Independence Blue Cross

Personal Choice PPO Gold Classic

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Medical Deductible	Individual: $1,250 Family: $2,500 Per Person: $1,250
Prescription Drug Deductible	Individual: $0 Family: $0 Per Person: $0
Medical Out-of-Pocket Maximum	Individual: $9,200 Family: $18,400 Per Person: $9,200
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Primary Doctor	Standard: 20% Coinsurance
Specialist	Standard: 20% Coinsurance after deductible

Hospital Services	Standard: 20% Coinsurance after deductible
Inpatient Services	Standard: 20% Coinsurance after deductible

Emergency Room