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Cigarette specifications: Resin 6 mg, nicotine o.4 mg, CO 8 mg

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Capital Blue Cross Value PPO (segments 001 005) Capital Blue Cross Select PPO (segments 001 004) Capital Blue Cross Enhanced PPO (segments 001 004) Capital Blue Cross Complete PPO (segments 001-005) Capital Blue Cross Basic PPO (New plan with segments 002,003, and 005) The counties in each segment are as follows: Segment 001 Centre, Dauphin, Juniata, Mifflin, Perry Segment 002 Columbia, Montour, Northumberland, Snyder, Union Segment 003 Berks, Lehigh, Northampton, Schuylkill Segment 004 Cumberland, Fulton, Lancaster, Lebanon Segment 005 Adams, Franklin, York Preauthorization Requirements : Some services may require preauthorization in advance of treatment to determine whether certain proposed services are a Medical Necessity and Covered Service under a members Medicare Advantage plan