New Mexico Retiree Health Care Authority

Frequently Asked Questions about
NMRHCA Basic Plan

I'm eligible for Medicare. Can I purchase the Basic Plan in place of Medicare?
Will the Basic Plan cover services that are not covered by Medicare?
Do I need to have a Primary Care Physician (PCP) and referrals to see a specialist?
Do I need to go to a certain laboratory to have my lab work done?
Will I have coverage when traveling outside of the United States?
Do I have prescription drug coverage?
What if I have questions about my medical plan benefits?


I'm eligible for Medicare. Can I purchase the Basic Plan in place of Medicare?

No, you must be enrolled in both Medicare Part A and Part B to be eligible for this Basic Plan.

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Will the Basic Plan cover services that are not covered by Medicare?

No, except for treatment outside Medicare territorial limits and additional inpatient hospital days if you have already used the maximum Medicare hospital reserve. This plan covers expenses that are covered by Medicare and is designed to supplement the Medicare coverage you already have.

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Do I need to have a Primary Care Physician (PCP) and referrals to see a specialist?

The Basic Plan does not require you to select a PCP or require referrals. However, it is wise to establish a relationship with a doctor so he/she knows your medical history.

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Do I need to go to a certain laboratory to have my lab work done?

You may go to any Medicare-contracted lab.

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Will I have coverage when traveling outside of the United States?

Emergency medical services received while temporarily outside the Medicare territorial limits are covered by the Basic Plan at 100 percent of the BCBSNM maximum allowable fee.

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Do I have prescription drug coverage?

Blue Cross and Blue Shield of New Mexico does not administer your prescription drug plan — it is administered by Express Scripts. For questions about your prescription drug plan, call Express Scripts customer service toll-free at 1-800-811-0297 or visit www.express-scripts.com*.

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What if I have questions about my medical plan benefits?

BCBSNM's customer service advocates are available to answer your questions 6 a.m to 10 p.m. MT, Monday through Friday, and 8 a.m. to 5 p.m. MT, Saturdays and holidays. If you call after hours, you can leave a message and we will return your call by the next business day. Call the NMRHCA Designated Service Unit toll-free at 1-800-788-1792; the number is also printed on the back of your member ID card. Please have your ID card available when you call. You may also email your questions to BCBSNM Customer Service.

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*We do our best to ensure that the information on other health-related Web sites such as the one listed above is useful, but can't be responsible for the content of those sites or any information you may take from them (please read our legal disclaimer). When you click on a choice above, it will open in a new window so that you can explore that site without having to leave here. When you are through visiting the other site, you can close that window and return to the BCBSNM site.

 

 

 

 

 

 

 

 

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