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Celtic
Individual and Family Health Insurance |
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Celtic Basic Health
Insurance A no-hassle PPO with 80/20
coinsurance and $1,500, $2,500 or $5,000 deductible choice.
Maximum lifetime protection of $5 million.
Two $30 copay office visits per year.
$200 wellness benefit (eligible after 12 months of
coverage)
Optional copay Prescription Drug Card
12 month initial rate guarantee
| Features/Benefits |
Specifics |
| Eligibility |
Ages 6 mos. - 64 1/2
years |
| Plan Type |
Physician and
Hospital PPO |
|
Coinsurance |
80/20 Coverage after
deductible of the next $10,000 |
| Annual
Deductibles |
$1,500,
$2,500, & $5,000
Out-of-network deductible: $1,500 + Annual Ded. |
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Lifetime
Maximum |
$5,000,000 |
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Non-Preventive
office visits to Network Provider |
2 visit, $30 copay per
person, per calendar year. 3rd and subsequent visits subject
to annual deductible and coinsurance. |
| Labs and x-rays |
Subject to annual
deductible and coinsurance. |
|
Emergency Room
Deductible |
$250 deductible per
visit, (waived if admitted to hospital) + Annual Deductible |
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Hospital
Confinement/Inpatient Services |
$500 deductible per
admission + Annual Deductible. Average semi-private room rate.
Intensive care at 4 times the average semi-private room rate. |
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Outpatient
Hospital Services (in addition to annual deductible) |
$250 deductible per
occurrence + Annual Deductible. Day surgery, major diagnostic
procedures and medical services including charges for x-rays, lab
test, EKGs and radiation therapy are eligible expenses. |
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Out-of-Network
Services Doctors and Hospitals per occurrence |
Eligible charges
reduced additional 20%, no cap |
| Preventive Care
(eligibility begins after 12 months of coverage) |
Eligible expenses for
medical services and supplies incurred for preventive care in an
asymptomatic individual are covered first dollar up to $200 per
person, per calendar year. |
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Home Health
Care |
20 visits per person,
per calendar year, one visit per day. |
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Rehabilitation
Facility |
Inpatient - up to 30
days confinement per person, per calendar year. |
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Transplants |
Covered up to amount
negotiated by network if Transplant Network used; capped at $100,000
per procedure if insured goes out of network. |
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Ambulance |
$3,000 covered per
person, per calendar year for emergency air or ground ambulance
service. |
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FREE RX
Discount Card* |
Use your card at more
than 50,000 participating pharmacies nationwide and receive
discounts on prescription drug purchases. |
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Optional
Features/Benefits |
Prescription Drug Card Option**
$500 Deductible
Retail purchases:
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Generic drugs w/no available brand: $25 copay
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Brand drugs w/a generic substitute: $25 copay + 100% of the cost
difference between the brand name drug and the generic
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Preferred brand drugs: 35% coinsurance
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$Non-preferred brand and specialty drugs: 50% coinsurance
Mail Order purchases: (90 day supply)
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Generic drugs w/no available brand: $75 copay
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Brand drugs w/a generic substitute: $75 copay + 100% of the cost
difference between the brand name drug and the generic
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Preferred brand drugs: 35% coinsurance
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$Non-preferred brand and specialty drugs: 50% coinsurance
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* The Rx Discount Card is a value-added feature and not part of the
insurance contract.
** When the Prescription Drug Card Option is chose, it
replaces the Rx Discount Card.
Note: The total family deductible is the amount equal to three
times the per-person deductible.
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For the following states AL, AK, FL, GA, IL, IN, IA, MS,
MT, NE, NH, NM, OK, PA, & TN
Click here for the Celtic Basic benefit chart
For the following states AZ, AR, CA, CO,
DE, DC, KS, LA, MI, NC, OH, SC, SD, TX, WV, WI &WY Click here for the Celtic Basic benefit chart. |
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Celtic Care II Health
Insurance Celticare Select PPO (Doctor and Hospical Network)
You receive high quality health insurance care for the
lowest premium by accessing participating providers within the respected PHCS
Network. This new physician and hospital PPO plan offers savings on every visit
to any network provider with a $15 copay.
CeltiCare "Any Doc" PPO (Hospital Network)
With the CeltiCare "Any Doc" PPO plan you don’t have to
change doctors to realize the advantage of a low $35
office visit copay. You have the flexibility to choose
your own physicians while saving money with preferred
rates at prominent hospitals in the nationwide PHCS
Network.
CeltiCare
Managed Indemnity (No Network)
Offers you traditional, comprehensive major medical
health insurance with the flexibility to select the
doctors and hospitals of your choice.
|
Features/Benefits |
CeltiCare II Select PPO |
CeltiCare II "Any Doc" PPO |
CeltiCare II Managed Indemnity Plan |
| Annual
Deductibles |
$500,
$1,000, $1,500, $2,500, $5,000 |
$500,
$1,000, $1,500, $2,500, $5,000 |
$500,
$1,000, $1,500, $2,500, $5,000 |
Choices
of
Coinsurance after the deductible |
80/20 of
the next $10,000 & 100% thereafter; or 100%
(100% only available
w/$2,500 & $5,000 deductibles) |
80/20 of
the next $10,000 & 100% thereafter; or 100%
(100% only available
w/$2,500 & $5,000 deductibles) |
80/20 of
the next $10,000 & 100% thereafter; or 100%
(100% only available
w/$2,500 & $5,000 deductibles) |
| Lifetime
Maximum |
$7,000,000 |
$7,000,000 |
$7,000,00 |
| Physician
Copay Services |
$15 copay/6visits per person, per calendar
year |
$35 copay/6visits per person, per calendar
year |
Subject to deductible and coinsurance |
|
Physician & Hospital Services |
Benefits
at PHCS network physicians and hospitals
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Benefits
at any physician and PHCS network hospitals
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Benefits
at any physician and hospital |
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Emergency Room Deductible (in
addition to annual deductible) |
$250 per
visit, if not admitted. |
$250 per
visit, if not admitted. |
$250 per
visit, if not admitted. |
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Out-of-Network Services
(in addition to annual plan deductible) |
Doctor & Hospital
$1,500 annual ded.
Eligible charges reduced additional 20% per
occurrence. |
Hospital (only)
$1,500 annual ded.
Eligible charges reduced additional 20% per
occurrence. |
Not applicable |
| Healthy
Lifestyle Program |
Pays 25% of fees for eligible physical
health programs up to $300 max. per person,
per year. |
Pays 25% of fees for eligible physical
health programs up to $300 max. per person,
per year. |
Pays 25% of fees for eligible physical
health programs up to $300 max. per person,
per year. |
| Billing
Options |
Monthly,
Quarterly, EFT |
Monthly,
Quarterly, EFT |
Monthly,
Quarterly, EFT |
|
Eligibility |
6 mos. -
64 ½ yrs |
6 mos. -
64 ½ yrs |
6 mos.-
64 ½ yrs |
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Optional Benefits |
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Preventive Care |
CeltiCare
II Plus Option |
CeltiCare
II Plus Option |
CeltiCare
II Plus Option |
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Prescription Drug option |
Stand-alone Option or part of CeltiCare II
Plus Option |
Stand-alone Option or part of CeltiCareII
Plus Option |
Stand-along Option or part of CeltiCare II
Plus Option |
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Supplemental Accident |
CeltiCare
II Plus Option |
CeltiCare
II Plus Option |
CeltiCare
II Plus Option |
Term
Life Insurance
(not available in all
states) |
$25,000 |
$25,000 |
$25,000 |
For the following states AL, FL, IL, IA, MT, NE, NC,
NM, OK & PA
View Celtic Care II Plans.
For
the following states AZ, AK, AR, CA, CO, DE, DC, GA,
IN, KS, LA, MI, MO, MS, NC, NH, OH, SC, SD, TN, TX,
WV, WI & WY View CeltiCare II Plans.
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Celtic Care HSA
Health Insurance
Quality coverage for individuals ages 18 to 64 ½ years and their families.
High Deductible choices for Individuals - $1,500, $2,600
& $5,000.
High Deductible choices for Families - $3,000, $5,150 &
$10,000.
80/20 or 100% coinsurance after deductible.
$7,000,000 lifetime maximum.
Initial 12 month rate guarantee.
Prenegotiated fees at participating physician offices,
hospitals & pharmacies.
CelticSaver HSA PPO
(Doctor and Hospital Network)
You receive high quality care for the lowest premium by
accessing respected network physicians and hospitals.
This doctor and hospital PPO offers savings on every
visit to any network provider.
CelticSaver HSA Managed
Indemnity (No Network)
Offers you comprehensive
coverage with the flexibility to select the doctors and
hospitals of your choice. |
| Features/Benefits |
Specifics |
| Eligibility |
Ages 18-64
1/2 years* |
| Plan
Options |
PPO**
or Managed Indemnity |
| Annual Plan
Deductibles and Coinsurance |
Individual
$1,500
(80/20of the next $18,000)
$2,600
(80/20 of the next $12,000)
$1,500
(100%)
$2,600
(100%)
$5,000
(100%)
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Family
$3,000
(80/20of the next $36,000)
$5,150
(80/20 of the next $24,000)
$3,000
(100%)
$5,150
(100%)
$10,000
(100%)
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| Lifetime
Maximum |
$7,000,000
per person |
| Non-Preventive
office visits |
80%
or 100% after
deductible |
|
Emergency
Room Deductible
(in
addition to annual plan deductible) |
$250
per visit (waived if admitted to hospital) |
| Prescription Drugs |
80% or 100% after
deductible |
| Preventive Care |
Eligible
expenses for medical services and supplies incurred for preventive
care in an asymptomatic individual are
covered up to $300 per person per calendar year, which includes $50
for routine eye exams. |
| 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*** |
$500
maximum per person, per calendar year. |
| 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. |
| Value-Added Features/Benefits |
Preferred
Rates - Preferred rates are available for qualifying
applicants. Applicants and/or their spouses who have not used
tobacco in the past 12 months will also receive additional premium
savings.
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View Celtic HSA Plans
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our plans, please
Contact Us. |
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