Low cost health insurance coverage is offered by Celtic Insurance Company, known for its financial stability and rated “B++“ by A.M. Best Company. Celtic’s most affordable medical policy in Pennsylvania is the Indemnity Bronze plan, which offers comprehensive benefits at a surprisingly low cost. Coverage is available to individuals, families, the self-employed and the uninsured. If you need benefits for a few months or a few years, it's worth considering.
This policy is considered a Bronze tier contract and can be purchased "off-Exchange." Since a federal subsidy does not apply to the plan, if your household income is under 400% of the Federal Poverty Level, a policy with another carrier should be purchased instead.
Individual deductible is $6,000 while family deductible is $12,000. Once met, maximum out-of-pocket expenses are $6,350 per person and $12,700 per family.
Physician Office Visits
Both primary care (pcp) and specialist visits are subject to the deductible and a 20% coinsurance. There is no limit to the number of visits allowed during the calendar year or your lifetime. Diagnostic and/or lab tests are also covered but subject to the deductible.
Any preventive visit is covered without any charge. No copay or deductible will apply either. Examples of "preventive" expenses include annual physicals, wellness exams, OBGYN visits and mammograms.
Complications or additional testing may not be covered at 100%. For example, if the cost of your colonoscopy costs $1,000 and an additional $300 to remove several suspicious polyps, you may be responsible for paying the $300. However, if "in-network," your portion may be lower.
Generic, Preferred Brand, Non-Preferred, Specialty and 90-Day mail-order are subject to the deductible and 20% coinsurance.
Inpatient And Outpatient Services
Once again, subject to deductible and coinsurance is facility, physician and surgical expenses. Lab and professional fees are included along with ER, Urgent-Care and emergency transportation (typically considered through ambulance only, whether ground or air).
Substance Abuse And Mental/Behavioral Disorders
Covered (both inpatient and outpatient). Specific benefits must comply with ACA legislative mandates and updates each year.
Since this is an ACA-compliant policy (although available off-Exchange), standard maternity benefits are included, such as normal and vaginal delivery, prenatal and postnatal expenses, delivery and related inpatient costs, and routine lab tests and other needed expenses. The deductible and coinsurance apply so there will be a fairly significant out-of-pocket cost (possibly up to $6,350).
If you need to find health insurance in Pennsylvania that covers maternity, we devoted an entire article to the subject. Under new federal guidelines, it is now one of 10 required essential benefits. Although a deductible may apply, there is a cap on out-of-pocket expenses.
Additional Miscellaneous Coverage
Chiropractor visits, speech, physical and occupational therapy, approved durable medical equipment, mandates state benefits (required either by state or local government), habilitation expenses, and skilled nursing or hospice services and/or facilities.
Children's Benefits (Ages 1-18)
One allowed eye exam every 12 months. $150 available towards the purchase of glasses and/or contact lenses. Two dental exams per 12 months allowed. Both dental and vision benefits are subject to applicable deductible. Celtic Insurance also offers additional discounts through various affiliates.
Non-Covered Items And Limitations
If a service or product is provided to you free of charge, you can not submit this item as a claim. Also, if a person that is part of your immediate family provides a medical service, it is not covered. Any expense that is not specifically mentioned in the policy, you will have to pay.
Internal bypass surgery, weight modification treatment, breast augmentation or reduction, braces and vasectomies are not covered. Additional exclusions include (but are not limited to) eye refraction surgery, investigative or experimental services and treatment, self-inflicted injuries, services and treatment provided outside of the US, and rehab and custodial care, unless specifically mentioned as a covered benefit.
Important Note: Since the original publish date of this article, Celtic has revamped their portfolio. Currently, Ambetter products are offered in many states. However, these plans are not available in Pennsylvania.