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r <br /> 15 <br /> Category Traditional Plan PPQ P_PO <br /> Preferred Non-Preferred <br /> Hospital Services <br /> Selection of any hospital Preferred Hospital Non-preferred <br /> Hospitals from list provided Hospitals <br /> by BC/BS <br /> Inpatient Care 80% covered 90% covered 80%PRC <br /> Outpatient 80%co-,ered 90%covered 80%PRC <br /> Room& Board 80% covered 90%covered 80% PRC <br /> semi-private semi-private semi-private <br /> room rate room rate room rate <br /> Emergency Services <br /> And Out of Area <br /> Hospital Services 80%covered 90%covered 90%PRC <br /> initial visit* <br /> Physician Services 80% covered 90% covered 90% PRC <br /> initial visit* <br /> Urgent Care Centers 80%covered 90%covered 80% PRC <br /> Surgery <br /> Operating & 80%covered 90%covered 80%PRC <br /> Recovery <br /> Outpatient 100%PRC 100%PRC 100% PRC <br /> Second Surgical 100%PRC 100%PRC 100%PRC <br /> Opinion <br /> Ambulatory 80%covered 90%covered 80%PRC <br /> Surgical Facility <br /> Services <br /> *In an emergency, services will be paid at the preferred level of benefits at a non preferred hospital <br /> which includes a$200 deductible ($600 for family)an a 10 percent copayment. <br />