March 19, 2010

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Celtic – CeltiCare "Any Doc" PPO Plan – PENNSYLVANIA

A comparison of the CeltiCare "Any Doc" PPO 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 CeltiCare "Any Doc" PPO Plan Application CeltiCare "Any Doc" PPO Plan Application
Brochure CeltiCare "Any Doc" PPO Plan Brochure CeltiCare "Any Doc" PPO Plan Brochure
Copay
  • Non-preventive: $25, $30 copay (for CT only)
    		•
  • Non-preventive: $25, $30 copay (for CT only)
    		•
    Office Visit
  • Non-preventive: $25, $30 copay (for CT only)
    		•
  • Non-preventive: $25, $30 copay (for CT only)
    		•
    Deductible Individual: $250, Family: $750
  • 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 Rx discount card, average 15% discount. Subject to Deductible and Coinsurance. Optional Copay Drug Card Available (see Plus Option) Rx discount card, average 15% discount. Subject to Deductible and Coinsurance. Optional Copay Drug Card Available (see Plus Option)
    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 Optional- Plus Option benefit Optional- Plus Option benefit
    Child Preventative Care Optional- Plus Option benefit Optional- Plus Option benefit
    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.
  • 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 Plus Option II includes:
    • Preventive- 100% up to $300 per person per year (after 90 day wait)
    • Supplemental Accident- Covered at 100% up to $500 per person per year
    		 Plus Option II includes:
    • Preventive- 100% up to $300 per person per year (after 90 day wait)
    • Supplemental Accident- Covered at 100% up to $500 per person per year