Page 4 - Demo

Coinsurance: The portion you pay for services after you meet your deductible. It%u2019s often a percentage of the costs. For example, you pay 30%, and the health care plan pays 70%.Copay: The set amount you pay for a covered service when you get it. The amount can vary based on the type of service.Deductible: The annual amount for medical expenses you pay before your plan starts to pay its portion.Tiering: Providers and facilities are grouped into tiers based on quality, cost and best practice clinical guidelines. Tier 1 providers and facilities offer top performance and best value. You pay less when you choose Tier 1 and may pay more when you choose Tier 2.Emergency: A sudden and unexpected change in a person%u2019s physical or mental condition that needs immediate medical care and could result in:%u2022 placing the person%u2019s health in serious jeopardy (including death)%u2022 serious impairment to bodily function%u2022 serious dysfunction of a body part or organ%u2022 serious disfiguration%u2022 serious threat to the health of a fetusGeneric drug: A prescription drug that%u2019s the generic equivalent of a brand-name drug listed on your health plan%u2019s formulary and costs less than the brand-name drug.Maximum out-of-pocket: The maximum amount you pay each year for medical costs. After reaching your MOOP, the plan pays 100% of allowable charges for covered services. Recommended Clinical Revie An optional review of certain services, procedures and treatments to determine if they%u2019re medically necessary. They should be completed before treatment to limit situations where claims are denied afterward.Premium: The amount you pay monthly for health care coverage.Preventive care services: Routine health care like screenings, check-ups and patient counseling to prevent illnesses, diseases or other health problems.Primary Care Provider: The provider you choose to be your first contact for medical care. With TRS-ActiveCare Primary*, your PCP coordinates all your medical care, including hospital admissions and referrals to specialists.Referral: A written authorization from your PCP to get care from a different contracted provider, specialist or facility.Specialist: A health care professional whose practice is limited to a certain branch of medicine, like specific procedures, age categories, body systems or certain types of diseases. * including TRS-ActiveCare Primary x Arlington and TRS-ActiveCare Primary x Region 4 plansKnow the Terms 4 www.bcbstx.com/trsactivecare