| General Benefits |
| In-Network Benefits |
Out-Of-Network Benefits |
| PPO Select®Saver Series III, 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®Saver Series III, a Preferred Provider Health Insurance Plan, pays 60 percent and you pay 40 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 precertify your medical care. |
You must precertify hospital admissions and certain services. |
| There are usually no claim forms to file. |
You may have to submit claims for reimbursement. |
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| * Texas Department of Insurance Form: PPO-SELSAVER-3-OLC-2 |
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