Celticare II Select PPO - you receive high quality care for the lowest premium by accessing respected network physicians and hospitals.  This doctor and hospital PPO offers savings on every visit to any network provider.

CeltiCare II Select PPO Plan
Features / Benefits                Specifics
Eligibility	Ages 6 months - 64 1/2 years
Plan Type	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	$15 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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