Maine Community Health Options

Health Options Clear Choice Silver $4200 HMO NE

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Medical Deductible	Individual: $4,200 Family: $8,400 Per Person: $4,200
Prescription Drug Deductible	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical
Medical Out-of-Pocket Maximum	Individual: $8,000 Family: $16,000 Per Person: $8,000
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Primary Doctor	Standard: $40 Copay
Specialist	Standard: $60 Copay

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

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