• How does the BlueChoice Plus Plan work?
• Am I covered for the same services even if I get care from a Nonpreferred Provider?
• How does my prescription drug plan work?
• What if I have questions about my benefits?
How does the BlueChoice Plus Plan work?
BlueChoice Plus is a Preferred Provider Organization (PPO) plan that lets you see the providers you want to see. You do not have to choose a Primary Care Provider, and you do not need a referral to see a specialist. Providers are classified as "Preferred" (in-network) or "Nonpreferred" (out-of-network), and your choice of provider will determine the amount of your out-of-pocket costs. You will pay a higher deductible and higher out-of-pocket costs if you visit Nonpreferred Providers, but it is your choice to receive most covered health care services from any licensed provider. For most services, you will first meet a deductible, and then you will be responsible for paying coinsurance (a percentage of covered charges).
Note: BlueChoice Plus does not cover maternity services, mental health services, or alcoholism and drug abuse treatment.
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 physical therapy services from Preferred Providers to be covered. Your Benefit Booklet lists these services in detail. Also, benefits for some services are limited if you receive them from Nonpreferred Providers, but are not limited if received from Preferred Providers.
How does my prescription drug plan work?
BlueChoice Plus features a 25/50 percent prescription drug benefit, except for the $5,000 deductible option (which covers mandated drugs only, such as diabetic insulin and supplies).
Your copayment for prescription drugs purchased through this drug plan is 25 percent of the covered charge for generic drugs and 50 percent of the covered charge for brand-name drugs. If the percentage of the covered charge falls between the minimum/maximum copayment, you will pay the actual percentage amount.
| Program | Percentage You Pay | Minimum Amount | Maximum Amount |
| Retail Pharmacy: Up to a 30-day supply or 180 units, whichever is less. | |||
| Generic drug | 25% | $20 | $75 |
| Brand-name drug | 50% | $40 | $125 |
| PrimeMail Pharmacy Mail-Order Service: Up to a 90-day supply or 540 units, whichever is less. | |||
| Generic drug | 25% | $40 | $150 |
| Brand-name drug | 50% | $80 | $250 |
| Prior-approved enteral nutritional products and special medical foods. | 50% | N/A – you pay 50% | N/A – you pay 50% |
Your copayment will never exceed the maximum copayment listed. In all cases, your copayments are applied to an annual out-of-pocket limit of $2,500. (This limit is separate from the medical plan's out-of-pocket limit.) Be sure to have your prescriptions filled at a participating pharmacy (search the Provider Finder®) or through the PrimeMail Pharmacy mail-order service. Coverage is always subject to the limitations of your health care plan. For some medications, prior approval, generic substitution, or quantity limits may apply. See your Prescription Drug Plan Rider for details, limitations, and exclusions.
The BCBSNM Drug List does not apply to the 25/50 Percent Prescription Drug Plan.
What if I have questions about my benefits?
BCBSNM's customer service representatives are available to answer your questions 6 a.m. to 8 p.m. MT, Monday through Friday, and 8 a.m. to 5 p.m. MT on weekends and holidays (closed Thanksgiving and Christmas Day). If you call after hours, you can leave a message and we will return your call by the next business day. Call the toll-free number printed on the back of your member ID card. Please have your ID card available when you call. You may also e-mail your questions to BCBSNM Customer Service.
Learn More About BlueChoice Plus
Overview
Benefit Information
Downloadable Forms
