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Coinsurance: The portion you pay for services after you meet your deductible. It%u2019s often a percentage of the costs. For example, you pay 20%, and the health care plan pays 80%. Copay: The set amount you pay for a covered service when you get it. The amount can vary by the type of service.Deductible: The annual amount for medical expenses you must pay before your plan starts to pay its portion.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 jeopardy to the health of a fetusGeneric drug: A prescription drug that%u2019s the generic equivalent of a brand-name drug 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 When you need approval from BCBSTX before they%u2019ll cover certain services or medications.Premium: The amount you pay monthly for health care coverage.Preventive care services: Routine health care like screenings, checkups 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 some plans, your PCP coordinates all your medical care, including hospital admissions and referrals to specialists. Not all health plans require a PCP, but we always recommend you have one.Referral: A written authorization from your PCP to get care from a different in-network 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 types of diseases.KNOW THE TERMS www.bcbstx.com/trsactivecare 5