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CeltiCare II Managed Indemnity Plan - offers you comprehensive major medical coverage with the flexibility to select the doctors and hospitals of your choice.
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CeltiCare II Managed Indemnity Plan
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| Features / Benefits Specifics |
| Eligibility |
Ages 6 months - 64 1/2 years |
| Plan Type |
No Network Requirements |
| Coinsurance |
80/20 Coverage after annual plan ded. of next $10,000 |
100% Coverage after annual plan ded |
| Annual Plan Deductibles |
$500, $1,000, $1,500, $2,500, $5,000 |
$2,500, $5,000 |
Out-of-Pocket Maximum*
(includes annual plan deductibles) |
$2,500, $3,000, $3,500, $4,500, $7,000 |
$2,500, $5,000 |
Emergency Room Deductible
(In addition to annual plan deductible) |
$250 per visit (waived if admitted to hospital). |
| Optional Features/ Benefits |
Prescription Drug Option
(stand alone) |
Prescription Drugs* - Drugs with generic alternatives require the specified copay plus 100% of the cost difference between the drug and the generic alternative. Prescription availible by mail order with a 90 days supply.
Retail:
Generic Brand (Preferred and Nonpreferred/Specialty)
No deductible $100 annual deductible per person per calendar year
$20 copay $40 copay for preferred drugs
$75 copay for nonpreferred/specialty drugs |
* Prescription drugs for psychiatric Note: The total family deductible is the amount equal to three times the per-person annual
care not included deductible. Out-of-pocket maximum is three times the per-person maximum, per calendar year, with no carry over
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