Health insurance costs include monthly premium payments, deductibles, copayments, coinsurance, and out-of-pocket limits. For BlueDirect plans, there are limited out-of-pocket costs, but here’s what you can expect:

• Monthly payment amounts vary based upon the number of individuals you choose to cover, their habits, and add-ons you include.  To see what your monthly payments would be, get a quick quote.
• Individual deductibles ranging from $500 to $10,000 — customize your coverage by choosing a deductible amount that works best for your situation.
• No charge for preventive care services (100% coverage)
• Copayments for generic prescription drugs are as low as $7.
• Coinsurance ranging from 15 to 50 percent of services provided, after deductible and copayments are met.

Members choose from our statewide network of Preferred Providers and specialists for lowest out-of-pocket costs for many services. Or members may see other providers for covered services and receive less extensive benefits.

For more information on costs, including out-of-pocket costs, see the Summary of Benefits documents under What’s Included with BlueDirect, More Health Insurance Plan Details.

• A wide range of covered services, including emergency care and urgent care, specialist services, hospitalization, surgery, acupuncture, chiropractic, prescription drug benefits, diagnostic tests, organ transplants and outpatient procedures
• You do not have to select a primary care provider and you do not need a referral to see a specialist (prior approval required for some services)
• Choose from the most comprehensive provider network in New Mexico
• No referrals required to see specialists (prior approval required for some services)
• No claims forms to submit when using preferred providers
• No pre-existing conditions limitation with prior creditable coverage
• 24/7 Nurseline
• Coverage when you travel, including the unique BlueCard^® program

In order to keep health care costs down for everyone, every insurance plan has limitations. Here’s an overview of some of the plan limits.

• Dependent children are covered only through age 25.
• There are no benefits for maternity services, complications of pregnancy, behavioral health services or prescription drugs for behavioral health diagnosis, or chemical dependency treatment.
• Transplants must be received at facilities that contract with BCBSNM or through our national BCBS transplant network and must be prior-approved in order to be covered.
• There is no coverage for transplant services if received from non-preferred providers.
• For some services, you will pay a higher deductible and higher out-of-pocket costs if you visit non-preferred (out-of-network) providers, but it is your choice to receive most health care services from any licensed provider.

It’s important to know the limitations of your health insurance plan. For a full list of exclusions and limitations, see the Benefit Booklet documents under What’s Included with BlueDirect, More Health Insurance Plan Details.

You can customize your coverage by applying for these options when filling out the application forms for BlueDirect health insurance. These options are available for any BlueDirect plan you choose.

Dental Insurance

• Coverage from day one with no deductible required
• Up to $1,500 of included dental work per covered person per year
• 100 percent coverage for cleanings, examinations, X-rays, sealants and space maintainers*
• 80 - 50 percent coverage for most other common dental services*
• 20 percent discount on orthodontics, up to a maximum of $1,000*

*These percentages reflect coverage and discounts when using in-networks providers.

For more information on this option, download the dental coverage brochure .

• Prescription drug coverage is included with this plan.
• Copayments for prescription drugs vary based on the plan and options you choose.
• You have the option to order your prescription drugs through the mail with our Prescription Mail-Order Program .
• Prescription Drug Utilization/Benefit Management Programs are being added to policies with effective dates on or after 1/1/2012. See Compare Plans Chart for more information.
• NOTE: The list does not reflect the BlueDirect^® plans’ exclusion of prescription drugs for behavioral health diagnosis.

Benefit Summaries

The summary of benefits for each BlueDirect plan provides a snapshot of coverage (see the Benefit Booklet for details and limitations).

• View BlueDirect Basic Summary  (no Spanish available at this time)
• View BlueDirect Enhanced Summary  (no Spanish available at this time)
• View BlueDirect Premier Summary  (no Spanish available at this time)

We know that choosing a health insurance plan is a big decision. So we want to give you all the information you need to make the right choice for you. Explore our library of documents for comprehensive information on all BlueDirect plans.

Benefit Booklet and Endorsements

• BlueDirect Benefit Booklet 
• Endorsement: 2010 Plan Option Changes for BlueDirect Basic, Enhanced, and Premier Plans 
• Endorsement: Out-of-Network Pricing for Fully Insured Health Plans 
• Endorsement: 2011 Transplant Benefits – Per Diem Changes