2020 New Mexico QHP Small Group Actual Policy Documents

Below is a list of actual policy documents for QHP small group coverage. These policies describe how the plans generally work and include eligible expenses, claim filing and appeals procedures, and coverage limitations and exceptions, among other things.

If you have questions, contact a customer service representative at the number provided on the back of your ID card for more information.

Return to Sample Policy Documents

Platinum Plans

Blue PPO Platinum Plans
Off Exchange

P811PPO Blue PPO Platinum 111
P810PPO Blue PPO Platinum 110

Blue Preferred Platinum EPO Plans
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P821PFR Blue Preferred Platinum EPO 128
P820PFR Blue Preferred Platinum EPO 127

Gold Plans

Blue PPO Gold Plans
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G822PPO Blue PPO Gold 104
G7E1PPO Blue PPO Gold 114
G820PPO Blue PPO Gold 102
G821PPO Blue PPO Gold 103
G823PPO Blue PPO Gold 107
G7E3PPO Blue PPO Gold 115

Blue HMO Network Gold Plans
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G7E1HMO Blue HMO Network Gold 204
G7E3HMO Blue HMO Network Gold 205

Blue Advantage Gold Plans
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G7E1ADT Blue Advantage Gold HMO 207

Blue Preferred EPO Gold Plans
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G802PFR Blue Preferred Gold EPO 930
G832PFR Blue Preferred Gold EPO 122
G833PFR Blue Preferred Gold EPO 123
G836PFR Blue Preferred Gold EPO 130
G7E1PFR Blue Preferred Gold EPO 137
G801PFR Blue Preferred Gold EPO 208
G835PFR Blue Preferred Gold EPO 129

Silver Plans

Blue PPO Silver Plans
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S830PPO Blue PPO Silver 105
S7E4PPO Blue PPO Silver 116
S831PPO Blue PPO Silver 106
S7E7PPO Blue PPO Silver 117
S833PPO Blue PPO Silver 108
S7F1PPO Blue PPO Silver 118

Blue Preferred Silver EPO
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S7E1PFR Blue Preferred Silver EPO 135
S842PFR Blue Preferred Silver EPO 131
S7E5PFR Blue Preferred Silver EPO 136
S840PFR Blue Preferred Silver EPO 125

Blue HMO Network Silver Plans
Off Exchange

S810HMO Blue HMO Network Silver 202

Blue Advantage Silver Plans
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S7E3ADT Blue Advantage Silver HMO 208

Bronze Plans

Blue PPO Bronze Plans
Off Exchange

B830PPO Blue PPO Bronze 101
B831PPO Blue PPO Bronze 109

Blue Preferred Bronze EPO Plans
Off Exchange

B832PFR Blue Preferred Bronze EPO 134