March 19, 2010

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Celtic – CeltiCare Select PPO Plan – VIRGINIA

A comparison of the CeltiCare Select 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 Select PPO Plan Application CeltiCare Select PPO Plan Application
Brochure CeltiCare Select PPO Plan Brochure CeltiCare Select PPO Plan Brochure
Copay Non-preventive: $10 Non-preventive: $10
Office Visit Non-preventive: $10 Non-preventive: $10
Deductible Individual: $2,500, Family: $7,500
  • Out of Network Deductible is $1500 + Annual Deductible
    		•
    Coinsurance CeltiCare Select PPO Plan CeltiCare Select PPO Plan
    Coinsurance Limit CeltiCare Select PPO Plan CeltiCare Select PPO Plan
    Out-of-Pocket Maximum CeltiCare Select PPO Plan CeltiCare Select PPO Plan
    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 CeltiCare Select PPO Plan CeltiCare Select PPO 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.
  • 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 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