BlueEdge gives employees freedom of choice, flexibility, a broad range of benefits, and the most comprehensive provider network in New Mexico. Across the country, Blue Cross and Blue Shield PPO networks are linked through the BlueCard® Program so members can get help finding a network doctor or hospital almost anywhere in the United States.
When employees receive care from preferred providers (doctors, hospitals, and other providers contracted as Blue Cross and Blue Shield PPO providers):
- Benefits are paid at the highest level.
- There are no claim forms to complete.
- They are not responsible for any charges above the Blue Cross and Blue Shield negotiated fee or allowable amount.
- They do not need a referral to see the doctor of their choice.
- Once PPO coverage begins, the only other out-of-pocket expenses are any plan-specific coinsurance payments for covered benefits, plus any charges for non-covered services.
- Employees can always choose to receive care from providers who are not in network (nonpreferred providers), but benefits will be paid at a lower level.
BlueEdge Benefit Overview
Preventive Care Benefits
Preventive care services are covered at 100 percent when received from preferred providers (annual $400 maximum for adults, remainder applies to deductible and coinsurance).
- Well-child and adult care, including immunizations
- Screenings such as cholesterol, breast cancer, and cervical cancer
Doctor and Hospital Benefits
- Doctor office visits
- Hospital and surgical care
- Diagnostic testing
- Emergency care benefits
- Maternity care
Other Coverage
- Rehabilitation therapy (physical, speech, occupational therapy)
- Mental health and chemical dependency treatment
- Prescription drug benefits
- Reconstructive surgery following a mastectomy
Care Management
- Blue Care Connection Disease Management Programs (including programs for asthma, diabetes, coronary artery disease, congestive heart failure, COPD, and low back pain)
- Case management services
- Special Beginnings Prenatal Program
Benefit Summaries:
- BlueEdge HCA Basic Plan (PDF)
- BlueEdge HCA – Enhanced Plan (PDF)
- BlueEdge HCA – Premier Plan (PDF)
- BlueEdge HCA – View all plans (PDF)
Learn More About BlueEdge HCA for Groups:
Product Summary
Overview
Spending Account and the Deductible
FAQs
Prospective Producers: To apply to become a contracted producer, see our Instructions, Agreement, and Business Associate Addendum (BAA).
Back to main Health Plans page | Back to main Producer page
