Comparison of CeltiCare II Health Plans

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Quick Comparison of 2010 Celtic Health Insurance Plans = ;

Features/Benefits

= CeltiCare II

= CeltiCare Preferred

= Celtic Saver HSA

= Celtic Basic

Eligibility

6 mos.= - 64 ½ yrs

18- 64 ½ yrs

6 mos.= - 64 ½ yrs

Plan T= ype (s)

Select= PPO (doctor and hospital PPO)

Any Do= c PPO (hospital PPO)

Managed Indemnity

Select= PPO (doctor and hospital PPO)

Any Do= c PPO (hospital PPO)

Managed Indemnity

PPO (d= octor and hospital)

Managed Indemnity

PPO (d= octor and hospital)

Annual Deductibles

$500, $1,000, $1,500, $2,500, $5,000

Indivi= dual:

$1,500 (80/20% of the next $18,000 or 100%)

$2,600 (80/20% of the next $12,000 or 100%)

$5,000 (100%)

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Family= :

$3,000 (80/20% of the next $36,000 or 100%)

$5,150 (80/20% of the next $24,000 or 100%)

$10,000 (100%)

$1,500, $2,500, $5,000

Choices of
Coinsuran= ce after the deductible

80/20%= of the next $10,000 & 100% thereafter; or 100% (100% only available w/$2,500 &a= mp; $5,000 deductibles)

80/20% of the next $10,000 & 100% thereafter; or 100% (100% only available w/$2,500 &a= mp; $5,000 deductibles)

80/20%= of the next $10,000

Deduct= ibles in addition to annual deductible

$250 ER ded., waived if admitted

$500 Inpatient hospital

$350 Outpatient hospital

Lifetime Max.

$7,000= ,000

$5,000= ,000

Out-of-network services (in addition to annual plan deductible

$1,500 annual deductible; eligible charges reduced additional 20% per occurrence=

Eligib= le charges reduced additional 20% per occurrence

$1,500 annual deductible; eligible charges reduced additional 20% per occurrence=

Non-preventive Office Visits to Network Provider

Select= : $15 copay

Any Do= c: $35 copay

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6 visi= ts per person, per calendar year;

7+ vis= its subject to ded./coins.

Select= : $15 copay

Any Do= c: $35 copay

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2 visi= ts per person, per calendar year; 3+ visits subject to ded./coins= .=

Covered after deductible and subject to coinsurance

$30 co= pay

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2 visi= ts per person, per calendar year; 3+ visits subject to ded./coins.

Labs and X-rays

100% u= p to $200 per person, per calendar year, then subject to ded./coins.

Subjec= t to annual deductible and coinsurance

Preventive Care

Part of CeltiCare II Plus Option: $300 per person per calendar year; eligibility begins after 90 days of coverage

First-dollar $300 per person, per calendar y= ear; eligibility begins after 90 days of coverage

Subject to Ded & Coins – Eligible Expens= es Covered up to $300 per person per calendar year Incl. annual eye exam; eligibility begins after 90 days of coverage

Stand- alone Option:

First-dollar $300 per person, per calendar y= ear; eligibility begins after 90 days of coverage

First-dollar $200 per person, per calendar year; eligibility begins after 3 months of coverage

Ambulance

$3,000 maximum per person, per calendar year for emergency air or ground ambulan= ce service

$5,000= maximu= m per person, per calendar year for emergency air or ground ambulance service

$3,000 maximum per person, per calendar year for emergency air or ground ambulan= ce service

Current Rx Drugs

Standa= rd Rx benefit:

-$500 annual deductible

-Generic: $20 copay

-Pref. Brand: $40 copay

-Non-pref/Specialty Brand: $75 copay

-Brand w/generic alternative: specified copay + 100% cost difference between Bra= nd & Generic

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Stand-= alone or part of Plus Option:

-No annual deductible for Generic

-$100 annual ded. for Brand

-Generic: $20 copay

-Pref. Brand: $40 copay

-Non-pref/Specialty Brand: $75 copay

-Brand w/generic alternative: specified copay + 100% cost difference between Bra= nd & Generic

(Mail order: 90-day supply)

Standard Rx benefit: (SEE NEW RX)

-Generic: $20 copay

-$500 annual deductible

-Pref. Brand: $40 copay

-Non-pref/Specialty Brand: $75 copay

-Brand w/generic alternative: specified copay + 100% cost difference between Bra= nd & Generic

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Stand-= alone Option:

-No annual deductible for Generic

-$100 annual ded. for Brand

-Generic: $20 copay

-Pref. Brand: $40 copay

-Non-pref/Specialty Brand: $75 copay

-Brand w/generic alternative: specified copay + 100% cost difference between Bra= nd & Generic

(Mail = order: 90-day supply)

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Rx Dis= count: standard

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Covered after deductible and subject to coinsurance

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Standa= rd Rx benefit: (SEE NEW RX)<= /o:p>

-$1,000 annual deductible

-Generic: $25 copay

-Pref. Brand: 35% coinsurance

-Non-pref/Specialty Brand: 50% coinsurance

-Brand w/generic alternative: $25 copay + 100% cost difference between Brand &am= p; Generic

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Rx Drug Option:

-$500 annual deductible

-Generic: $25 copay

-Pref. Brand: 35% coinsurance

-Non-pref/Specialty Brand: 50% coinsurance

-Brand w/generic alternative: $25 copay + 100% cost difference between Brand &am= p; Generic

(Mail order: 90-day supply)

New Rx Drugs benefit

Standa= rd Rx benefit:

-$500 annual deductible

-Generic: $20 copay

-Pref. Brand: $40 copay

-Non-pref/Specialty Brand: $75 copay

-Brand w/generic alternative: specified copay + 100% cost difference between Bra= nd & Generic

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Stand-= alone or part of Plus Option:

-No annual deductible for Generic

-$100 annual ded. for Brand

-Generic: $20 copay

-Pref. Brand: $40 copay

-Non-pref/Specialty Brand: $75 copay

-Brand w/generic alternative: specified copay + 100% cost difference between. Br= and & Generic

(Mail order: 90-day supply)

Standard Rx benefit:

-Generic: $10 copay (No Deductible)

-$500 annual deductible

-Pref. Brand: $40 copay

-Non-pref/Specialty Brand: 30% coinsurance

-Brand w/generic alternative:
$10 copay + 100% cost difference between Brand & Generic

Rx Drug Option:

-Generic: $5 copay (No Deductible)

-$100 annual ded. for Brand

-Pref. Brand: $40 copay

-Non-pref/Specialty Brand: 30% coinsurance

-Brand w/generic alternative:
$5 copay + 100% cost difference between Brand & Generic

(Mail order: 2 ½ times ret= ail)

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Standard Rx benefit:

-Generic: $15 copay (No Deductible)

-$1,000 annual deductible

-Pref. Brand: 35% coinsurance

-Non-pref/Specialty Brand: 50% coinsurance

-Brand w/generic alternative:

$15 copay + 100% cost difference between B= rand & Generic

Rx Drug Option:

-Generic: $10 copay (No Deductible)

-$500 annual deductible

-Pref. Brand: 35% coinsurance

-Non-pref/Specialty Brand: 50% coinsurance

-Brand w/generic alternative:
$10 copay + 100% cost difference between Brand & Generic

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(Mail order: 2 ½ times retail)

Supplemental Accident

Part of CeltiCare II Plus Option: Covered at 100% up to $500 per person, per occurrence

Supplement Accident: Cover= ed at 100% up to $500 per person, per occurrence

N/A

Healthy Lifestyle Program

Pays 2= 5% of fees for eligible physical health programs to $300 max. per person, per y= ear

Pays 25% of fees for eligible phys= ical health programs to $300 max. per person, per year <= /p>

Psych Coverage

Inpati= ent: up to $2,500 per person, per calendar year.

Outpat= ient: paid at 50% of eligible expenses up to a $40 maximum and limited to a max= of $1,000 per insured, per calendar year.

Outpat= ient prescription Rx: not covered

$10,000 lifetime max per insured for inpatient/outpatient services.

Inpati= ent: up to $2,500 per person, per calendar year.

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Outpat= ient: $1,000 per insured, for physician office visits and outpatient prescripti= on drugs, per calendar year.

$10,000 lifetime max per insured for inpatient/outpatient services.

Inpati= ent: up to $2,500 per person, per calendar year.

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Outpat= ient: $1,000 per insured, for physician office visits and outpatient prescripti= on drugs, per calendar year.

$10,000 lifetime max per insured for inpatient/outpatient services.

N/A

Billing Options

Monthl= y or Quarterly billing, monthly EFT

Quarte= rly billing, monthly EFT

For internal use by OnlineAdviser enrollment= support service. Not approved for use as a sales material.