•You must select a primary care physician
(PCP)
•No deductible for doctors
•$15 PCP copay per visit
•$30 Specialist copay
•$250 per person $500 family per hospital
admission
•$75 outpatient services (first three
visits) – X-rays, etc.
•$100 emergency room visits
•
•Please read pages 59-69 of the 2007
Benefits Guide carefully before you select Blue Choice HMO.