CeltiCare Kids Health Insurance -Illinois

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










	Last Updated Friday, February 23, 2001


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CeltiCare for Kids Health Plan is a major medical designed specifically to meet the needs of children ages 6 months 18 years. From sore throats to allergy testing to broken bones and X-rays, this plan provides the protection children need at a price parents can afford.

These plans offer 80/20 or 100% coverage and a choice of deductibles and plans designs.

Celtic has made the move from the “Affordable PPO” to PHCS PPO network as of 5/1/98..

QuickStat	PPO Net	Maternity


	Plan Options Available:

Maternity	No
Dental	No
Life	Yes
Disability	No


	Plan Availability:

Illinois Only

CeltiCare^tm. for For Kids

Kids Select PPO- physician and hospital PPO.
Kids “Any Doc” PPO- all doctors get the copay with a hospital PPO.


	Deductible Options: $250 or $500 with 80% coinsurance. or $1000 deductible 100% plans. Maximum Lifetime Benefit: $5,000,000 Strengths: PHCS Network, copay’s, cost Weakness: Out of pocket exposure for out of network charges.


		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.

Celticare - Kids “Select Plan” - Hospital and Doctor PPO

	Plan Summary - 100% PPO plan available with deductible of $1000

Benefit Description	In Network Benefits	Out of Network Benefits
Calendar Year Deductible (3x per family)	$250 or $500	$250 or $500
Coinsurance	80%	60%
Out of pocket limit (plus deductible 3x per family)	$ 1000	Unlimited
Primary care - and specialist Office visits	$10 copayment, balance covered at 100% up to $200 per visit.	Subject to deductible, then covered at 60%
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 80%	Subject to deductible, then covered at 60%
Hospital Services Inpatient Outpatient surgical facility Other Outpatient charges	Subject to deductible, then covered at 80%	Subject to deductible, then covered at 60%
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 80%	Subject to deductible, then covered at 60%
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.
LIFETIME MAXIMUM	$5,000,000	$5,000,000

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


	Celticare - Kids “Any Doc Plan” - Hospital and Doctor PPO

		Plan Summary - 100% PPO plan available with deductible of $1000

Benefit Description	In Network Benefits	Out of Network Benefits
Calendar Year Deductible (3x per family)	$250 or $500	$250 or $500
Coinsurance	80%	60%
Out of pocket limit (plus deductible 3x per family)	$ 1000	$2,000 per occurrence
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 80%	Subject to deductible, then covered at 80%
Hospital Services Inpatient Outpatient surgical facility Other Outpatient charges	Subject to deductible, then covered at 80%	Subject to deductible, then covered at 60%
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 80%	Subject to deductible, then covered at 80%
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.
LIFETIME MAXIMUM	$5,000,000	$5,000,000

* Waiver of preexisting condition clause for any condition mentioned on application 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.