PPO Select^® Choice Series III

Policy Form Number: PPO-SELCHOICE-3

Preventive Care

PPO Select Choice emphasizes preventive care with coverage for routine physicals, immunizations and diagnostic tests. When you use network providers for your medical care, office visits and certain office setting services are generally covered 100% of allowable amount after your copay up to the $300 calendar year maximum. So, depending on the plan you choose, you will receive the services below for $25 per visit! Immunizations for children through age 7 are covered 100% of allowable amount, no copayment required.

View Office Setting Services for PPO Select Choice

• General Benefits
• Preventive Care
• Child-Only Coverage
• Prescription Drug Program
• View Outline of Coverage