• Can I find information about my health plan on the Internet?
• How does my prescription drug plan work?
• How can I find out if the prescription drug I'm taking is listed on the BCBSNM Drug List?
• I take a prescription drug that is not on the BCBSNM Drug List. Will the drug still be covered?
• Where can I get a prescription drug claim form, a prescription mail-order form, or a standard medical claim form?
• Do I need to have Medicare Part A and B to be eligible for the NMSU Medicare Carveout Plan?
• Do I have to use a contracted BCBSNM doctor to receive benefits from Medicare and BCBSNM?
• Do I have to file a claim for payment to BCBSNM after Medicare pays?
• How do I find out what Medicare pays for?
• Who should I call if I have questions about my medical plan benefits?
• Who should I call for mental health services or chemical dependency treatments?
Can I find information about my health plan on the Internet?
Yes, here in the NMSU corner, you can look at benefit information, search for a physician via our online Provider Finder®, view the BCBSNM Drug List, and download and print forms.
When you have a question, you can send an email inquiry directly to BCBSNM Customer Service.
How does my prescription drug plan work?
With your prescription drug plan, you pay a percentage of the covered charge if the percentage is between the minimum and maximum copayments listed below. Your copayment will never exceed the "maximum" copayment listed. You pay different amounts for generic drugs, brand-name drugs, drugs not on the BCBSNM Drug List, and specialty drugs.
| Type of Prescription | Percentage of covered charge you pay (coinsurance) | Minimum Copayment | Maximum Copayment | |
| Retail Pharmacy Program Up to a 30-day supply or 120 units, whichever is less |
Generic drug on the BCBSNM Drug List | 20% | $10 | $20 |
| Brand-name drug on the BCBSNM Drug List | 30% | $25 | $45 | |
| Not on the BCBSNM Drug List | 40% | $45 | $80 | |
| Specialty Drug | 25% | $125 | $250 | |
| PrimeMail Pharmacy Program/Mail-Order Service Up to a 90-day supply or 360 units, whichever is less |
Generic drug on the BCBSNM Drug List | 20% | $20 | $40 |
| Brand-name drug on the BCBSNM Drug List | 30% | $50 | $90 | |
| Not on the BCBSNM Drug List | 40% | $90 | $160 |
How can I find out if the prescription drug I'm taking is listed on the BCBSNM Drug List?
View the BCBSNM Drug List online and you can print a copy if you need one (a print-friendly version is available in PDF format). Or, you can contact BCBSNM to verify that a drug is on the BCBSNM Drug List, and to request a list.
I take a prescription drug that is not on the BCBSNM Drug List. Will the drug still be covered?
Yes, the drug must be medically necessary and prescribed by a licensed provider. For a drug that is not on the BCBSNM Drug List that is purchased at a participating retail pharmacy, you will pay 40% of the covered charge (minimum copayment: $45; maximum copayment: $80) for a 30-day supply or 120 units, whichever is less. For a drug not on the BCBSNM Drug List that is purchased through the mail-order service, you will pay 40% of the covered charge (minimum copayment: $90; maximum copayment: $160) for a 90-day supply or 360 units, whichever is less. For a specialty drug that is not on the BCBSNM Drug List, you will pay 25% of the covered charge (minimum copayment: $125; maximum copayment: $250).
Where can I get a prescription drug claim form, a prescription mail-order form, or a standard medical claim form?
You can print these and other types of forms from the Downloadable Forms page. You can also request forms by calling BCBSNM Customer Service at the toll-free number on the back of your member ID card.
Do I need to have Medicare Part A and B to be eligible for the NMSU Medicare Carveout Plan?
No. To be eligible for coverage under the Medicare Carveout Plan, you must be an NMSU retiree, the eligible dependent of a retiree, or an eligible surviving dependent of a retiree or employee and:
- be enrolled in, and eligible for, primary coverage under at least Medicare Part A (regardless of age), or
- be age 65 or older (regardless of Medicare entitlement).
The Medicare Carveout Plan bases payment on how Medicare paid your claim. The Carveout Plan pays your Medicare deductible and coinsurance when you receive services from a provider that accepts Medicare assignment.
If you do not have Medicare Part A, you will be responsible for paying the amount Medicare would have paid for medical services (generally 80%), in addition to the Carveout Plan deductible and coinsurance.
Do I have to use a contracted BCBSNM doctor to receive benefits from Medicare and BCBSNM?
No, you can go to any provider anywhere in the United States or around the world. Your out-of-pocket expenses will differ depending on whether the provider accepts Medicare assignment. If you receive Medicare-covered services from a provider that accepts Medicare assignment, you will be responsible for $0 out-of-pocket expenses. If you receive Medicare-covered services from a provider that does not accept Medicare assignment, you will be responsible for meeting the $100 deductible and 20 percent coinsurance.
Do I have to file a claim for payment to BCBSNM after Medicare pays?
If you receive services from a doctor who accepts Medicare assignment, the claim will be sent to BCBSNM automatically. You will not have to file a claim. If you receive services from a provider that does not accept Medicare assignment, you may have to send the claim to BCBSNM for processing. You will have to include the Medicare Explanation of Medicare Benefits (EOMB) with your claim.
How do I find out what Medicare pays for?
You can call toll-free at 1-800-MEDICARE (633-4227). Or you can send an e-mail inquiry to Medicare at www.medicare.gov. You can also request a Medicare and You Handbook that explains your Medicare benefits.
Who should I call if I have questions about my medical plan benefits?
Whenever you have a question about your medical or prescription drug plan, contact BCBSNM Customer Service at the toll-free number on the back of your member ID card. You may also directly email inquiries to Customer Service.
Who should I call for mental health services and chemical dependency treatments?
Medicare Carveout (MCO) Plan members do not need to call Mesa Mental Health or get a referral for services. However, if a service is not covered by Medicare, you or your physician will need to obtain prior approval from BCBSNM toll-free at 1-800-325-8334.
Learn More About NMSU Medicare Carveout
Benefit Information
Provider Information
