BlueDirect®
Comprehensive Plans
Please note: Quotes are not available for 2012 major medical policies pending rate approval from the New Mexico Division of Insurance. Quotes are available for short term plans.
BlueDirect® Comparison Chart
| 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 | ||||||
| $500 | √ | 2x | √ | 2x | ||
| $1,000 | √ | 2x | √ | 2x | √ | 2x |
| $2,000 | √ | 2x | √ | 2x | √ | 2x |
| $3,500 | √ | 2x | √ | 2x | √ | 2x |
| $5,000 | √ | 2x | √ | 2x | √ | 2x |
| $7,500 | √ | 2x | √ | 2x | ||
| $10,000 | √ | 2x | ||||
| 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. Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay the share plus the difference in cost. |
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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.
