New Mexico Public Schools Insurance Authority

NMPSIA Dual Option PPO Plan

teacher and kids photo

BCBSNM offers NMPSIA High Option and Low Option Plans to meet your health care needs.

Special Features:

  • No referrals necessary.
  • Members choose their own provider – in or out of network.
  • Coverage when traveling – check out the BlueCard® program.
  • In-network preventive health benefits with no copayment and no deductible.

The High Option Plan has lower out-of-pocket costs and predictable copayments for office visits to in-network providers. Out-of-network benefits include a deductible and coinsurance.

The Low Option Plan has a lower premium and includes a deductible and coinsurance for most in-network and out-of-network benefits. Some services (such as physician office visits and preventive services) include predictable copayments.

High Option Plan – Members pay:

  

Low Option Plan – Members pay:

• $300/900 deductible (single/family)
• $20 copayment for primary care office visits
• $30 copayment for specialist office visits (in-network)
• Plan pays 100% for preventive services (in-network)
• 20% coinsurance (after deductible is met) for emergency room services
• $500 copayment plus 20% coinsurance for hospitalization (in-network) after deductible
• 30% coinsurance for most services from out-of-network providers, after deductible

  

• $1,500/4,500 deductible (single/family) for in-network and out-of-network care
• $25 copayment for primary care office visits
• $35 copayment for specialist office visits (in-network)
• Plan pays 100% for preventive services (in-network)
• 25% coinsurance for emergency room services and physician emergency services (deductible waived)
• 25% coinsurance for hospitalization after deductible (in-network)
• 50% coinsurance for most services from out-of-network providers, after deductible

View your current NMPSIA Dual Option PPO Benefit Summary or Booklet, or see answers to Frequently Asked Questions about this plan.

 

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