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Penn Aetna student health plan vs. CeltiCare Basic PPO

KM | January 1, 2010

Q: I am a student in The University of Pennsylvania and I want to find a health insurance plan for myself, I quoted online and was interested in the Celtic Basic PPO 80/20 Plan. But I'm not quite sure if it is qualified for my school's alternative plan. The attached file is the file that I need to fill out, could you tell me how can I fill out the 4 "REQUIRED" fields if I use Celtic Basic PPO 80/20 Plan?

 

Penn Aetna Student Health Plan

CeltiCare Basic PPO

Annual Premium (single student)

$ 2,560

$662

Covers you while a registered student at Penn

Yes

 

Yes

Covers students who are on a leave of absence from Penn

Yes

 

Yes

Covers you after graduation or while not registered

No

Yes

Offers local provider network in Philadelphia area

Yes
Aetna PPO network

Yes

 PHCS network

Offers national provider network

Yes

Aetna network

Yes

PHCS network

Covers health care expenses anywhere in the world

Yes

Emergency care only outside of U.S.

Covers pre-existing conditions

Yes

Yes, if disclosed on the application.

Covers in-patient treatment (including mental health hospitalization)

Preferred Care: 100%

Non-Preferred Care: 70% of the

Reasonable charge

 

$200 wellness benefit included at 100%, then

80% of the reasonable charge, mental health coverage not included except as required by state and federal mandate.

Covers out-patient care, including office visits, mental health services, diagnostic testing and other ancillary procedures

Preferred Care: 100% after a $25 co-pay

for office and mental health visits,

(No co-pay at SHS) - $35 co-pay for

diagnostic testing

Non-Preferred Care: 70% of the reasonable charge (up to $80 max for mental health visits)

 

First two doctor or specialist visits per year for flat $30 co-pay, additional visits subject to deductible and 20% co-insurance

Lifetime maximum coverage

$2,000,000

$$5,000,000

Limits out-of-pocket expenses for medical and prescription costs

Out-of-pocket maximum $1,500

Out-of-pocket maximum $7,000

Requires referrals to access health care in the Philadelphia area

SHS referral required for most non-emergency medical care in the Philadelphia area

No referrals required

Requires referrals to access health care out of the Philadelphia area

No

 

No referrals required

Provides prescription drug benefits

$15 co-pay generic/$30 co-pay

brand

$25 generic or brand name co-pay, 30% co-insurance for name brand, mail order service available to lower costs for long term medications

Required Immunizations

Covered 100% at SHS

Preferred Care: 90% of the Negotiated Rate

Non-Preferred Care: 60% of the Reasonable charge

Covered 100% at any provider

 

 A: You are not likely to have any difficulties meeting Penn's student health insurance requirement. Other Penn students have used this same Celtic insurance plan with no difficulties. Details in the procedure for waiving out of the Penn Student Health Services (SHS) plan and enrolling in the less expensive Celtic plan are available online at Penn's Web site. All information in the Celtic plan is available at Celticenrollment.com.

The chart fairly summarizes the differences between the two plans.  Of the four required provisions you indicated, the Celtic plan appears to be superior in two of the four provisions (wellness benefits and maximum coverage). Both plans cover pre-existing medical conditions but the Celtic plan only admits applicants who have a clean health history. The maximum out-of-pocket limit is much lower in Aetna plan; this is typical when comparing managed care plans to traditional commercial health insurance. But since the majority of Penn students are covered by a parent's employer-provided policy that has a higher maximum out-of-pocket charge than the $1,500 indicated, we presume that this provision is not considered too literally. If supplemental insurance coverage is needed to reduce the maximum out-of-pocket risk, this is available at MedSave.com on a guaranteed issue basis at reasonable additional cost.

Of course it is necessary to check the actual policy for full information on any insurance plan, but the chart is useful in pointing out the major distinctions. (A sample policy form for Celtic Basic insurance policy is available in PDF form. The Aetna policy is not available online).

Celtic Insurance plans have grown in popularity among Penn students over the past two years and the Celtic Basic PPO seems to be the most popular choice this fall. We have had periodic communications with Penn staff and are not aware of any difficulties that students have had with the use of the Celtic PPO. Either insurance plan provides coverage at least as good as the average employer provided health insurance plan in the United States.

The Aetna plan is integrated with Penn's Student Health Services, providing free on campus visits and uses SHS as a gatekeeper to some other services. The Celtic plan allows the patent to select any doctor or hospital. This distinction in is largely a matter of personal preference.

The Aetna plan is better for a student with a history of health problems who needs ongoing medical treatment. (Managed care plans are always a better way to provide for known and expected medical expenses). The Celtic plan is likely to be a better choice for a healthy student who rarely uses medical services and would likely need only normal preventative care and protection from large unexpected medical expenses. The Aetna plan provides more up-front managed care services and lower out-of-pocket costs, the Celtic plan provides more catastrophic coverage and allows more freedom in selecting treatment but has the potential for higher out-of-pocket costs. /span>

Private insurance patients seldom pay these high co-insurance amounts primarily because patients are able to privately negotiate with providers to avoid large co-payment expenses in return for continued treatment. Providers are typically willing to accept 70% or 80% of reasonable amounts for patient care when negotiated in advance since this is more than the amount paid by Medicare and many of the other large health plans. Medical providers know that declining such a financial arrangement with a patient with large ongoing expenses primarily paid by insurance would mean losing the patient, so this is a common business decision.

The biggest difference between the two insurance plans is cost. Aetna is priced at more than $200 per month and Celtic is $55 per month. This huge difference underscores the differences in plans hat accept all applicants and those insurance plans that accept only preferred risk applicants.

If you have any difficulties presenting your evidence of health insurance at registration, please let us know - including the contact information of the Registrant's Office or the Student Health Services office. It is important for MedSave.com to maintain working relationships with many of the nation's colleges and universities for this purpose.


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