0 Copay and it is limited to preventive generic medication.
  •         Supplemental Hospital Benefit: $5,000 and it is limited to $1,000 daily for five days.

 

4.  EASE Bronze

Besides providing Minimum Essential Coverage, EASE Bronze protects employers from different ACA penalties if they pay it for full-time workers. Here are its payments:

  •         Deductible: $0 for individuals and $0 for families.
  •         Out of Pocket Maximum: $8,150 for individuals and $16,300 for families.
  •         Preventive and Wellness Services: $0 Copay
  •         Telemedicine Services: $0
  •         Direct Primary Care (DPC): $10 Copay for a primary doctor and $25 for Urgent healthcare.
  •         Primary Care Office Visit: $25 Copay for up to eight visits per year.
  •         Specialist Office Visit: $50 Copay for three visits per year.
  •         Laboratory Service and Radiology: $50 Copay for three visits per year.
  •         CT/MRI/MRA/Pet Scan: $350 Copay per year.
  •         Urgent Care: $50 Copay for two visits per year.
  •         Outpatient Hospital/ Free Standing Facility Services and Surgery: $350 Copay for one visit per year.
  •         Inpatient Hospitalization and Inpatient Surgery: $350 Copay for each admission. It is limited to two surgeries and five days per year.
  •         Emergency Room Services: $350 Copay for one visit per year.
  •         Pharmacy Benefits: $0 Copay and it is limited to preventive generic medicine.
  •         Treatment for Chemical Abuse and Dependency: $25 Copay for outpatient daily and $250 for inpatient daily.
  •         Home Health Care: $25 Copay for up to 10 visits per year.

 

Employer-based healthcare plans are important. They help organizations retain skilled personnel and offer workers exceptional health services. It is advisable to choose health plans that accountants, employee benefits specialists, tax, and ERISA attorneys have built. Some of them cover employers against fines and ACA non-compliance penalties.

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