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Are you looking for health insurance with coverage similar to that offered by large employers? If so, the BlueDirect portfolio is for you.
Our BlueDirect plans include: BlueDirect Basic, Enhanced and Premier Plan Options.
BlueDirect plans provide extensive, affordable and cost-effective coverage. BlueDirect offers the benefits that you need the most. Key features of the coverage of these plans include:
A BlueDirect plan may be right for you and/or your family if:
We offer three BlueDirect plans that provide different levels of annual out-of-pocket limits, deductibles, coinsurance, and copayments. Compare the coverage to find the plan that’s right for you.
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:
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.
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.
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.
*These percentages reflect coverage and discounts when using in-networks providers.
For more information on this option, download the dental coverage brochure .
The summary of benefits for each BlueDirect plan provides a snapshot of coverage (see the Benefit Booklet for details and limitations).
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 Highlight||Basic Plan||Enhanced Plan||Premier Plan|
|PPO Preferred Provider||NonPPO Nonpreferred Provider||PPO Preferred Provider||NonPPO Nonpreferred Provider||PPO Preferred Provider||NonPPO Nonpreferred Provider|
|Lifetime Maximum Benefit||Unlimited||Unlimited||Unlimited|
|Deductible Options — NonPPO Deductible is double (2x) the PPO deductible|
|Individual Out-of-Pocket Expense Limit *||$7,000||$14,000||$4,000||$8,000||$3,000||$6,000|
|Coinsurance||You pay 30%||You pay 50%||You pay 20%||You pay 40%||You pay 15%||You pay 30%|
|Preventive Care**||No Charge||No Charge||No Charge||No Charge||No Charge||No Charge|
|Prescription Drugs||4-Tier Rx Plan — you pay copayment for retail/mail-order prescriptions||4-Tier Rx Plan — you pay copayment for retail/mail-order prescriptions||4-Tier Rx Plan — you pay copayment for retail/mail-order prescriptions|
|Prescription Drug Utilization/ Benefit Management Programs||Dispensing Limits: Benefits include coverage limits on certain medications. These limits are based on approved guidelines.
Prior Authorization/Step Therapy Requirements: Before receiving coverage for some medications, your doctor will need to receive authorization from BCBSNM and/or certain criteria must be met.
Specialty Pharmacy Program: Specialty medications must be received through the preferred Specialty Pharmacy Provider.
Reminder about coverage for self-administered specialty medications .
Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay the share plus the difference in cost.
Note: The above chart highlights key plan differences and is not intended to be a comprehensive benefit summary. For more information, please click on each plan’s Benefit Summary.
*Includes coinsurance only; does not include deductible, copays, penalty amounts, or non-covered charges.
**Includes well-child care, immunizations, routine physicals, mammograms, colonoscopy, prostate exams.
Important note: Any plan coverage information here is intended to provide an overview. For more complete coverage specifics and limitations of each plan you are considering, view the Summary of Benefits, or view the full Benefit Booklet.
For preventive care services delivered by Non-preferred providers, yes, you are covered. However, some services are not covered if you receive them from Non-preferred Providers. Also, benefits for some services are limited if you receive them from Non-preferred Providers, but are not limited if received from Preferred Providers. For emergency room visits, copayment covers both facility and provider charges.
Chiropractic services are covered the same as services from any other licensed provider, and some services, such as routine office visits and X-rays, are not limited. However, other limits may apply. These include coverage for certain types of services, such as spinal manipulation and physical therapy. Your deductible and copayments for therapy and office visits may also apply.
Yes, a variety of technical procedures for treatment or diagnosis of disease or injury are covered. Some coverage highlights:
The prescription drug plans found in BlueDirect Basic, Enhanced and Premier plans are structured the same and vary only in copayment amounts. This means your copayment will vary depending on four categories of prescription drugs based on your specific plan.
|Tier 1||Generic drugs||$15||$10||$7|
|Tier 2||Brand-name drugs on our drug list*||$45||$40||$35|
|Tier 3||Brand-name not on our drug list with no generic available*||$75||$70||$65|
|Tier 4||Specialty drugs||15% of covered charges or $250 maximum||15% of covered charges or $250 maximum||15% of covered charges or $250 maximum|
*If you or your doctor prefer that you receive a brand-name drug when a generic equivalent is available, you'll pay the Tier 1 copayment PLUS the difference in cost between the generic and brand-name drug.
See the Prescription Drug Plan Rider for details, limitations, exclusions.
If you are applying for BlueDirect and have benefit questions, please call 1-866-445-1396.
If you are a BlueDirect member and have questions, call BCBSNM Customer Service at the toll-free number on the back of your BCBSNM member ID card.