|
Features/Benefits |
80/20 |
100% |
|
Coinsurance |
80/20 Coverage after deductible of the next $10,000 |
100% Coverage after deductible |
|
Deductibles |
$500, $1000, $1500, $2500, $5000 |
$2500, $5000 |
|
Out-of-Pocket Maximum |
$2500, $3000, $3500, $4500, $7000 |
$2500, $5000 |
|
Lifetime Maximum |
$7,000,000 |
$7,000,000 |
|
Non-preventive office visits to Network Provider |
$15 copay 6 visits per year per person.
Deductible Does Not Apply
|
$15 copay 6 visits per year per person.
NoDeductible |
|
Emergency Room Deductible (in addition to plan deductible) |
$250 deductible per visit, if not admitted. |
$250 deductible per visit, if not admitted. |
|
Out-of-Network Services at Doctors and Hospitals per occurrence |
$1500 annual deductible. Eligible charges reduced additional 20% no cap.
Does not include medical emergencies.
PPO Network is Nationwide |
$1500 annual deductible. Eligible charges reduced additional 20% no cap.
Network Nationwide |
|
Supplemental Accident |
$500 per injury with Plus Option |
$500 per injury with Plus Option |
|
FREE RX Discount Card |
An average savings of 15% at over 40,000 U.S pharmacies.
See Optional Benefits below. |
|
Psychiatric Care* |
Inpatient annual maximum of $2,500 per person, per calendar year. Outpatient annual maximum of $1,000 per person per calendar year. Lifetime maximum of $10,000 per person per inpatient and outpatient combined. |
|
Manipulative Therapy (benefits vary by state) |
$500 maximum per person, per calendar year after deductible. |
|
Hospital |
Average semi-private room rate. Intensive care at four times the average semi-private room rate. |
|
Home Health Care |
30 visits per person, per calendar year, one visit per day. |
|
Rehabilitation Facility |
Inpatient - up to 30 days confinement per person, per calendar year. |
|
Rehabilitation Therapy |
Outpatient - up to 30 visits per person, per calendar year. |
|
Extended Care Facility |
Up to 12 days of confinement, per person, per calendar year. |
|
Transplants |
Covered up to amount negotiated by network if Transplant Network used; capped at $100,000 per procedure if insured goes out of network. |
|
Ambulance |
$3,000 covered per person, per calendar year for emergency air or ground ambulance service. |
|
Optional Features/Benefits |
CeltiCare Plus Option Outline
Term Life Insurance Option (not available in all states)
|