Page 19 - Demo

Let%u2019s see what Gary may pay to manage his diabetes with in-network providers, services, facilities and labs.This example includes:%u2022 hospital stay%u2022 specialist visit %u2013 one per year%u2022 PCP visits %u2013 four per year%u2022 prescription medicationCOST OF CARE $18,300 TRS-ACTIVECARE PRIMARYDeductible $2,500Coinsurance 30% after deductibleCopay for PCP $30Copay for specialist $70Hospital/facility coinsuranceBased on one night at a cost of $11,000 30% after deductibleInsulin out-of-pocket costsBased on yearly cost of $6,000$25 for 31-day supply$75 for 61- to 90-day supplyWHAT GARY MAY PAY BASED ON $18,300 TOTAL COST OF CAREDeductible $2,500Office copays $190Insulin copays $300Coinsurance $2,550Health plan paid $12,760Total paid by Gary $5,540www.bcbstx.com/trsactivecare 19