This page may have documents that can’t be read by screen reader software. For help with these documents, please call 1-800-975-6314.

Coverage and Eligibility

Blue Cross and Blue Shield of New Mexico (BCBSNM) health plans cover medically necessary health benefits, including physician services, hospitalization and emergency services.

In addition, we have put in place working solutions to help our members get the care they need during these uncertain times.

With a BCBSNM health plan, our members have access to care for COVID-19 related health issues. Members can use doctors, labs and facilities in their BCBSNM health plan’s provider network for:

  • Tests to diagnose COVID-19
  • COVID-19 testing-related doctor’s visits
  • COVID-19 treatment

In response to the pandemic, BCBSNM made some temporary changes impacting coverage for various services. Some of these changes will end with the end of the public health emergency. Some may end sooner, depending on the member’s plan. To understand what is currently in effect, please view effective coverage dates.

COVID-19 Vaccines

With a BCBSNM health plan, members have access to COVID-19 vaccines at no cost to them. Members should talk with their doctors about when they should get vaccinated once available and discuss any questions they have about the vaccines.

While most plans cover COVID-19 vaccines at no cost, some self-funded groups do not cover preventive services, including COVID-19 vaccines. Members who are unsure what their plan covers should contact their company’s benefits administrator or call BCBSNM Customer Service at the number listed on their member ID card.

Cost-Sharing Waived

To make it easier for our members to get the care and treatment they need amid the COVID-19 outbreak, we are waiving member cost-sharing,  including copays, deductibles and coinsurance, related to testing and treatment for COVID-19.

Cost-sharing waivers end with the end of HHS public health emergency. For fully insured and IBAC plan members, there is currently no end date for the State of New Mexico’s rule requiring cost-sharing waivers for COVID-19-related testing and treatment.

Telemedicine Expanded

We are offering additional options for telemedicine services to give members in fully insured plans improved access to care while reducing their risk of exposure. 

Members insured by BCBSNM, including Medicare (excluding Part D plans) and Medicare Supplement members, can access provider visits for covered services through telemedicine as outlined in their benefit plan.

The state’s COVID-19 cost-sharing rules will continue to apply to COVID-19-related testing and treatment delivered by telemedicine for fully insured and IBAC plan members.

For non-COVID-19 testing and treatment, cost-share waivers for fully insured group, retail, Medicare (not Part D) and Medicare Supplement plans ended on Dec. 31, 2020. That means copays, deductibles and coinsurance apply after Dec. 31.

Telemedicine services may be available for members with plans that include MDLIVE®*, our telemedicine service provider, or any in-network provider who offers the service through two-way, live interactive telephone and/or digital video consultations.

Telemedicine benefits may differ based on the plan. 

Self-funded customers have some choices about how we administer COVID-19 related treatment coverage for their employees.

Prescription Coverage

Members with pharmacy benefits through Prime Therapeutics®** can get an early refill on all current prescriptions. They may be able to get a 90-day refill on many prescriptions. They can also sign up for mail-order delivery with AllianceRx Walgreens Prime by calling customer service at the number on their BCBSNM member ID card.

Members with these Medicare and Medicaid plans can get 90-day fills through mail order:

Prior Authorization

For Transfers. Prior authorization from an inpatient hospital to an in-network medically appropriate, post-acute site of care such as long-term acute care hospitals and skilled nursing facilities will not be required through Feb. 28. 2021. This will help promote availability of acute care capacity for COVID-19 patients during this public health emergency. It also allows our members to continue to access medically necessary care. Transfers to a behavioral health facility will still require prior authorization.

On Previously Approved Elective Surgeries, Procedures and Therapies.  We temporarily extended approvals on existing prior authorizations for most non-emergent elective surgeries, procedures, therapies and home visits, if the service was provided by Dec. 31, 2020. This applies to services that were originally approved or scheduled between Jan. 1, 2020 and June 30, 2020.

Relaxed Eligibility Requirements

Groups can maintain employees who were enrolled as of March 20, 2020 through Sept. 30, 2020, regardless of the eligibility definition stated in their plan or the BPA. This includes reduced work hours, furlough, leave of absence or layoffs. This flexibility does not apply to those who are newly electing coverage via a special enrollment period.

See what is being communicated directly to our members about these coverage changes.

*Virtual Visits may not be available on all plans. Virtual Visits are subject to the terms and conditions of your benefit plan, including benefits, limitations and exclusions. Non-emergency medical service in Arkansas and Idaho is limited to interactive audio/video (video only) for initial consultation. Service availability depends on location at the time of consultation.

MDLIVE®, a separate company, operates and administers the virtual visit program for Blue Cross and Blue Shield of New Mexico and is solely responsible for its operations and that of its contracted providers.

MDLIVE® and the MDLIVE logo are registered trademarks of MDLIVE, Inc., and may not be used without written permission.

Insurance products issued by Dearborn Life Insurance Company, 701 E. 22nd St. Suite 300, Lombard, IL 60148. Blue Cross and Blue Shield of New Mexico is the trade name of Dearborn Life Insurance Company, an independent licensee of the Blue Cross and Blue Shield Association. BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.