You have two PPO medical options to choose from: Blue Cross / Blue Shield Preferred and Blue Cross / Blue Shield Premium.

Both plan options:

• Enable you to go to any doctor or hospital, but you will pay less when you go to a doctor in the PPO network
• Provide prescription drug coverage through Express Scripts
• Provide health/substance abuse treatment coverage through ValueOptions
• Provide a preventive care benefit, which means:
  • There is no dollar limit for in-network preventive care services, such as routine physicals and mammograms
    • Services must be coded as "routine" care by your physician to be covered (deductibles and coinsurance will not apply)
    • Services not coded as "routine" will not be eligible for preventive care reimbursement (will be paid as coded and covered; deductibles and coinsurance will apply
  • Office visit copayments still apply

Comparing the PPO Medical Plan Options

	BCBS Preferred PPO		BCBS Premium PPO
	In-network	Out-of-network	In-network	Out-of-network
Benefit plan year deductible	$500 per individual/$1,000 per family	$800 per individual/$1,000 per family	$300 per individual/$600 per family	$800 per individual/$1,600 per family
Office visit copay	$20 (specialist visit: $40)	40% coinsurance	$15 (specialist visit: $30)	40% coinsurance
Coinsurance	10%	40%	10%	40%
Benefit plan year out-of-pocket maximum	$3,000 per individual / $6,000 per family	$5,000 per individual / $10,000 per family	$2,000 per individual / $4,000 per family	$5,000 per individual / $10,000 per family

Note: Preventive care is not subject to the plan deductible. Preventive care for adults age 19 and older is subject to a $300 benefit plan year maximum per person.