| Features/Benefits |
80/20 |
100% |
| Coinsurance |
80/20 Coverage after deductible of the next $5,000 |
100% Coverage after deductible |
| Deductibles |
$250 |
$500 |
$1,000 |
$2,500 |
$5,000 |
$1,000 |
$2,500 |
$5,000 |
| Out-of-Pocket Maximum |
$1,250 |
$1,500 |
$2,000 |
$3,500 |
$6,000 |
$1,000 |
$2,500 |
$5,000 |
| Lifetime Maximum |
$5,000,000 |
$5,000,000 |
| Non-Preventive office visits to any doctor |
$25 copay |
$25 copay |
| Emergency Room Deductible (in addition to plan deductible) |
$50 deductible per visit, if not admitted. |
$50 deductible per visit, if not admitted. |
| Out-of-Network Services at Hospitals per occurrence |
Eligible charges reduced additional 20% capped at $5,000 per occurrence. |
Eligible charges reduced additional 20% capped at $5,000 per occurrence. |
| Supplemental Accident |
$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 and ground ambulance service. |
| Optional Features/Benefits |
CeltiCare Plus Option |
Term Life Insurance Option not available in all states
|