 |
| 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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