ssive PPO 2000 100% 80% 50% Dependent Children Only Only None $50 / $2,000 Dependent Children 350 / $2.000 ALTERNATE PRODUCT(S) Option 10; DMO Copay 41 Per Schedule Per Schedulefer Schedule None I I J $5 Noce/None N/A N/A / N/A Option 2; DMO 100% 80% I 50% None I None None None