BlueEdge HCA for Groups: This benefit information is available as PDF files. If you do not have Adobe® Reader®, download it free of charge at Adobe's site. |
BlueEdge gives you freedom of choice, flexibility, a broad range of benefits, and the most comprehensive provider network in New Mexico. Across the country, PPO networks are linked through the BlueCard® program so it should be easy to find a network doctor or hospital when traveling, living, working, or studying anywhere in the United States.
When you receive care from contracting PPO network doctors and hospitals:
- Benefits are paid at the highest level.
- There are no claim forms to complete.
- You are not responsible for any charges above the Blue Cross and Blue Shield negotiated fee or allowable amount.
- You do not need a referral to see the doctor of your choice.
- Once your PPO coverage begins, your only other out-of-pocket expenses are any plan-specific coinsurance payments for covered benefits, plus any charges for non-covered services.
You can always choose to receive care from doctors and hospitals outside the network, but benefits will be paid at a lower level.
BlueEdge Benefit Overview
Preventive Care Benefits
Preventive care services are covered at 100 percent when received in network (annual $400 maximum for adults, remainder applies to deductible and coinsurance)
- Well-child and adult care, including immunizations
- Screenings such as cholesterol, breast cancer, and cervical cancer
Doctor and Hospital Benefits
- Doctor office visits
- Hospital and surgical care
- Diagnostic testing
- Emergency care benefits
- Maternity care
Other Coverage
- Rehabilitation therapy (physical, speech, occupational therapy)
- Mental health and chemical dependency treatment
- Prescription drug benefits
- Reconstructive surgery following a mastectomy
Care Management
- Blue Care® Connection Disease Managment Programs (including programs for Asthma, Diabetes, Coronary Artery Disease, Congestive Heart Failure, COPD, and Low Back Pain)
- Case management services
- Special Beginnings Prenatal Program
Welcome Call
Within one month of enrollment, expect a call from a BlueEdge expert to help you better understand BlueEdge and how to maximize the benefits of BlueEdge. The welcome call provides a convenient opportunity to get answers to questions you may have about your health plan.
Learn More About BlueEdge HCA
Overview
How BlueEdge HCA Works
Spending Account and the Deductible
FAQs
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