CeltiCare Saver 2000

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Features/Benefits Specifics
Plan Type HMO
Annual Deductibles $2,000 (individual)
$4,000 (family)
Out-of-Pocket Maximum $5,000 (individual)
$10,000 (family)
Office Visits
Well-child Care Visit $0
Routine Adult Physical $0
Routine GYN Exam $0
Routine Vision Exam (one per 12 months) $30
Emergency Room Visit $150 after deductible (waived if admitted)
Most Other Office Visits $30 (Primary Care Provider)
$45 (Specialist)
Prescription Drugs
Retail Tier 1: $10
Tier 2: $30 after Prescription Drug deductible of $250 (individual) or $500 (family)
Tier 3: $50 after Prescription Drug deductible of $250 (individual) or $500 (family)
Mail Order Tier 1: $20
Tier 2: $60 after Prescription Drug deductible of $250 (individual) or $500 (family)
Tier 3: $90 after Prescription Drug deductible of $250 (individual) or $500 (family)
X-rays, Labs, and Diagnostic Tests $0 after deductible
Inpatient Care (including Maternity Care)
Semi-private room and board $500 per admission after deductible
Outpatient Surgery $250 per surgery after deductible
Mental Health and Substance Abuse
Outpatient office visits $30
Inpatient Admission $500 per admission after deductible
Ambulance $0 after deductible
Value-Added Benefits
CentAccount Healthy Rewards Program Get rewarded for completing designated healthy behaviors,
starting with your first PCP visit within 90 days of enrollment
Nursewise A free health information phone line staffed with registered nurses
ready to answer your health questions 24-hours a day – every day of the year
Balance Free health and wellness program offering resources to help you
remove life barriers and focus on a healthier you