The CelticSaver HSA Health Plan is a qualified high deductible health plan designed to provide you with major medical coverage including up to $5,000,000 of reliable health insurance protection combined with a Health Savings Account (HSA) option to make your health plan even more affordable.

Click on the following for more details:

Hospital and Surgical Charges--Charges by a hospital or physician for medical and surgical services and supplies while hospital confined are eligible expenses.  The maximum eligible expense for hospital daily room and board charges for normal care is the average semi-private room rate in that hospital.   For intensive care, the maximum eligible expense is four times the average semi-private room rate in that hospital. 

Medical Service Charges--Charges for the following medical services are eligible expenses:

• nonsurgical professional services by a physician or nurse;
• radiologist or laboratory charges for X-ray or radiation therapy, diagnosis or treatment;
• up to 30 visits per person, per calendar year of home health care by a home health care agency, but only if a hospital, skilled nursing or extended care facility confinement would otherwise be needed and the visit is prescribed by a physician;
• non-surgical treatment for tonsils, adenoids or hernia and surgical treatment for tonsils, adenoids or hernia after coverage is in force for 6 months;
• one screening by low-dose mammography, per calendar year beginning at age 35;
• emergency air or ground transportation in an ambulance to the nearest hospital up to $3,000;
• if a tubal ligation is performed during a pregnancy or complication of pregnancy, then those charges will be considered as eligible expenses.  Tubal ligation and vasectomies performed as outpatient surgery are covered after 12 months of continuous coverage;
• one cytological screening per calendar year for women age 18 and older;
• coverage for one prostate cancer screening per calendar year for an insured person age 50 and over.

Medical Supply Charges--Charges for the following medical supplies are eligible expenses:

• prescription drugs;
• blood, blood plasma, oxygen and anesthesia and their administration;
• initial artificial limbs or eyes needed to replace natural limbs or eyes that are lost while an insured person's coverage is in force (however, no benefit will be paid for repair or replacement of artificial limbs or eyes, or other prosthetic devices);
• initial prosthetic devices required as a result of a mastectomy performed while an insured person's coverage is in force;
• casts, splints, surgical dressings, crutches, and the rental of wheelchairs, hospital beds, and other durable medical equipment;
• diabetic equipment and supplies prescribed by a physician. 

Dental & Cosmetic Charges--Treatment of sound, natural teeth due to bodily injury that occurs while the insured person's coverage is in force.  No benefits will be paid for the prevention or correction of teeth irregularities and malocclusion of jaws by removal, replacement, or treatment on or to teeth or any other surrounding tissue.

Reconstructive surgery needed to correct a bodily injury or sickness that occurs while the insured person's coverage is in force is covered.  Cosmetic or reconstructive surgery that is not medically necessary will not be covered.

Psychiatric Care Charges--Hospital, medical service and supply charges for psychiatric care while hospital confined are eligible expenses, up to $2,500 per insured person, per calendar year.  Outpatient psychiatric care charges including medical service charges outpatient prescription drug charges.  Medical Service Charges are paid at 50% of eligible expenses up to $40 per visit. Twenty-five visits per calendar year. Outpatient prescription drugs are covered at 50% of eligible charges. This  benefit is limited to a maximum of $1,000 per insured person, per calendar year.  $10,000 lifetime maximum benefit per insured for inpatient and outpatient combined. 

Reconstructive Breast Surgery -- as a result of a partial or total mastectomy.

Human Organ and Transplant Charges--Hospital, medical service and medical supply charges for non-experimental human organ and/or tissue transplant charges are eligible expenses.  If the insured person uses the Transplant Network, benefits will be paid up to the amount of the charges negotiated by the Network.   In addition, there is a limited travel and lodging benefit.  If the insured person elects to have the procedure performed outside the Transplant Network, up to $100,000 will be reimbursed per procedure. 

Hospice Care--Hospice care, services and supplies, up to $5,000 per an insured person's lifetime.

Complications of Pregnancy--Complications of pregnancy covered as any other illness.  No benefits are paid for a normal pregnancy, normal childbirth, elective Cesarean Section, or elective abortion.

Preventive Care -- Eligible expenses for medical services and supplies incurred for preventive care in an asymptomatic insured person are covered up to $300 per insured person per calendar year.  

Preventive Care Benefits include, but are not limited to, charges for the following:

• Annual physical examinations, including office visits;

• Routine x-rays, labs and diagnostic tests;

• Screening services such as colorectal cancer tests, bone mass measurement and cardiovascular and diabetes tests;

• Immunizations; and

• Routine eye exam.

Preventive Care Benefits in excess of the calendar year maximum are not eligible expenses. 

CelticSaver HSA Plan--

Network Services-- To maximize the benefits received under the CelticSaver HSA PPO Plan and insured person must receive services from network providers.

Non-network Services--Each time an out-of-network provider (physician and/or hospital) is used, eligible chargers are reduced by an additional 20%, which does not apply to the out-of-pocket maximum.  Also, the office visit copay does not apply when non-network physicians are used. 

If charges by a non-network provider  are incurred by an insured person due to a medical emergency, the deductible and coinsurance will be the same as if provided by a network provider.