Benefits & Coverage

Insurance Type
Individual Health Insurance
Insurance Provider
Celtic
Plan Type
PPO
Deductible
$2500
Out-of-Pocket Maximum
$4500
Plan Highlights

    Cost & Coverage

    Estimated Monthly Base Rate
    Estimated monthly premium starts at $116.99
    How many applications are denied?
    27% of the applicants were denied
    How accurate is this estimate?
    1% of the applicants ended up paying a higher amount than the quoted price
    Deductible
    Individual: $2500
    Family: $7500
    In-Network Out-of-Pocket Limit
    Individual: $4500
    Family: $13500
    What is included in the in-network out-of-pocket limit?
    Deductible + Coinsurance
    Is this plan Health Savings Account (HSA) eligible?
    No
    Plan Type
    PPO

    Health Services Options

    Service
    In Network
    Out of Network
    Primary care physician office visit
    $15 Copay
    40% Coinsurance after deductible
    Specialist
    $15 Copay
    40% Coinsurance after deductible
    Diagnostic Test (X-ray, blood work)
    20% Coinsurance after deductible
    40% Coinsurance after deductible
    Outpatient Facility Fee
    20% Coinsurance after deductible
    40% Coinsurance after deductible
    Outpatient Physician/Surgeon Fee
    20% Coinsurance after deductible
    40% Coinsurance after deductible
    Hospital facility fee
    20% Coinsurance after deductible
    40% Coinsurance after deductible
    Hospital physician/surgeon fee
    20% Coinsurance after deductible
    40% Coinsurance after deductible
    Emergency Room
    20% Coinsurance after deductible
    20% Coinsurance after deductible

    Drug Services

    Generic Drugs
    Coverage: $10 Copay
    Preferred Brand Drugs
    Coverage: $40 Copay
    Specialty Drugs
    Coverage: 30% Coinsurance after deductible

    Mental Health or Substance Abuse Services

    Service
    In Network
    Out of Network
    Mental/behavioral health outpatient services
    20% Coinsurance after deductible
    40% Coinsurance after deductible
    Mental/behavioral health inpatient services
    20% Coinsurance after deductible
    40% Coinsurance after deductible
    Substance use disorder inpatient services
    Not Covered
    Not Covered
    Substance use disorder outpatient services
    Not Covered
    Not Covered

    Maternity Services

    Service
    In Network
    Out of Network
    Prenatal/postnatal care
    Not Covered
    Not Covered
    Delivery and all inpatient services for maternity care
    Not Covered
    Not Covered

    Coverage Options Summary

    Included Benefits
    • Durable medical equipment
    • Emergency Transportation
    • Eye glasses children
    • Home health care
    • Hospice
    • Imaging (CT/PET scans, MRIs)
    • Inpatient rehabilitation
    • Non-preferred brand drugs
    • Skilled nursing care
    • Other practitioner office visit
    • Outpatient rehabilitation
    • Preventive care, screening, immunization
    • Routine eye exam children
    • Urgent Care
    Excluded Benefits
    • Acupuncture
    • Bariatric surgery
    • Chiropractic
    • Cosmetic surgery
    • Dental care adult
    • Dental check up children
    • Eye exam adult
    • Habilitation
    • Hearing Aid
    • Infertility treatment
    • Long Term Care
    • Non-emergency care outside U.S.
    • Private duty nursing
    • Routine foot care
    • Routine hearing tests
    • Weight loss program

    What To Know

    • 27%of the applicants were denied
    • 1%of the applicants ended up paying a higher amount than the quoted price
    • Deductible amount is NOT included as part of the out-of-pocket limit

    Physician Directory

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