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Celticare II "Any Doc" PPO - 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 our prominent nationwide hospital network.
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CeltiCare II "Any Doc" PPO Plan
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| Features / Benefits Specifics |
| Eligibility |
Ages 6 months - 64 1/2 years |
| Plan Type |
Any Physician and Hospital PPO |
| 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 |
| Non-Preventive office visits to Network Provider |
$35 copay/6 visits per person, per calendar year. 7th and subsequent visits subject to annual plan deductible and coinsurance. |
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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