Maine Community Health Options

Health Options Clear Choice Gold $1500 PPO NE

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Medical Deductible	Individual: $1,500 Family: $3,000 Per Person: $1,500
Prescription Drug Deductible	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical
Medical Out-of-Pocket Maximum	Individual: $5,000 Family: $10,000 Per Person: $5,000
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Primary Doctor	Standard: $25 Copay
Specialist	Standard: $50 Copay

Preferred Brand Drugs	Standard: $50 Copay
Generic Drugs	Standard: $25 Copay