2021 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

Off Exchange

P821PFR Blue Preferred Platinum EPO 128

P820PFR Blue Preferred Platinum EPO 127

Blue Advantage Platinum HMO Plans

P7J4ADT Blue Advantage Platinum HMO 210

Gold Plans

Blue PPO Gold Plans

Off Exchange

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

Off Exchange

G7E1HMO Blue HMO Network Gold 204

G7E3HMO Blue HMO Network Gold 205

G7J3HMO Blue HMO Network Gold 101

Blue Advantage Gold Plans

Off Exchange

G7E1ADT Blue Advantage Gold HMO 207

G7J5ADT Blue Advantage Gold HMO 209

Blue Preferred EPO Gold Plans

Off Exchange

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

Off Exchange

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

S7J1PPO Blue PPO Silver 101

Blue Preferred Silver EPO

Off Exchange

S7E1PFR Blue Preferred Silver EPO 135

S842PFR Blue Preferred Silver EPO 131

S7E5PFR Blue Preferred Silver EPO 136

S840PFR Blue Preferred Silver EPO 125

S7J2PFR Blue Preferred Silver EPO 101

Blue HMO Network Silver Plans

Off Exchange

S810HMO Blue HMO Network Silver 202

Blue Advantage Silver Plans

Off Exchange

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

Last Updated: July 11, 2023