CeltiCare Managed Indemnity Plan

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What is Covered
Exclusions and Limitations
Eligibility Information

Features/Benefits	80/20					100%
Eligibility	Six months to 64-1/2 years
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
Emergency Room Deductible (in addition to plan deductible)	$50 deductible per visit, if not admitted.					$50 deductible per visit, if not admitted.
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