• How does my health plan work?
• What is a Primary Preferred Provider (PPP)?
• 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 SONM health plan options let you see the providers you want to see. 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). Transplants and certain other services listed on your Summary of Benefits are covered only if you receive them from a Preferred Provider.
What is a Primary Preferred Provider (PPP)?
A Primary Preferred Provider (PPP) is a Preferred Provider in one of the following medical specialties: Family Practice, General Practice, Internal Medicine, Obstetrics/Gynecology, Gynecology, or Pediatrics. PPPs do not include physicians specializing in any other fields such as Obstetrics only, Geriatrics, Pediatric Surgery, or Pediatric Allergy. When you see a PPP for an office visit, you pay a set copayment rather than a percentage of the charges (the deductible is waived). The amount of the copayment is $15. To find a PPP in New Mexico, check the printed provider directory or search our online Provider Finder®. You may also call Customer Service at the number on the back of your member ID card (1-877-994-2583) for help looking for a PPP. Your health plan does not require you to visit a PPP or get a referral from a PPP to see a specialist.
Am I covered for the same services even if I get care from a Nonpreferred Provider?
You have out-of-network benefits for most services, but you will pay a higher deductible and coinsurance if you seek care from a Nonpreferred Provider. Please refer to your Summary of Benefits or Benefit Booklet for applicable deductibles and coinsurance, and to see a detailed list of these services. Also, benefits for some services 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 preventive 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 30 percent.
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 1-877-849-5530 or visit www.express-scripts.com*.
What if I have questions about my medical plan benefits?
BCBSNM's customer service representatives 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 on 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 SONM Designated Service Unit toll-free at 1-877-994-2583; the number is 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.
*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.
Back to main State of New Mexico page
