CeltiCare "Any Doc" PPO Plan

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Exclusions and Limitations
Eligibility Information

CeltiCare "Any Doc" PPO Plan
(Hospital Network Only)

You don't have to change doctors to realize the advantage of a low office visit copayment. With the Celtic "Any Doc" PPO you have the flexibility to choose your own physician while saving money with the preferred rates of our prominent nationwide hospital network. In offering this PPO plan, Celtic is in partnership with Private HealthCare Systems (PHCS), a widely-respected national network.

Note: The CeltiCare "Any Doc" PPO is available in areas in which there are Preferred Provider Hospitals.

Features/Benefits	80/20					100%
Coinsurance	80/20 Coverage after deductible of the next $5,000					100% Coverage after deductible
Deductibles	$250	$500	$1,000	$2,500	$5,000	$1,000	$2,500	$5,000
Out-of-Pocket Maximum	$1,250	$1,500	$2,000	$3,500	$6,000	$1,000	$2,500	$5,000
Lifetime Maximum	$5,000,000					$5,000,000
Non-Preventive office visits to any doctor	$25 copay					$25 copay
Emergency Room Deductible (in addition to plan deductible)	$50 deductible per visit, if not admitted.					$50 deductible per visit, if not admitted.
Out-of-Network Services at Hospitals per occurrence	Eligible charges reduced additional 20% capped at $5,000 per occurrence.					Eligible charges reduced additional 20% capped at $5,000 per occurrence.
Supplemental Accident	$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 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.
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 and ground ambulance service.
Optional Features/Benefits	CeltiCare Plus Option					Term Life Insurance Option not available in all states