 |
| CeltiCare Managed
Indemnity Plan |
| Features/Benefits |
50/50 |
80/20 |
100% |
| Coinsurance |
50/50
Coverage after deductible of the next
$5,000 |
80/20
Coverage after deductible of the next
$5,000 |
100%
Coverage after deductible |
| Deductibles |
$250 |
$500 |
$1,000 |
$250 |
$500 |
$1,000 |
$1,000 |
$2,500 |
$5,000 |
| Out-of-Pocket
Maximum |
$2,750 |
$3,000 |
$3,5000 |
$1,250 |
$1,500 |
$2,000 |
$1,000 |
$2,500 |
$5,000 |
| Lifetime
Maximum |
$5,000,000 |
$5,000,000 |
$5,000,000 |
| Emergency
Room (in addition to plan deductible) |
$50
deductible per visit, if not admitted |
$50
deductible per visit, if not admitted |
$50
deductible per visit, if not admitted |
| Supplemental
Accident |
$500
per injury |
$500
per injury |
$500
per injury |
| FREE
RX Discount Card |
An
average savings of 15% at over 40,000 U.S. pharmacies. |
| Psychiatric
Care* |
Inpatient
annual maximum of $2,500 per person, per calender year.
Outpatioent annual maximum of $1,000 per person per calendar
year. Lifetime maximum of $10,000 per person for
inpatient and outpatient combined. |
| Manipulative
Therapy (benefits vary by state) |
$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. |
| Optional
Features/Benefits |
CeltiCare
Plus Option |
Term
Life Insurance Option |
Important Note: The information
contained on this web page and the other linked pages is not intended
to provide full details of Celtic plans and may change at the
discretion of Celtic Insurance Company. Benefits and Plan
details may vary by state. Complete terms of coverage are
outlined in the individual Certificate Booklets and set forth in the
applicable insurance Policy and Trust agreement. In applying
for coverage, the primary insured agrees to be bound by the
Certificate. The benefits described in these pages and any
accompanying literature are the standard benefits offered by Celtic.
Policy provisions vary in some states.
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