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	PPO Select BasicSM Overview Plan Highlights General Benefits Preventive Care Child-Only Coverage Prescription Drug Program BlueCard PPO Outline of Coverage* Apply Today! Products Group HMO Blue Texas BlueCard PPO BlueChoice PPO Small Group (2-50) Individual Select Blue Advantage Series III PPO Select® Choice Series III PPO Select® Saver Series III BlueEdgeSM Individual HSA PPO Select Value® CareSM PPO Select BasicSM Foundation Hospital Care SelecTEMP® PPO Dental Indemnity USA		General Benefits In-Network Benefits Out-Of-Network Benefits PPO Select BasicSM, a Preferred Provider Health Insurance Plan pays 75 percent and you pay 25 percent of the allowable amount after you meet your deductible. PPO Select BasicSM, a Preferred Provider Health Insurance Plan pays 50 percent and you pay 50 percent of the allowable amount after you meet your deductible. All physician office visits will be subject to deductible and coinsurance. All physician office visits will be subject to deductible and coinsurance. Network providers will preauthorize your medical care. You must preauthorize hospital admissions and certain services. There are usually no claim forms to file. You may have to submit claims for reimbursement. Emergency Room visit subject to deductible and 75/25 coinsurance. Emergency Room visit subject to deductible and 50/50 coinsurance.   * Texas Department of Insurance Form: PPO-CCHBP-OC-2
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