March 20, 2010

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Celtic – CeltiCare Select PPO Plan - Plus Option – MARYLAND

A comparison of the CeltiCare Select PPO Plan - Plus Option 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 CeltiCare Select PPO Plan - Plus Option Application CeltiCare Select PPO Plan - Plus Option Application
Brochure CeltiCare Select PPO Plan - Plus Option Brochure CeltiCare Select PPO Plan - Plus Option Brochure
Copay Non-preventive: $10 Non-preventive: $10
Office Visit Non-preventive: $10 Non-preventive: $10
Deductible Individual: $5,000, Family: $15,000
  • Out of Network Deductible is $1500 + Annual Deductible
    		•
    Coinsurance see brochure see brochure
    Coinsurance Limit see brochure see brochure
    Out-of-Pocket Maximum see brochure see brochure
    Lifetime Maximum $5 Million $5 Million
    Prescription Drugs
  • Generic- $15 Copay
  • Brand- $35 Copay plus 20%coinsurance with no generic (100% of cost difference is generic available)
    		•
  • Generic- $15 Copay
  • Brand- $35 Copay plus 20%coinsurance with no generic (100% of cost difference is generic available)
    		•
    Emergency Room
  • $50 deductible [in addition to plan deductible] waived if admitted or if charges are due to an accident
    		•
  • $50 deductible [in addition to plan deductible] waived if admitted or if charges are due to an accident
    		•
    Adult Preventative Care Preventive- 100% up to $300 per person per year Preventive- 100% up to $300 per person per year
    Child Preventative Care Preventive- 100% up to $300 per person per year Preventive- 100% up to $300 per person per year
    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 see brochure see brochure
    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.
  • Up to $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.
  • Up to $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 see brochure see brochure