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Let%u2019s see what Lily may pay to get control and manage her multiple sclerosis with in-network providers, services, and facilities.This example includes:%u2022 PCP visit %u2013 one visit to diagnose her MS%u2022 $0 annual well-woman visit%u2022 specialist visits %u2013 four per year %u2022 12 months of specialty prescription medication at $8,700 per month before insurance%u2022 MRI %u2022 physical therapy visits %u2013 eight visits per year%u2022 lab work %u2013 two per yearNote: When Lily uses third-party copay assistance for any specialty medication, she won%u2019t get credit toward her MOOP or deductible for any copay or coinsurance amounts applied by a manufacturer coupon or rebate. Only the amount she pays out of pocket applies toward her deductible and MOOP. *Some specialty medications may qualify for third-party copay assistance programs, which can lower your out-of-pocket costs. COST OF CARE $106,450 TRS-ACTIVECARE PRIMARYDeductible $2,500Coinsurance 30% after deductibleCopay for PCP $30Copay for specialist $70Copay for physical therapy $30Coinsurance for high-tech radiology 30% after deductibleLab work $0Specialty medication copayBased on a yearly cost of $104,400$0 through the specialty medication copay assistance programWHAT LILY MAY PAY BASED ON $106,450 TOTAL COST OF CAREDeductible $750 for MRICopays $550Coinsurance $0Health plan paid $105,150Total paid by Lily $1,300www.bcbstx.com/trsactivecare 21