CeltiCare- Anydoc PPO

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	[Illinois- PPO] [Illinois - Select] [Illinois- Kids] [Indiana - Adults] [Indiana - Kids]










	Last Updated Friday, February 23, 2001


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The CeltiCare Health “AnyDoc” offers the opportunity to go to any primary care r specialist for only a Copay. 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 the prominent nationwide hospital network with PHCS.

Check out network providers online at www.phcs.com/ .


	Plan Options Available:

Maternity	No
Dental	No
Life	Yes
Disability	No


	Plan Availability:

Illinois Only


	Deductible Options: $250, $500, $1000, 80% and 50% plans. $1000-$5000 deducitble 100% plans. Maximum Lifetime Benefit: $5,000,000 Strengths: PHCS Network, copay’s, cost Weakness: Per occurnace coinsurance.


		The following summary is NOT a solicitation to sell you insurance. Solicitations can only be made with state, and insurance company, approved brochures. Information contained in this web may contain generalities or inaccuracies. Please read the brochures and policies for specific limitations and exclusions.



	Plan Summary - ( 80% PPO plan available)

Benefit Description	In Network Benefits	Out of Network Benefits
Calendar Year Deductible (3x per family)	$1000, $2500 or $5000	$1000, $2500 or $5,000
Coinsurance	100%	80%
Out of pocket limit (plus deductible 3x per family)	$ 0	$1,000 per occurance
Primary care - and specialist Office visits	$25 copayment, balance covered at 100% up to $200 per visit.	$25 copayment, balance covered at 100% up to $200 per visit
Preventive care *If Plus option is elected* Physical Exams Up to $50 of Routine Eye care Well child care	Covered at 100% up to $200 annual benefit.	Covered at 100% up to $200 annual benefit.
Other Physician Services Surgical procedures Assistant surgeons Anesthesia Facility charges.	Subject to deductible, then covered at 100%	Subject to deductible, then covered at 100%
Hospital Services Inpatient Outpatient surgical facility Other Outpatient charges	Subject to deductible, then covered at 100%	Subject to deductible, then covered at 80%
Other Services Hospice Home Health Care- 30 visits per year, 1 per day. Extended Care facility- 12 days per confinement Rehab facility- 30 days per year. Medical Equipment and supplies Outpatient X-ray, lab test, diagnostic imaging, radiation therapy.	Subject to deductible, then covered at 100%	Subject to deductible, then covered at 100%
Mental Health Benefits Inpatient Benefits Outpatient Benefits	Inpatient to $2500 per insured, per year. Outpatient at 50% up to $40 per visit, 25 visits per year.	Inpatient to $2500 per insured, per year. Outpatient at 50% up to $40 per visit, 25 visits per year.
Prescription Drug Card - If Plus option is elected Most pharmacies accept card.	$10.00 Copay for generics $20.00 Copay for Brand Name Drugs	Mail order (90 day supply) $15.00 Copay for generics $30.00 Copay for Brand Name Drugs
Emergency Room Copay	Additional $50 Copay per visit.	Additional $50 Copay per visit.
Accident Benefit -	1st $500 per incident covered hospital or doctor.	1st $500 per incident covered hospital or doctor
Healthy Lifestyle	Deductible waived,- pays 25% of eligible programs for improvement of health up to $300 per year.	Such as Health Club Smoking cessation.
LIFETIME MAXIMUM	$5,000,000	$5,000,000

* Waiver of preexisting condition clause for any condition mentioned on applicaiton and not excluded.




	feedback legal copyright © 1999 Castle Group Health

	The following summary is NOT a solicitation to sell you insurance. Solicitations can only be made with state, and insurance company, approved brochures. Information contained in this web may contain generalities or inaccuracies. Please read the brochures and policies for specific limitations and exclusions.