|

|
|
CeltiCare "Any Doc" PPO Plan
(Hospital Network Only)
You don't have to change doctors to realize the
advantage of a low office visit copayment. With the Celtic "Any
Doc" PPO you have the flexibility to choose your own physician while saving
money with the preferred rates of our prominent nationwide hospital network.
In offering this PPO plan, Celtic is in partnership with Private HealthCare
Systems (PHCS), a widely-respected national network.
Note: The CeltiCare "Any Doc" PPO is
available in areas in which there are Preferred Provider Hospitals.
|
|
Features/Benefits
|
80/20
|
100%
|
|
Coinsurance
|
80/20 Coverage after deductible of the next $5,000
|
100% Coverage after deductible
|
|
Deductibles
|
$250
|
$500
|
$1,000
|
$1,000
|
$2,500
|
$5,000
|
|
Out-of-Pocket Maximum
|
$1,250
|
$1,500
|
$2,000
|
$1,000
|
$2,500
|
$5,000
|
|
Lifetime Maximum
|
$5,000,000
|
$5,000,000
|
|
Non-preventive office visits to any doctor
|
$25 copay
|
$25 copay
|
|
Emergency Room Deductible (in addition to plan
deductible)
|
$50 deductible per visit, if not admitted.
|
$50 deductible per visit, if not admitted.
|
|
Out-of-Network Services at Hospitals per
occurrence
|
Eligible charges reduced additional 20% capped
at $5,000 per occurrence.
|
Eligible charges reduced additional 20% capped
at $5,000 per occurrence.
|
|
Supplemental Accident
|
$500 per injury
|
$500 per injury
|
|
FREE RX Discount Card
|
An average savings of 15% at over 40,000 U.S
pharmacies.
|
|
Psychiatric Care*
|
Inpatient annual maximum of $2,500 per person, per
calendar year. Outpatient annual maximum of $1,000 per person per
calendar year. Lifetime maximum of $10,000 per person per inpatient and
outpatient combined.
|
|
Manipulative Therapy (benefits vary by state)
|
$500 maximum per person, per calendar year.
|
|
Hospital
|
Average semi-private room rate. Intensive care
at four times the average semi-private room rate.
|
|
Home Health Care
|
30 visits per person, per calendar year, one visit per
day.
|
|
Rehabilitation Facility
|
Inpatient - up to 30 days confinement per person, per
calendar year.
|
|
Rehabilitation Therapy
|
Outpatient - up to 30 visits per person, per calendar
year.
|
|
Extended Care Facility
|
Up to 12 days of confinement, per person, per calendar
year.
|
|
Transplants
|
Covered up to amount negotiated by network if
Transplant Network used; capped at $100,000 per procedure if insured goes out of
network.
|
|
Optional Features/Benefits
|
CeltiCare Plus Option
|
Term Life Insurance Option not available
in all states
|
Important Note: The
information contained on this web page and the other linked pages is not
intended to provide full details of Celtic plans and may change at the
discretion of Celtic Insurance Company. Benefits and Plan details may vary
by state. Complete terms of coverage are outlined in the individual
Certificate Booklets and set forth in the applicable insurance Policy and Trust
agreement. In applying for coverage, the primary insured agrees to be
bound by the Certificate. The benefits described in these pages and any
accompanying literature are the standard benefits offered by Celtic.
Policy provisions vary in some states.
| |