NMPSIA Dual Option PPO Plan

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 (after deductible is met) for emergency room services • 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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