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Frequently Asked Questions

NMRHCA Value Plan

  • How does my Health Plan Work ?

    The NMHRCA Value Plan does not require you to choose a primary care provider (PCP), or to obtain referrals to see a specialist. This plan is offered statewide and you MUST see a Value Plan contracted provider in NM or you will not be covered except for emergency or urgently needed care. You may not enroll in this plan if you are living outside of New Mexico. To obtain benefits under this plan, you must use our Value Plan providers (except in an emergency). For most services, you will have a deductible to meet and then be responsible for paying coinsurance (a percentage of covered charges). Services that are subject to copayments instead of percentage coinsurance amounts are not subject to the deductibles.

  • Are services covered if I get care from a Nonpreferred Provider?
    Services are not covered if you receive them from Nonpreferred Providers (out-of-network providers). However, if you need to see a Non-Preferred Provider for emergency care and urgent care, then those services will be covered.
  • Do I have to meet the deductible before my preventive services are covered?
    No, the deductibles are waived when you receive services from Preferred Providers. Preventive services for adults, such as routine physicals and related routine testing, including mammograms, cholesterol tests, and immunizations are covered at 100%. Preventive services for children, including well-child care, routine vision or hearing screenings, and routine testing and immunizations are covered at 100%. Services will not be covered if you receive preventive services from Nonpreferred Providers.
  • Do I have prescription drug coverage?

    Your prescription coverage is provided by a third-party pharmacy benefits manager. Contact your company’s pharmacy benefits manager for more information.

  • What if I have questions about my medical plan benefits?
    BCBSNM's customer service advocates are available to answer your questions 6 a.m. to 8 p.m. MT, Monday through Friday, and 8 a.m. to 5 p.m. MT, Saturdays and holidays (closed Thanksgiving and Christmas). If you call after hours, you can leave a message and we will return your call by the next business day. Call the NMRHCA Designated Service Unit toll-free at 1-800-788-1792; the number is also printed on the back of your member ID card. Please have your ID card available when you call. You can also contact Customer Service with a secure message through Blue Access for Members.