March 21, 2010

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Celtic – CeltiCare Managed Indemnity Plan – VIRGINIA

A comparison of the CeltiCare Managed Indemnity 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 Managed Indemnity Plan Application CeltiCare Managed Indemnity Plan Application
Brochure CeltiCare Managed Indemnity Plan Brochure CeltiCare Managed Indemnity Plan Brochure
Copay N/A N/A
Office Visit
  • Non-preventive: Deductible then coinsurance
    		•
  • Non-preventive: Deductible then coinsurance
    		•
    Deductible Individual: $1,500, Family: $4,500
  • Out of Network Deductible is $1500 + Annual Deductible
    		•
    Coinsurance CeltiCare Managed Indemnity Plan CeltiCare Managed Indemnity Plan
    Coinsurance Limit CeltiCare Managed Indemnity Plan CeltiCare Managed Indemnity Plan
    Out-of-Pocket Maximum CeltiCare Managed Indemnity Plan CeltiCare Managed Indemnity Plan
    Lifetime Maximum $7 Million $7 Million
    Prescription Drugs
  • Annual Rx Deductible: $500
  • Generic Drugs: $20 copay
  • Brand Drugs with a generic substitute: $40 copay + 100% of the cost difference between the brand name drug and the generic
  • Preferred Brand Drugs: $40 copay
  • Non-preferred Brand and Specialty Drugs: $75 copay
    		•
  • Annual Rx Deductible: $500
  • Generic Drugs: $20 copay
  • Brand Drugs with a generic substitute: $40 copay + 100% of the cost difference between the brand name drug and the generic
  • Preferred Brand Drugs: $40 copay
  • Non-preferred Brand and Specialty Drugs: $75 copay
    		•
    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 Optional- Plus Option benefit Optional- Plus Option benefit
    Child Preventative Care Optional- Plus Option benefit Optional- Plus Option benefit
    Lab / X-Ray
  • Paid at 100% up to $200, then subject to deductible and coinsurance
    		•
  • Paid at 100% up to $200, then 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 CeltiCare Managed Indemnity Plan CeltiCare Managed Indemnity 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 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