Gynecology coverage under Celtic Basic PPO

TA | August 18, 2008

Q: I'm thinking about signing up for the Celtic Basic PPO-80/20 plan but before I do I need to make sure this is the best coverage for me. My main concern is good PCP/GYN doctors I use and need. I need to make sure the that certain practices take this kind of insurance. I currently live Philadelphia Pa and work in the Center City area, so it would be nice to find doctors in that area. If possible I would like to receive a book or brochure stating exactly what this particular plan does and does not cover. I need as much information about this insurance before I make my final decision and start paying $65.39 per month.

A: These are very valid concerns when purchasing a low cost health insurance. It is wise to question how much preventative benefit you could possibly be getting for the $65 per month premium. Checking the doctor's participation in the PPO network is easy; see www.PHCS.com and follow the links to Multiplan for patients looking for a PHCS provider. This popular PPO network is used by many different health insurance plans.

The summary of benefits is included in the online or downloadable brochure are well written and should be easy to understand the wellness features. If you have any other specific questions after reviewing the detailed description of coverage, please let us know.

Celtic Basic provides liberal primary care, wellness and gynecological coverage, especially for a plan with such a low premium cost. It is important to enter your zip code and date of birth first on the quote page to get the accurate plan details. The quote page includes a number of options including the "Compare Plans" feature and the block on the right under the "Learn More:" section that says "Choosing the Right Celtic Plan". A sample policy certificate for this form of Celtic Basic health insurance is also available but keep in mind that certificates vary from state to state and are sometimes modified with riders. This sample is only for illustrative purposes. You always have at least 10 days to examine the specific certificate issued to you without financial risk or obligation. But the only way to get an actual certificate is to apply online.

Keep in mind, however that primary gynecological benefits are covered by state and federal mandates and not the provisions of the insurance plan. You can be assured that no matter what else the brochure or policy says, there is a provision that says that the insurance will meet the state-required mandates. In other words, all health insurance plans are required to cover things like mammograms and PAP tests at least as generously as law requires, regardless of what the insurance brochure says. The primary effect of this provision for patients is often that these mandated benefits, when performed under AMA guidelines for your age and health, are covered without incurring a deductible.

Another way of looking at it is that, as far as these specific gynecological services are concerned, is does not make sense to compare specific low cost insurance plans since they all provide the same legally mandated benefit.

Be aware that while the PAP smear and mammogram may be covered at 100% with no deductible, the other services provided by the doctor and the office visit itself are not necessarily covered at 100%. So speak with your doctor's office in advance about what is your expected financial responsibility. While the Celtic Basic Insurance does have generous wellness and preventative benefits (in addition to the mandated benefits), this provision usually begins in the second year of the policy.


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