March 21, 2010

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Celtic – CelticSaver HSA PPO Health Plan – CONNECTICUT

A comparison of the CelticSaver HSA PPO Health Plan offered by Celtic is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application CelticSaver HSA PPO Health Plan Application CelticSaver HSA PPO Health Plan Application
Brochure CelticSaver HSA PPO Health Plan Brochure CelticSaver HSA PPO Health Plan Brochure
Copay N/A N/A
Office Visit Subject to Deductible and Coinsurance Subject to Deductible and Coinsurance
Deductible CelticSaver HSA PPO Health Plan CelticSaver HSA PPO Health Plan
Coinsurance CelticSaver HSA PPO Health Plan CelticSaver HSA PPO Health Plan
Coinsurance Limit CelticSaver HSA PPO Health Plan CelticSaver HSA PPO Health Plan
Out-of-Pocket Maximum CelticSaver HSA PPO Health Plan CelticSaver HSA PPO Health Plan
Lifetime Maximum $7 Million $7 Million
Prescription Drugs Subject to Deductible and Coinsurance Subject to Deductible and Coinsurance
Emergency Room
  • $250 deductible [in addition to plan deductible] waived if admitted or if charges are due to an accident
    		•
  • $250 deductible [in addition to plan deductible] waived if admitted or if charges are due to an accident
    		•
    Adult Preventative Care
  • Periodic Health Exam (Preventive Care)- Subject to Deductible - Eligible Expenses Covered up to $300 per person per calendar year which includes annual eye exam.
  • Periodic OB-GYN Exam - Subject to Deductible and Coinsurance
    		•
  • Well baby Care - See Periodic Health Exam: Subject to Deductible - Eligible Expenses Covered up to $300 per person per calendar year which includes $50 for annual eye exam
    		•
    Child Preventative Care
  • Well baby Care - See Periodic Health Exam: Subject to Deductible - Eligible Expenses Covered up to $300 per person per calendar year which includes $50 for annual eye exam
    		•
  • Well baby Care - See Periodic Health Exam: Subject to Deductible - Eligible Expenses Covered up to $300 per person per calendar year which includes $50 for annual eye exam
    		•
    Lab / X-Ray Subject to Deductible and Coinsurance Subject to Deductible and Coinsurance
    Maternity
  • Maternity (Prenatal/Postnatal)- Not Covered - Varies by State
  • Maternity - Not Covered (except for complications of pregnancy) - Varies by State
    		•
  • Maternity (Prenatal/Postnatal)- Not Covered - Varies by State
  • Maternity - Not Covered (except for complications of pregnancy) - Varies by State
    		•
    Physical Therapy
  • Up to 30 visits per year
    		•
  • Up to 30 visits per year
    		•
    Skilled Nursing CelticSaver HSA PPO Health Plan CelticSaver HSA PPO Health Plan
    Home Health Care
  • 30 visits per person, per calendar year (Varies by State)
    		•
  • 30 visits per person, per calendar year (Varies by State)
    		•
    Mental Health
  • Inpatient annual maximum of $2,500 per person, per calendar year. $10,000 lifetime maximum inpatient and out patient combined.
  • Outpatient annual maximum of $1,000 per insured per calendar year. $10,000 lifetime maximum inpatient and out patient combined.
    		•
  • Inpatient annual maximum of $2,500 per person, per calendar year. $10,000 lifetime maximum inpatient and out patient combined.
  • Outpatient annual maximum of $1,000 per insured per calendar year. $10,000 lifetime maximum inpatient and out patient combined.
    		•
    Hospital Care Subject to Deductible and Coinsurance Subject to Deductible and Coinsurance
    Optional Benefits CelticSaver HSA PPO Health Plan CelticSaver HSA PPO Health Plan