Maine Community Health Options

Health Options Clear Choice Platinum PPO NE

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Medical Deductible	Individual: $500 Family: $1,000 Per Person: $500
Prescription Drug Deductible	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical
Medical Out-of-Pocket Maximum	Individual: $3,000 Family: $6,000 Per Person: $3,000
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Primary Doctor	Standard: $20 Copay
Specialist	Standard: $40 Copay

Preferred Brand Drugs	Standard: $15 Copay
Generic Drugs	Standard: No Charge