General Benefits

In-Network Benefits	Out-of-Network Benefits
Preferred Provider Health Insurance Plan (PPO) Select^® Choice Series III pays 80 percent and the policyholder pays 20 percent of covered expenses after deductible has been met.	Preferred Provider Health Insurance Plan (PPO) Select^® Choice Series III pays 70 percent and policyholder pays 30 percent of covered expenses after the deductible has been met.
$25 office visit copay (physician consultation only) Emergency care within 24-hours of accident - 80 percent of allowable charges after deductible.	Physician office visits subject to deductible and coinsurance. Emergency care within 24-hours of accident - 80 percent of allowable charges after deductible.
Network providers will precertify medical care.	Policyholders must precertify hospital admissions and certain services.
There are usually no claim forms to file.	Policyholder may have to be submit claims for reimbursement.