Frequently Asked Questions about Blue TransitionsSM
- How does the Blue Transitions Short-Term/Travel EPO Plan work?
- Who is eligible for Blue Transitions?
- How soon is the Blue Transitions policy effective after an employee applies for coverage?
- Can an employee coordinate effective dates with other BCBSNM plans?
- Why are there separate charges when visiting a provider?
- What are out-of-pocket costs for emergency room services?
- Do my employees have prescription drug coverage?
- Which provider network do members use with the Blue Transitions Short-Term/Travel EPO Plan?
- What if my employees have questions about their medical plan benefits?
Blue Transitions is affordable, temporary health insurance for individuals and families from Blue Cross and Blue Shield of New Mexico (BCBSNM) that provides your employees essential, basic protection against unexpected accidents or illnesses. Blue Transitions does not cover conditions that are present when an employee applies for coverage, and it does not cover preventive services. Blue Transitions offers various benefit periods and deductibles to let your employees tailor coverage, premium rates, and out-of-pocket expenses to their needs and budgets.
To obtain benefits under Blue Transitions, members must use our in-network/Preferred Providers (except in an emergency). Preferred Providers have Preferred Provider Organization (PPO) contracts with BCBSNM or another Blue Cross and Blue Shield company.
With this short-term/travel coverage, members:
- Choose a $500, $1,000, or $2,000 deductible
- Choose a coverage period of 1-11 months
- Receive benefits from Preferred Providers – health care providers who are contracted to be in our PPO network (benefits from out-of-network/nonpreferred providers are not covered except for emergencies)
- Do not have to file their own claims
- Pay 30% of eligible expenses after meeting the deductible; Blue Transitions pays 70%
Your employees are eligible for Blue Transitions if they meet these criteria:
- A New Mexico resident at least 60 days old or under 65 years old
- A U.S. citizen or a permanent resident living in the U.S. at least two years
- Not currently pregnant
- Not anticipating adding newborns or children to the policy except if required by court order
- An unmarried dependent child at least 60 days old or under 25 years old
- Not on Medicare or Medicaid
The benefit period an applicant chooses (from one to six months of coverage) begins on the later of:
- the requested effective date or
- the day after the application is postmarked by the United States Post Office
Note: If the envelope containing the application is not postmarked by the United States Post Office or the postmark is not legible, the effective date will be the later of the requested effective date or the date received by BCBSNM. Also, coverage begins at 12:01 a.m. on the effective date shown on the BCBSNM member ID card.
If an employee is applying for other BCBSNM coverage and needs a short-term plan until the other BCBSNM coverage becomes effective, we will help ensure that there is no lapse in coverage between the date the Blue Transitions coverage ends and the date the other BCBSNM coverage begins. BCBSNM must receive the application for the other coverage at least 30 days before the Blue Transitions coverage expires.
There may be separate charges for any therapies or diagnostic tests performed during or as a result of the visit. Members may be responsible for paying additional coinsurance or deductible amounts for these services. Please check the Benefit Booklet for more information.
The Blue Transitions emergency room benefit is subject to deductible and coinsurance for the facility and provider charges. See the Benefit Booklet for more information about covered emergency services.
Yes. Members pay 30% coinsurance per prescription; BCBSNM covers up to $500 maximum per benefit period. Some prescriptions drugs will need prior approval or they may not be covered. Please see the Benefit Booklet for more information.
Members use the Blue Cross and Blue Shield of New Mexico PPO provider network to access contracted doctors, hospitals, and other health care professionals within New Mexico. Blue Transitions members also have access to BlueCard® PPO providers when outside New Mexico.
BCBSNM's customer service representatives are available to answer your employees' questions 6 a.m. to 8 p.m. MT, Monday through Friday, and 8 a.m. to 5 p.m. MT on weekends and holidays (closed Thanksgiving and Christmas). If a member calls after hours, he or she can leave a message and we will return the call by the next business day. Members should call the toll-free number printed on the back of the member ID card and should have the ID card available when calling. They can also log in to Blue Access for Members and contact Customer Service via secure messaging.
Learn More About Blue Transitions