Arkansas health plan · 2026

Complete Gold + Vision + Adult Dental · 62141AR0100014

Celtic Insurance Company offers this marketplace health insurance plan (Plan ID 62141AR0100014) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Gold Plan type: PPO CSR: Limited Cost Sharing Plan Variation Issuer: Celtic Insurance Company
Telehealth Data pending HSA eligible No Dental Adult Vision Adult/Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 81.64%. Expect to pay roughly 18.36% of covered costs out of pocket, based on issuer reporting.

2026 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$446 – $1751

Before subsidies

Estimate after subsidies

Deductible

$1,450

$2900 per group

See deductible details

Max out-of-pocket

$7,500

$15000 per group

Review MOOP rules

Office visits

Primary care $15.00
Specialist $35.00
HSA Not eligible

Drug tiers

Generic $3.00
Preferred brand $30.00

View formulary tiers

$612 / mo before subsidies

≈ $7339 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1938 / mo before subsidies

≈ $23258 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$2347 / mo before subsidies

≈ $28167 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1492 / mo before subsidies

≈ $17900 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

20.00% Coinsurance after deductible

Durable Medical Equipment

20.00% Coinsurance after deductible

Advertisement

Enrollment guidance

Stay on top of 2026 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Arkansas). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Limited Cost Sharing Plan Variation plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

20.00% Coinsurance after deductible

Durable Medical Equipment

20.00% Coinsurance after deductible

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 62141AR0100014
Coverage year 2026
State Arkansas
Issuer Celtic Insurance Company
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 62141AR0100014-03
Available variants

Standard Off Exchange Plan · 62141AR0100014-00

Standard On Exchange Plan · 62141AR0100014-01

Open to Indians below 300% FPL · 62141AR0100014-02

Open to Indians above 300% FPL · 62141AR0100014-03
Last plan update Wed, 15 Oct 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Arkansas 1065
PCPs in Arkansas 142
Telehealth support Data pending
Nationwide providers 10958
1,065 doctors statewide 142 PCPs 5 OB/GYN

Provider network(s)

Providers Arkansas All US states
All 1065 10958
PCP 142 1544
Allergy 1 10
OB/GYN 5 40
Dentists 23 547

Drug coverage overview

4,670 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
GENERIC 2,652
NON-PREFERREDGENERIC-NON-PREFERREDBRAND 2,018
Prior authorization Drugs
Required 1,230
Not Required 3,440
Step therapy Drugs
Required 77
Not Required 4,593
Quantity limits Drugs
Has Limit 2,158
No Limit 2,512

Customer highlights

What stands out for members

  • Issuer: Celtic Insurance Company · Plan ID 62141AR0100014 · 2026 filing.
  • Disease management programs available: Asthma, Diabetes, Heart Disease, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 62141AR0100014-03 (Open to Indians above 300% FPL) currently displayed.
Advertisement

Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$35.00
Tier 1 in-network $35.00
Out-of-network 50.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

Limited to a combined 30 visit limit per year for outpatient physical therapy, speech therapy, occupational therapy, and chiropractic care. Note: Limits do not apply when provided for a mental health/substance use disorder diagnosis.

Diabetes Care Management

$35.00
Tier 1 in-network $35.00
Out-of-network 50.00% Coinsurance after deductible

Diabetes Education

$35.00
Tier 1 in-network $35.00
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Home Health Care Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 50.0 Visit(s) per Year

Prior authorization may be required - please contact the number listed on your ID card.

Laboratory Outpatient and Professional Services

$15.00
Tier 1 in-network $15.00
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card. Laboratory services provided to treat a behavioral health diagnosis fall under mental/behavioral health services. Coverage includes medically necessary genetic/molecular cancer biomarker testing.

Mental/Behavioral Health Urgent Care

$15.00
Tier 1 in-network $15.00
Out-of-network 50.00% Coinsurance after deductible

Other Practitioner Office Visit (Nurse, Physician Assistant)

$15.00
Tier 1 in-network $15.00
Out-of-network 50.00% Coinsurance after deductible

Benefits include covered services rendered by a certified community health worker within their scope of certification.

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00% Coinsurance after deductible

Covered in accordance with ACA guidelines.

Primary Care Visit to Treat an Injury or Illness

$15.00
Tier 1 in-network $15.00
Out-of-network 50.00% Coinsurance after deductible

Primary care visits provided to treat a behavioral health diagnosis fall under mental/behavioral health services.

Rehabilitative Occupational and Rehabilitative Physical Therapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

60 inpatient days/year. Prior authorization may be required - please contact the number listed on your ID card. Limited to a combined 30 visit limit per year for outpatient physical therapy, speech therapy, occupational therapy, and chiropractic care. Note: Limits do not apply when provided for a mental health/substance use disorder diagnosis.

Rehabilitative Speech Therapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

Prior authorization may be required - please contact the number listed on your ID card. Limited to a combined 30 visit limit per year for outpatient physical therapy, speech therapy, occupational therapy, and chiropractic care. Note: Limits do not apply when provided for a mental health/substance use disorder diagnosis.

Specialist Visit

$35.00
Tier 1 in-network $35.00
Out-of-network 50.00% Coinsurance after deductible

Specialist visits provided to treat a behavioral health diagnosis fall under mental/behavioral health services.

Substance Use Disorder Urgent Care

$15.00
Tier 1 in-network $15.00
Out-of-network 50.00% Coinsurance after deductible

Urgent Care Centers or Facilities

$35.00
Tier 1 in-network $35.00
Out-of-network 50.00% Coinsurance after deductible

X-rays and Diagnostic Imaging

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Delivery and All Inpatient Services for Maternity Care

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Dialysis

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Durable Medical Equipment

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Emergency Room Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

Emergency Transportation/Ambulance

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

Prior authorization is not required for emergency transport, however, all non-emergent transport requires prior authorization.

Hospice Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Inpatient Hospital Services (e.g., Hospital Stay)

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Inpatient Physician and Surgical Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Mental/Behavioral Health Emergency Room

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

Mental/Behavioral Health Emergency Transportation/Ambulance

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

Prior authorization is not required for emergency transport, however, all non-emergent transport requires prior authorization.

Mental/Behavioral Health Inpatient Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Mental/Behavioral Health Outpatient Other Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card. Note: Cost share will be waived for Behavioral Health screening services.

Mental/Behavioral Health Outpatient Services

$15.00
Tier 1 in-network $15.00
Out-of-network 50.00% Coinsurance after deductible

Cost sharing shown applies to outpatient office visits only. See Summary of Benefits and Coverage and the policy for more information on an additional outpatient category, Other Outpatient Services, which may apply a different cost share amount and require prior authorization. Note: Office visits do not require prior authorization. Cost share will be waived for Behavioral Health screening services.

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Outpatient Rehabilitation Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

Prior authorization may be required - please contact the number listed on your ID card. Limited to a combined 30 visit limit per year for outpatient physical therapy, speech therapy, occupational therapy, and chiropractic care. Note: Limits do not apply when provided for a mental health/substance use disorder diagnosis.

Outpatient Surgery Physician/Surgical Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Radiation

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Skilled Nursing Facility

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 60.0 Days per Year

Prior authorization may be required - please contact the number listed on your ID card.

Substance Abuse Disorder Inpatient Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Substance Abuse Disorder Outpatient Services

$15.00
Tier 1 in-network $15.00
Out-of-network 50.00% Coinsurance after deductible

Cost sharing shown applies to outpatient office visits only. See Summary of Benefits and Coverage and the policy for more information on an additional outpatient category, Other Outpatient Services, which may apply a different cost share amount and require prior authorization. Note: Office visits do not require prior authorization. Cost share will be waived for Behavioral Health screening services.

Substance Use Disorder Emergency Room

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

Substance Use Disorder Emergency Transportation/Ambulance

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

Prior authorization is not required for emergency transport, however, all non-emergent transport requires prior authorization.

Substance Use Disorder Outpatient Other Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card. Note: Cost share will be waived for Behavioral Health screening services.

Transplant

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Mental health & substance use

Behavioral health visits and substance use treatment.

Mental/Behavioral Health ER Physician Fee

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

Substance Use Disorder ER Physician Fee

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Hearing Aids

20.00%
Tier 1 in-network 20.00%
Out-of-network 50.00%

Limit: 2.0 Item(s) per 3 Years

Prior authorization may be required - please contact the number listed on your ID card.

Major Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prenatal and Postnatal Care

$15.00
Tier 1 in-network $15.00
Out-of-network 50.00% Coinsurance after deductible

Coverage includes services rendered by a certified community based doula within the scope of their certification.

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Out-of-network No Charge

Limit: 1.0 Exam(s) per Year

Up to $38.50 OON

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00% Coinsurance after deductible

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$3.00
Tier 1 in-network $3.00
Out-of-network 100.00%

Cost sharing shown applies to Tier 1a-Preferred Generic Drugs only. See Summary of Benefits and the policy or service agreement for more information on an additional category, Tier 1b-Generic Drugs, which may apply a higher cost share. Up to a 30 day supply at any participating pharmacy or up to a 90 day supply at a 90 day retail pharmacy. Refer to the prescription drug list for more information.

Non-Preferred Brand Drugs

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Off Label Prescription Drugs

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Preferred Brand Drugs

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Preventative Drugs

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Specialty Drugs

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Tier 1b Generic Drugs

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

Up to a 30-day supply at any Participating Pharmacy or up to a 90-day supply at a Designated 90 day Retail Pharmacy. Refer to the prescription drug list for more information.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Basic Dental Care - Adult

50.00%
Tier 1 in-network 50.00%
Out-of-network 50.00%

Limit: 1000.0 Dollars per Year

$1,000 annual benefit maximum includes all Dental services (Routine, Basic and Major) for Adults

Dental Anesthesia

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Dental Check-Up for Children

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Infusion Therapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card. Coverage includes IVG treatment for PANS/PANDA diagnosis.

Major Dental Care - Adult

50.00%
Tier 1 in-network 50.00%
Out-of-network 50.00%

Limit: 1000.0 Dollars per Year

$1,000 annual benefit maximum includes all Dental services (Routine, Basic and Major) for Adults

Nutritional Counseling

$35.00
Tier 1 in-network $35.00
Out-of-network 50.00% Coinsurance after deductible

Nutritional counseling provided to treat a behavioral health diagnosis falls under mental/behavioral health services.

Orthodontia - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Orthodontia - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prosthetic Devices

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Routine Dental Services (Adult)

No Charge
Tier 1 in-network No Charge
Out-of-network No Charge

Limit: 1000.0 Dollars per Year

$1,000 annual benefit maximum includes all Dental services (Routine, Basic and Major) for Adults

Weight Loss Programs

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Weight Loss Treatment

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Coverage provided for the medically necessary treatment of severy obesity including bariatric surgery, preoperative, and postoperative care.

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Acquired Brain Injury

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Coverage provided for medically necessary treatments related to an aquired brain injury. See EOC for a list of covered services.

Acupuncture

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Allergy Testing

$35.00
Tier 1 in-network $35.00
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Applied Behavior Analysis Based Therapies

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Applied behavior analysis therapies provided to treat a behavioral health diagnosis falls under mental/behavioral health services.

Bariatric Surgery

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Coverage provided for medically necessary expenses for the treatment of diseases and conditions caused by severe obesity, including preoperative and postoperative care. Prior authorization may be required - please contact the number listed on your ID card.

Biomarke

$15.00
Tier 1 in-network $15.00
Out-of-network 50.00% Coinsurance after deductible

Coverage provided for medically necessary genetic/molecular cancer biomarker testing.

Cardiac Rehabilitation

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 36.0 Visit(s) per Year

Cochlear Implants

20.00%
Tier 1 in-network 20.00%
Out-of-network 50.00%

Community Health Worke

$15.00
Tier 1 in-network $15.00
Out-of-network 50.00% Coinsurance after deductible

Covered services must be rendered by a certified community health worker performing services within their scope of certification.

Cosmetic Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Craniofacial Surgery

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Coverage provided for a diagnosis of craniofacial anomaly where surgery and treatment are medically necessary to improve functional impairment.

Doulas

$15.00
Tier 1 in-network $15.00
Out-of-network 50.00% Coinsurance after deductible

Coverage includes services rendered by a certified community based doula within the scope of their certification.

Eye Glasses for Children

No Charge
Tier 1 in-network No Charge
Out-of-network No Charge

Limit: 1.0 Item(s) per Year

OON: Up to $50 for frames, $37.50 for lenses and $91 for contacts in lieu of eyeglasses. See EOC for lens limits.

Gastric Electrical Stimulation

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Habilitation Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

Prior authorization may be required - please contact the number listed on your ID card. Limited to a combined 30 visit limit per year for outpatient habilitation services; limited to 180 visits per year for developmental services. Habilitation services provided to treat a behavioral health diagnosis fall under mental/behavioral health services. Limits do not apply to mental/behavioral health services.

Imaging (CT/PET Scans, MRIs)

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Infertility Treatment

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required. Coverage includes testing to diagnose infertility, infertility counseling and planning services. Additionally, in vitro fertilization procedures and restorative reproductive treatments are covered.

Inherited Metabolic Disorder - PKU

$15.00
Tier 1 in-network $15.00
Out-of-network 50.00% Coinsurance after deductible

Long-Term/Custodial Nursing Home Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

PANS-PANDA

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Coverage provided for off-label use of intravenous immunoglobulin for the diagnosis of PANS, PANDA, or both.

Private-Duty Nursing

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Reconstructive Surgery

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

1. Treatment provided for the correction of defects incurred in an Accidental Injury sustained by the Member; 2. Surgery performed on a child for the correction of a cleft palate or cleft lip, removal of a port-wine stain or hemangioma (only on the face), or correction of a congenital abnormality; 3. Treatment provided when it is incidental to disease or for reconstructive surgery following neoplastic (cancer) surgery; 4. In connection with a mastectomy resulting from cancer surgery, services for (a) reconstruction of the breast on which the cancer-related surgery was performed; (b) surgery to reconstruct the other breast to produce a symmetrical appearance; and (c) prostheses and services to correct physical complications for all stages of the mastectomy, including lymphedemas; 5. Reduction mammoplasty, if such reduction mammoplasty meets Coverage Criteria. Prior Authorization may be required - please contact the number listed on your ID card.

Restorative Reproductive Treatment

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Coverage provided for patients with a history of unexplained infertility of at least 2 years duration, or for medical conditions including endometriosis, in utero exposure to diethylstilbestrol, blockage/removal of one/both fallopian tubes, or abnormal male factors contributing to infertility.

Routine Eye Exam (Adult)

No Charge
Tier 1 in-network No Charge
Out-of-network No Charge

Limit: 1.0 Exam(s) per Year

OON exam: Up to $38.50. Benefit also includes 1 pair of eye glasses or contacts per year, covered up to $130 In-Network for frames or $130 In-Network for contacts in lieu of eyeglasses. OON eyewear benefit: covered up to $50 for frames, lenses up to $37.50 and contact lenses up to $91.

Routine Foot Care

$35.00
Tier 1 in-network $35.00
Out-of-network 50.00% Coinsurance after deductible

Treatment for Temporomandibular Joint Disorders

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Well Child Care

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00% Coinsurance after deductible

Variant attributes

Complete Gold + Vision + Adult Dental · Variant 62141AR0100014-03

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

Limited Cost Sharing Plan Variation

HIOS Product ID

62141AR010

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

62141AR0100014-03

Plan Marketing Name

Complete Gold + Vision + Adult Dental

Plan Variant Marketing Name

Complete Gold + Vision + Adult Dental

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

81.64%

Issuer ID

62141

Issuer Marketplace Marketing Name

Ambetter from Arkansas Health & Wellness

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

ARN001

Out of Country Coverage

No

Out of Service Area Coverage

No

Service Area ID

ARS001

State Code

AR

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$0

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$0

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

$55000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

$27500 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

$27,500

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

20.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$15000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$7500 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$7,500

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

$40000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

$20000 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

$20,000

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

ARF002

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$0

SBC Scenario, Having Diabetes, Limit

$0

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Diabetes, Heart Disease, Pregnancy

EHB Percent of Total Premium

0.9673

First Tier Utilization

100%

Import Date

10/15/2025

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

Yes

Is a Referral Required for Specialist?

No

Plan Effective Date

1/1/2026

Plan Type

PPO

QHP/Non QHP

Both

Source Name

SERFF

Plan ID

62141AR0100014

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

$22900 per group

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

$11450 per person

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

$11,450

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$2900 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$1450 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$1,450

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

$20000 per group

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

$10000 per person

Combined Medical and Drug EHB Deductible, Out of Network, Individual

$10,000

Unique Plan Design

Yes

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Arkansas?

Complete Gold + Vision + Adult Dental (62141AR0100014) is a Gold PPO from Celtic Insurance Company in Arkansas for the 2026 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Complete Gold + Vision + Adult Dental support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Complete Gold + Vision + Adult Dental HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental add-ons: Adult.

Vision add-ons: Adult, Child.

Does Complete Gold + Vision + Adult Dental support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Complete Gold + Vision + Adult Dental?

The issuer lists disease management resources for: Asthma, Diabetes, Heart Disease, Pregnancy.

Is there out-of-country coverage for Complete Gold + Vision + Adult Dental?

No, out-of-country services are not covered for this plan.

Does Complete Gold + Vision + Adult Dental cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies.

How do I enroll in or manage payments for Complete Gold + Vision + Adult Dental?

Use the issuer portal https://www.ambetterhealth.com/en/ar/payments to pay premiums or start enrollment, then return to HealthPorta for benefit comparisons.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
Issuer profile More plans
Open comparison tray

Add at least two plans to launch side-by-side comparisons.