• How does my health plan work?
• Am I covered for the same services even if I get care from a Nonpreferred Provider?
• Do I have to meet the deductible before my preventive services are covered?
• Do I have prescription drug coverage?
• What if I have questions about my medical plan benefits?
Your NMRHCA health plan options let you see the providers you want to see. You have a choice of three levels of health plan options: Gold, Silver, and Bronze. Your out-of-pocket costs will generally be lower if you choose the Gold Plan. However, you will have lower premiums for both the Silver and Bronze plan options. Each family member can choose a plan to fit his/her lifestyle.
You do not have to choose a primary care provider and do not need a referral to see a specialist. Providers are classified as "Preferred" (in-network) or "Nonpreferred" (out-of-network). You'll generally pay more if you receive services from Nonpreferred Providers, but it is your choice to receive most covered health care services from any licensed provider. For most services, you will have a deductible to meet and then be responsible for paying coinsurance (a percentage of covered charges). Some services are only covered if you receive them from Preferred Providers. Services that are subject to copayments instead of percentage coinsurance amounts are not subject to the deductibles.
Am I covered for the same services even if I get care from a Nonpreferred Provider?
No, some services are not covered if you receive them from Nonpreferred Providers. For example, you must receive human organ transplants from Preferred Providers in order for the services to be covered. Also, benefits for prosthetics and orthotics are limited if you receive them from Nonpreferred Providers, but are not limited if received from Preferred Providers.
Do I have to meet the deductible before my preventive services are covered?
No, the deductibles are waived when you receive services from Preferred Providers. Preventive services for adults, such as routine physicals and related routine testing, including mammograms, cholesterol tests, and immunizations are covered at 100 percent. Preventive services for children, including well-child care, routine vision or hearing screenings (for children through age 18), and routine testing and immunizations are covered at 100 percent. If you receive preventive services from Nonpreferred Providers, you will pay the following coinsurance amounts: Gold Plan: 30%; Silver Plan: 40%; Bronze Plan: 50%.
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*.
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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