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The Celtic Adults Health Plan is a major
medical plan for individuals ages 18 to 64 1/2 and their families. This plan design is being phased out in many states in favor of the Celticare product line.
Prices in states where this plan is available is very competetive.
Celtic has made the move from the “Affordable PPO” to PHCS PPO network as of 5/1/98..
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Plan Options Available:
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Maternity
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No
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Dental
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No
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Life
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Yes
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Disability
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No
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Plan Availability:
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Celtic offers 50/50 plans and 80/20 plans, we recommend only their "Premier 100%" plans. The
Premier plan offers deductible choices of $1,000,$2,500, or $5,000. After that, all covered expenses are reimbursed at 100% (non-preferred hospitals at 80% plus an additional $1000 deductible). The
Premier plan also offers a "plus" option that, we believe, tops off a very competitive plan and plan design.
The Plus option allows you to visit any doctor and have only a copayment of $20, deductible waived. The Plus option also includes a prescription card that allows you to get generics for $10, name brand for $10 plus 20%. Included in this $5,000,000 maximum plan is a supplemental accident benefit and $200 of routine care.
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- Deductible Options: $250, $500, $1000, 80% and 50% plans. $1000-$5000 deductible 100% plans.
- Maximum Lifetime Benefit: $5,000,000
- Strengths: PHCS Network, copay’s, cost
- Weakness: No psych drug coverage.
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Benefit Description
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In Network Benefits
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Out of Network Benefits
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Calendar Year Deductible
(3x per family)
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$1000 to $5000
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$ 1000 to $5000
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Coinsurance
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100%
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80%
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Out of pocket limit
(plus deductible 3x per family)
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$ 0
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$ 2,000
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Primary care - and specialist Office visits
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$20 copayment, balance covered at 100% up to $200 per
visit.
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Subject to deductible, then covered at 80%
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Preventive care
If Plus option is elected
- Physical Exams
- Up to $50 of Routine Eye care
- Well child care
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Covered at 100% up to $200 annual benefit.
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Covered at 100% up to $200 annual benefit.
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Other Physician Services
- Surgical procedures
- Assistant surgeons
- Anesthesia
- Facility charges.
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Subject to deductible, then covered at 100%
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Subject to deductible, then covered at 80%
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Hospital Services
- Inpatient
- Outpatient surgical facility
- Other Outpatient charges
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Subject to deductible, then covered at 100%
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Subject to deductible, then covered at 80%
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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.
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Subject to deductible, then covered at 100%
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Subject to deductible, then covered at 80%
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Mental Health Benefits
- Inpatient Benefits
- Outpatient Benefits
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Inpatient to $2500 per insured, per year.
Outpatient at 50% up to $40 per visit, 25 visits per year.
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Inpatient to $2500 per insured, per year.
Outpatient at 50% up to $40 per visit, 25 visits per year.
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Prescription Drug Card - If Plus option is elected
- Most pharmacies accept card.
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$10.00 Copay for generics
$10.00 +20% Copay for Brand Name Drugs
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Mail order (90 day supply)
$15.00 Copay for generics
$20.00 Copay for Brand Name Drugs
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Accident Benefit -
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1st $500 per incident covered hospital or doctor.
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1st $500 per incident covered hospital or doctor
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Healthy Lifestyle
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Deductible waived,- pays 25% of eligible programs for improvement of health up to $300 per year.
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Such as
- Health Club
- Smoking cessation.
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LIFETIME MAXIMUM
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$5,000,000
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$5,000,000
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* Waiver of preexisting condition clause for any condition mentioned on application and not excluded.
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