b'Blue Cross Blue Shield PPOPROFESSIONAL AND OTHER SERVICESAllergy Shots80% PPO provider50% Non-PPO providerPlan Comparison:Ambulance80%Non-Medicare Chiropractic VisitsEligible Members 80% PPO provider50% Non-PPO providerLimited to 40 visits per yearDentalAccidental care only: coverage providedfor repair of accidental injury to sound natural teethEyeglasses and ContactsNot coveredContact BCBS customer service at 1-800-331-8032 for details on the vision discount program.Maternity80% PPO provider 50% Non-PPO providerPhysician Office Visits80% PPO provider 50% Non-PPO providerPreventive Care Services (physicals, diagnostic tests, immunizations)100% of allowed charges PPO and50% non-PPO providersIncludes routine physical examinations, diagnostic tests, and immunizationsProsthetic Devices and Medical Equipment80%PPO provider up to purchase price50% Non-PPO provider up to purchase priceVision Screening and ExamsNot coveredContact BCBS customer service at 1-800-331-8032 for details on the vision discount program.26 CTPF 2021 HEALTH INSURANCE HANDBOOKCTPF 2021 HEALTH INSURANCE HANDBOOK'