Page 12 - Demo

If you cover dependents, it%u2019s especially important to understand how deductibles and MOOPs work.Everyone in the family has their own deductible and MOOP. There%u2019s also a family deductible and MOOP. Individuals only have to meet their deductible before the plan begins to pay coinsurance. They don%u2019t have to meet the family deductible first.This is how deductibles work:%u2022 Claims that count toward an individual%u2019s deductible also count toward the family%u2019s deductible. Once an individual meets their deductible, they pay coinsurance and copays, which don%u2019t count toward the family deductible.%u2022 After any combination of family members meets the family deductible, the entire family only pays coinsurance and copays for medical care and prescriptions for the rest of the plan year.MOOPs work the same way:%u2022 An individual%u2019s deductible, copays and coinsurance all count toward both individual and family MOOPs. Once an individual meets their MOOP, their allowable expenses are covered at 100% for the rest of the year.%u2022 After any combination of family members meets the family%u2019s MOOP, the entire family%u2019s allowable medical care and prescriptions are covered at 100% for the rest of the year.Remember: Costs for out-of-network providers won%u2019t be covered at all.You%u2019re required to choose a PCP. Make sure you only see your PCP or a specialist referred by your PCP for care. If not, the plan will deny your claims, even if the provider is in network.You only have in-network coverage. If you get care out of network, you have to pay all the billed charges out of your own pocket %u2013 except in the case of a true emergency.Preventive care is covered at 100%. Work with your PCP to stay up to date on check-ups, immunizations and screenings.You pay coinsurance. Once you meet your deductible, your plan pays a percentage, and you pay a percentage. You have copays for doctor%u2019s visits. When you see your PCP or an in-network specialist referred by your PCP for non-preventive care, you pay a flat fee, or copay. You have to meet a deductible. The deductible is the amount you pay yearly for covered health care services before your health plan starts to pay. Your health plan pays the full cost of certain preventive benefits and medications, before you meet your deductible.You have a maximum out-of-pocket limit. This is the maximum amount you pay each year for medical costs. After reaching your MOOP, the plan pays 100% of allowable charges for covered services.How Your Plan Works 12 www.bcbstx.com/trsactivecare