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Frequently Asked Questions

NMRHCA PPO Premier 3-Tier Plan

  • How does my health plan work?
    The Premier 3-Tier Plan features 100% coverage for preventive services from Preferred Providers, and no lifetime maximum benefit limit. Your NMRHCA PPO Premier 3-Tier health coverage lets you see the providers you want to see. You do not have to choose a primary care provider and do not need a referral to see a specialist. The Premier 3-Tier Plan is one plan with three levels of benefits. Providers are classified as "Tier 1 Blue Preferred Plus (NBP)" (in-network), “Tier 2 Preferred” (in-network) or "Tier 3 Nonpreferred" (out-of-network). You'll generally pay more if you receive services from Nonpreferred Providers, but it is your choice to receive most covered health care services from any licensed provider. For most services, you will have a deductible to meet and then be responsible for paying coinsurance (a percentage of covered charges). If you seek services from a designated Tier 1 “Blue Preferred Plus (NBP)” provider, you will have lower out-of-pocket expenses; however, you still have access to any BCBS PPO “Preferred” provider. If you see Preferred Providers that are not designated as Tier 1 “Blue Preferred Plus” providers, your benefits will fall under the Tier 2 benefit level. Some services are only covered if you receive them from Preferred Providers. Services that are subject to copayments instead of percentage coinsurance amounts are not subject to the deductibles. Please contact BCBSNM’s customer service advocates if you have questions on how your plan works and locating a provider. The toll-free number is 1-800-788-1792.
  • Are services covered if I get care from a Nonpreferred Provider?
    Some services are not covered if you receive them from Nonpreferred Providers. For example, you must receive human organ transplants from Preferred Providers in order for the services to be covered. Also, benefits for prosthetics and orthotics are limited if you receive them from Nonpreferred Providers, but are not limited if received from Preferred Providers.
  • 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 percent. Preventive services for children, including well-child care, routine vision or hearing screenings, and routine testing and immunizations are covered at 100 percent. If you receive preventive services from Nonpreferred Providers, you will pay a coinsurance amount.
  • Do I have prescription drug coverage?
    Blue Cross and Blue Shield of New Mexico does not administer your prescription drug plan – it is administered by Express Scripts®. If you have questions about your pharmacy benefits, call Express Scripts customer service toll-free at 1-800-501-0987 or visit www.express-scripts.com.
  • 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.