• How does the Blue Transitions Short-Term/Travel EPO Plan work?
• Who is eligible for Blue Transitions?
• How soon is my Blue Transitions policy effective after I apply for coverage?
• Can I coordinate effective dates with other BCBSNM plans?
• Why are there separate charges when I visit a provider?
• What are my out-of-pocket costs for emergency room services?
• Do I have prescription drug coverage?
• Which provider network do I use with my Blue Transitions Short-Term/Travel EPO Plan?
• What if I have questions about medical plan benefits?
How does the Blue Transitions Short-Term/Travel EPO Plan work?
Blue Transitions is affordable, temporary health insurance for individuals and families from Blue Cross and Blue Shield of New Mexico (BCBSNM) that provides you, your spouse, and your children essential, basic protection against unexpected accidents or illnesses. Blue Transitions does not cover conditions that were present when you apply for coverage, and it does not cover preventive services. Blue Transitions offers various benefit periods and deductibles to let you tailor coverage, premium rates, and out-of-pocket expenses to your own needs and budget.
To obtain benefits under Blue Transitions, you must use our in-network/Preferred Providers (except in an emergency). Preferred Providers have Preferred Provider Organization (PPO) contracts with BCBSNM or another Blue Cross and Blue Shield company.
With this short-term/travel coverage you:
- Choose a $500, $1,000, or $2,000 deductible
- Decide how long you need coverage – 1, 2, 3, 4, 5, or 6 months of coverage
- Receive benefits from Preferred Providers – health care providers who are contracted to be in our PPO network (benefits from out-of-network/Nonpreferred Providers are not covered except for emergencies)
- Do not have to file your own claims
- Pay 30% of eligible expenses after you meet the deductible; Blue Transitions pays 70%
Who is eligible for Blue Transitions?
You are eligible for Blue Transitions if you are:
- A New Mexico resident at least 60 days old or under 65 years old
- A U.S. citizen or a permanent resident living in the U.S. at least two years
- Not currently pregnant
- Not anticipating adding newborns or children to the policy except if required by court order
- An unmarried dependent child at least 60 days old or under 25 years old
- Not on Medicare or Medicaid
How soon is my Blue Transitions policy effective after I apply for coverage?
The benefit period you choose (from one to six months of coverage) begins on the later of:
- the requested effective date or
- the day after the application is postmarked by the United States Post Office
Note: If the envelope containing the application is not postmarked by the United States Post Office or the postmark is not legible, the effective date will be the later of the requested effective date or the date received by BCBSNM. Also, your coverage begins at 12:01 a.m. on the effective date shown on the BCBSNM member ID card.
Can I coordinate effective dates with other BCBSNM plans?
If you are applying for other BCBSNM coverage and need a short-term plan until the other BCBSNM coverage becomes effective, we will help ensure that there is no lapse in coverage between the date the Blue Transitions coverage ends and the date the other BCBSNM coverage begins. BCBSNM must receive the application for the other coverage at least 30 days before your Blue Transitions coverage expires.
Why are there separate charges when I visit a provider?
There may be separate charges for any therapies or diagnostic tests performed during or as a result of the visit. You may be responsible for paying additional coinsurance or deductible amounts for these services. Please check your Benefit Booklet for more information.
What are my out-of-pocket costs for emergency room services?
The Blue Transitions emergency room benefit is subject to deductible and coinsurance for the facility and provider charges. See your Benefit Booklet for more information about covered emergency services.
Do I have prescription drug coverage?
Yes. You pay 30% coinsurance per prescription; BCBSNM covers up to $500 maximum per benefit period. Some prescriptions drugs will need prior approval or they may not be covered. Please see the Benefit Booklet for more information.
Which provider network do I use with my Blue Transitions Short-Term/Travel EPO Plan?
You will use the Blue Cross and Blue Shield of New Mexico PPO provider network to access contracted doctors, hospitals, and other health care professionals within New Mexico. Blue Transitions members also have access to BlueCard® PPO providers when outside New Mexico.
What if I have questions about medical plan 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 Blue Transitions
Overview
Benefit Information
Downloadable Forms
