| Preventive Care |
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Office Setting Services
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If using network providers PPO Select Value® Caresm, a preferred provider health benefit insurance plan, pays
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Physician Services
Routine Physical Examinations
Well Child Care
Hemoccult Tests
Pap Smears
Immunizations 8 years and over
Routine lab
X-ray
Annual Routine Vision and Hearing Exams
(Routine mammograms, colorectal cancer screening and prostate cancer screenings are not subject to the $300 maximum)
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50% of Allowable Amount
$300 Calendar Year Maximum per participant
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*When billed separately, medical / surgical coinsurance applies plus any applicable deductible.
**Subject to days or dollar maximums.
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