Dual Option PPO Plan

BCBSNM offers NMPSIA High Option and Low Option Plans to meet your health care needs.

Special Features:

No referrals necessary.
Members choose their own provider – in or out of network.
Coverage when traveling – check out the BlueCard® program.
In-network preventive health benefits with no copayment and no deductible.

The High Option Plan has lower out-of-pocket costs, does not require a deductible, and has predictable copayments for in-network benefits. Out-of-network benefits include a deductible and coinsurance except for preventive services.

The Low Option Plan has a lower premium and includes a deductible and coinsurance for most in-network and out-of-network benefits. Some services (such as physician office visits and preventive services) include predictable copayments.

High Option Plan		Low Option Plan
• $0 deductible for in-network care • $300/600/900 deductible (single/2-party/family) for out-of-network care • $25 copayment for primary care and specialist office visits (in-network) • Plan pays 100% for preventive services (in-network), deductible waived for out-of-network • $100 copayment for emergency room services • $500 copayment for hospitalization (in-network) • 30% coinsurance for most services from out-of-network providers, after deductible		• $1,500/3,000/4,500 deductible (single/2-party/family) for in-network and out-of-network care • $25 copayment for primary care and specialist office visits (in-network) • Plan pays 100% for preventive services (in-network), deductible waived for out-of-network • $100 copayment for emergency room services/25% coinsurance for physician emergency services • 25% coinsurance for hospitalization after deductible (in-network) • 50% coinsurance for most services from out-of-network providers, after deductible

View your current NMPSIA Dual Option PPO Benefit Summary or Booklet, or see answers to Frequently Asked Questions about this plan.

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