• Can I find information about my health plan on the Internet?
• What is the difference between a Preferred Provider and a Nonpreferred Provider, and how does the type of provider I visit affect my benefits?
• 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?
• 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.
What is the difference between a Preferred Provider and a Nonpreferred Provider, and how does the type of provider I visit affect my benefits?
A Preferred Provider has contracted with a Blue Cross and/or Blue Shield (BCBS) Plan to be a member of the Preferred Provider network. Nonpreferred Providers may have other kinds of contracts with BCBS Plans, but are not part of a Preferred Provider network. You will generally pay lower out-of-pocket expenses when you receive services from Preferred Providers and you are covered for more benefits when you receive services from Preferred Providers. See the table below for a few examples:
| Preferred Provider |
Nonpreferred Provider |
|
| Deductible amounts | $250 Individual | $500 Individual |
| Amount of coinsurance you pay after your deductible has been met. | 20% of covered charges | 40% of covered charges |
| Will the provider file claims for you? | Yes | Some providers may file claims for you. If not, you need to submit a member claim form with the provider bill. |
| Will the provider bill you for amounts above the BCBS covered charge? | No | Yes, if the provider has no contract with a BCBS Plan, the provider may bill you for these amounts. |
| Are office visits (nonsurgical) subject to the deductible? | No, you pay only a $25 copayment. | Yes |
| Are preventive health services covered? | For adults (ages 18 and over), the plan pays 100% for the first $400 in covered charges. For children through age 17, the plan pays 100% for the first $250 in covered charges. After these limits have been met, services are subject to copayment, deductible, and coinsurance. |
No |
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 Customer Service 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 Customer Service at the toll-free number on the back of your member ID card.
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 toll-free at 1-866-369-NMSU (6678). This number is printed on the back of your member ID card. Customer Service is available 6 a.m. to 10 p.m. MT, Monday through Friday, and 8 a.m. to 5 p.m. MT, Saturdays and holidays. (Messages left outside these hours are returned the next day.) You may also directly email inquiries to our Customer Service.
If you have specific questions about mental health or chemical dependency services, contact Mesa Mental Health toll-free at 1-800-583-6372, 24 hours a day, 7 days a week.
Who should I call for mental health services and chemical dependency treatments?
You or your physician must call the BCBSNM behavioral health services administrator, Mesa Mental Health, before you access mental health and chemical dependency services. Call Mesa Mental Health 24 hours a day, 7 days a week toll-free at 1-800-583-6372.
If you do not call before receiving nonemergency services, benefits for covered services will be reduced or denied.
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