b'Blue Cross Blue Shield PPOANNUAL MEDICAL PLAN YEAR DEDUCTIBLE$500PPO$1,000 Non-PPOPlan Comparison:ADDITIONAL DEDUCTIBLESNon-Medicare $200 Deductible each PPO hospital admission (notto exceed 2 copays per year)Eligible Members $400 Deductible each non-PPO hospital admission (not to exceed 2 copays per year)$150 Deductible each emergency room visit, unless admittedHOSPITAL SERVICESInpatient80%PPO hospital plus $200 hospital admission deductible50%Non-PPO hospital plus $400 hospitaladmission deductibleSkilled Nursing Facility (non-custodial)80%PPO facility plus $200 hospital admissiondeductible50%Non-PPO facility plus $400 hospital admission deductibleServices must be rendered in aBCBS-approved skilled nursing facility.OUTPATIENT SERVICESChemotherapy, Radiation Therapy80% PPO provider 50% Non-PPO providerEmergency Room100%After $150 emergency room deductible,unless admittedLab/X-ray80% PPO provider 50% Non-PPO providerSpeech, Physical and Occupational Therapy80%PPO provider 50%Non-PPO providerSurgery80% PPO provider50% Non-PPO providerUrgent Care80% PPO provider50% Non-PPO providerCTPF 2024 NON-MEDICARE HEALTH INSURANCE HANDBOOK CTPF 2024 NON-MEDICARE HEALTH INSURANCE HANDBOOK 13'