Plan Highlights
PPO Select® Choice Series III, a Preferred Provider Health Insurance Plan Provides:
$5,000,000 lifetime maximum benefit
Inpatient hospital benefits and professional care
Outpatient professional care (including office visits, X-rays,
lab and diagnostic services)24-hour, worldwide emergency care
Well-child care, routine physical, vision and hearing exams
Immunization benefits (up to age seven)
Human organ and tissue transplant benefits ($300,000
lifetime maximum for transplant benefits and subject to $5,000,000 policy lifetime maximum)Preventive Care - $300 maximum per person per calendar
year (subject to limitations)Home health care, hospice and skilled nursing facility
benefits (subject to limitations)Physical Medicine Services - In-network, 80 percent of
allowable charges up to calendar year maximum of $1,000
per person (in-network and out-of-network combined)Ground and Air Ambulance Services - In-network, 80
percent of allowable charges up to $1,500 calendar year maximum per person (in-network and out-of-network combined)Any day of the month effective date except the 29th,
30th, or the 31st.Age-banded, child-only coverage
Affordable, cost-effective health coverage
Prescription drug plan
Mail-order prescription drug program
