Kids

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










	Last Updated Friday, February 23, 2001


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This is probably the best stand alone children's medical plan. More expensive than Blue Cross, but more benefits. We recommend the Kids PPO with the Plus option.

The PLUS option provides coverage with no deductible or copayment coverage for well care (even school physicals) up to $200 per year. It also includes a doctor copay and prescription card. We generally recommend a higher deductible plan when there are many first dollar benefits, but pricing is unusual here and we recommend the lower ($100) deductible plan..

QuickStat	PPO Net	Maternity


	Plan Options Available:

Maternity	No
Dental	No
Life	Yes
Disability	No


	Plan Availability:

Indiana Only


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


Deductible Options: $100 or $500 with 80% coinsurance. Maximum Lifetime Benefit: $5,000,000 Strengths: PHCS Network, copay’s, cost Weakness: can be pricey.

	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.

		Celtic Kids Plan” - Hospital and Doctor PPO

Benefit Description	In Network Benefits	Out of Network Benefits
Calendar Year Deductible (3x per family)	$100 or $500	$100 or $500
Coinsurance	80%	60%
Out of pocket limit (plus deductible 3x per family)	$ 1000	$ 2000
Primary care - and specialist Office visits	$20 copayment, balance covered at 100% up to $200 per visit.	$20 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 School Physicals	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 $10.00 +20% Copay for Brand Name Drugs	Mail order (90 day supply) $15.00 Copay for generics $20.00 Copay for Brand Name Drugs
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.