| Features/Benefits |
70/30 |
80/20 |
100% |
| Coinsurance |
70/30 Coverage after deductible of the next $10,000 |
80/20 Coverage after deductible of the next $5,000 |
100% Coverage after deductible |
| Deductibles |
$1000, $2500, $5000, $10000 |
$250, $500 $1000, $2500, $5000, $10000 |
$1000, $2500, $5000, $10000 |
| Out-of-Pocket Maximum |
$4000, $5500, $8000, $13000 |
$1,250, $1500, $2000, $3500, $6000, $11000 |
$1000, $2500, $5000, $10000 |
| Lifetime Maximum |
$5,000,000 |
$5,000,000 |
$5,000,000 |
| Non-preventive office visits to Network Provider |
$10 copay |
$10 copay |
$10 copay |
| Emergency Room Deductible (in addition to plan deductible) |
$50 deductible per visit, if not admitted. |
$50 deductible per visit, if not admitted. |
$50 deductible per visit, if not admitted. |
| Out-of-Network Services at Doctors and Hospitals per occurrence |
Eligible charges reduced additional 20% no cap. |
Eligible charges reduced additional 20% no cap. |
Eligible charges reduced additional 20% no cap. |
| Supplemental Accident |
$500 per injury |
$500 per injury |
$500 per injury |
| FREE RX Discount Card |
An average savings of 15% at over 40,000 U.S pharmacies. |
| Psychiatric Care* |
Inpatient annual maximum of $2,500 per person, per calendar year. Outpatient annual maximum of $1,000 per person per calendar year. Lifetime maximum of $10,000 per person per inpatient and outpatient combined. |
| Manipulative Therapy (benefits vary by state) |
$500 maximum per person, per calendar year. |
| Hospital |
Average semi-private room rate. Intensive care at four times the average semi-private room rate. |
| Home Health Care |
30 visits per person, per calendar year, one visit per day. |
| Rehabilitation Facility |
Inpatient - up to 30 days confinement per person, per calendar year. |
| Rehabilitation Therapy |
Outpatient - up to 30 visits per person, per calendar year. |
| Extended Care Facility |
Up to 12 days of confinement, per person, per calendar year. |
| Transplants |
Covered up to amount negotiated by network if Transplant Network used; capped at $100,000 per procedure if insured goes out of network. |
| Ambulance |
$3,000 covered per person, per calendar year for emergency air or ground ambulance service. |
| Optional Features/Benefits |
CeltiCare Plus Option
Term Life Insurance Option (not available in all states)
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