1A Division of Health Care Service Corporation, A Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

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Your Health Plan

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Today We Will Cover:

Two Network Options

• Standard & Extended

• Same services available in both networks

• Differences between the two networks Provider network

Copayments

Bi-monthly premium

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Standard & Extended Network Similarities

In-network (HMO-type benefits)

There is no need to:

• Obtain referrals for specialist care

You receive the highest level of benefits:

• Use providers in specified networks

• Prior authorization required for certain services

• Provider files claims

• BlueCard & Away from Home Care Programs

Always verify provider network status

Out of Network:

• You pay more of the cost of

out-of-network benefits

- Higher deductibles,

coinsurance

• You may need to file your own claim

• You could be balance billed for

amounts over allowed amount

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Standard (LoboCare) Network

• Uses UNMH and First Choice providers

• UNM Hospitals and facilities

• PLUS additional providers and facilities including:

– urgent care centers

– laboratories

– durable medical equipment suppliers

– Pharmacies

– Home health care facilities

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Benefit Highlights In-Network Out-of-Network

Individual Deductible $250 $1,500

Family Deductible $500 $3,000

Individual Out-of-Pocket Max $5,000 $10,000

Preventive Care Services No Charge Not Covered

Primary Care Physician $30 40%*

Specialist Physician $40 40%*

Inpatient Admission $500 (per admission after deductible)

40%*

Emergency Room $250 (per visit after deductible)

Urgent Care $75 (per visit after deductible) N/A

Other Urgent Care $100 (per visit after deductible) 40%*

*After deductible you may be responsible for charges over the allowable fee.

Your Standard (LoboCare) Network Benefits

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Extended Network

Entire BCBSNM HMO network of over 22,000 providers including University and First Choice providers and UNM Hospitals, PLUS

• Lovelace Hospitals & Facilities

• Independent physicians

• Women’s Hospital

• West Mesa Medical Center

• Lovelace Medical Center

• Kindred Hospital

• Urgent Care Centers

• Heart Hospital of New Mexico

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Benefit Highlights In-Network Out-of-Network

Individual Deductible $250 $1,500

Family Deductible $500 $3,000

Individual Out-of-Pocket Max $5,000 $10,000

Preventive Care Services No Charge Not Covered

Primary Care Physician $45 40%*

Specialist Physician $60 40%*

Inpatient Admission $500 (per admission after deductible)

40%*

Emergency Room $300 (per visit after deductible)

Urgent Care $75 (per visit after deductible) N/A

Other Urgent Care $100 (per visit after deductible) 40%*

*After deductible you may be responsible for charges over the allowable fee.

Your Extended Network Benefits

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Services covered only when received from Standard & Extended Network providers• Preventive care (physicals, routine immunizations,

well-child exams, etc.)

• Infertility services (through UNMH only)

• Allergy testing and injections

• Acupuncture and chiropractic care

• Prescription drugs

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RxPharmacy Benefits

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Prescription Drug Benefit

*Retail Pharmacy:

Maximum

Generic $10

Brand-Name on Drug List $40

Brand-Name Not on Drug List $70

Specialty Medication 20% up to maximum copayment of $250

*Mail Order: Two copayments for Tiers 1,2 & 3 only (90 day supply)

Maximum

Generic $20

Brand-Name on Drug List $80

Brand-Name Not on Drug List $140

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Urgent Care

• Sudden onset of an illness or injury, not life-threatening

• Unable to see a PCP

• Urgent medical conditions such as sprains, high fever, minor cuts requiring stitches

• ABQ Health Partners Urgent Care Centers

• Concentra Urgent Care

• UNM Hospital Urgent Care

• Contact PCP for follow-up care

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BlueCard® Travels With You

• Urgent care when you’re away from home less than 90 consecutive days

• Call 1.800.810.BLUE to locate a provider or visit bcbsnm.com

• Call your PCP to obtain a prior authorization (within 48 hours)

• Simply present your member ID card to a participating provider and pay the applicable copayment

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Emergency Care

•Definition: A sudden and unexpected medical condition that a reasonable person feels could result in death or serious disability if no medical attention is received

•Call 911

•Go to the nearest emergency room

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Away From Home Care® Privileges• Reside outside New Mexico longer than 90

consecutive days

• college student

• divorce, dependent children

• work part of year outside of New Mexico

• Call customer service to enroll at 1-800-423-1630

• Choose a PCP and pay applicable copayments for services

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Call Customer Service at the number on the back of your BCBSNM ID card

800-423-1630

From your computer OR mobile phone, log on to bcbsnm.com and click on ‘Find a Doctor’

OR Contact your physicians and ask

How to Find a PPO Provider

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minuteA new member subscribes toBlue Access for Members every

Blue Access

for MembersSM

Secure member site

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My Claim Activity displays recent claims, or go to the Claims Center for all your claim details

Form Finder easier to view and find specific forms for members

Quick Links for easy access to Health Assessment, Fitness Program, Member Discounts, or to get an ID card

My Coverage includes benefit highlights, spending accounts, as well as deductibles and out-of-pocket and copay summaries

My Health tab links you to health and wellness content, articles, videos, and My Care Profile

Access the Provider Finder® to locate doctors & hospitals

Blue Access for MEMBERSSM

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Blue Access MobileSM

Blue Access for MembersSM

Public Site • Find a Doctor / Hospital• Health Care 101• Shop for Insurance • Log in or register for Blue

Access for Members• Contact Us

Text MessagingStatic – One-Way Alerts• Rx Reminders, Diabetes, CAD, Diet Tips,

Claim Status, Exercise & Fitness Tips

Dynamic – Two-Way• ID Card Management, Coverage Management

• Digital ID Card

• Benefits / eligibility

• Claims Status

• User Profile

• Pay My Bill

• Health and Wellness Articles – Diabetes, Maternity Care, Nutrition, Obesity, Fitness, My Care Profile, Metabolic Syndrome

20,000mobile page views per day

More than

Fivetext messages sent per minute

More than

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HealthServices and Programs

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Exclusive health and wellness deals from national and local retailers

Save money on gym memberships, vision exams and services, hearing aids and diet-related services

Share deals with friends and family and receive cash rewards on future offers

Blue365® Member Discount Program

Member discounts simply for being a BCBS member

Log on to Blue Access for MembersSM for updates and to register for weekly emails

Under the My Coverage tab

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Expectant mothers and babies

Enroll in the Special Beginnings®΄ program to receive guidance from pregnancy to six weeks after delivery

• Pregnancy risk assessment

• Frequent, personal contact based on risk

• Educational materials

• Coordinated care with your physician

• Screening for depression

WEB TEXT

get off to a healthy start with prenatal andpostnatal education and support

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Your Blue Care Connection® Condition Management

If you are identified as being at-risk or having one of the managed chronic conditions, such as asthma, high blood pressure, or diabetes, a Blue Care Advisor will contact you.

Call Back! This is a completely confidential service offered at no cost to you. Your participation is voluntary, but Blue Care Connection will help you better manage your condition and stay healthier.

Personalized Outreach andintegrated support by certified clinical professionals

24Available in English and Spanish

Nurseline24/7

800-973-6329

Advice anytime.Advice isn’t just needed from 9 to 5.

Round-the-clock health and the wellness advicefrom licensed professionals

More than 1,200 AudioHealth Library topics

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• Claim questions or status

• Medical benefit coverage questions

• Help with finding network providers

• Membership and eligibility

• Help with navigating online tools

• ID card requests

• Transition of care

What if I Have Questions?

Call your BCBSNM customer service team for:

800.423.1630 Toll-free

Enter your ID NumberMonday-Friday 6 AM – 8 PMSaturday & most holidays

8 AM – 5 PM

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Select a Network: Standard or Extended

•You must note your selection of either the Standard (LoboCare) Network or Extended Network when enrolling

•You cannot change your Network selection except during Open Enrollment, regardless of any qualifying event during the plan year (August 1 through July 31)

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Rates 2014/2015 Standard & Extended Networks

Standard (LoboCare) Network

COVERAGE TYPEEE COST Full Time

EE COST Part Time

Employee $ 0.00 $ 108.00

Employee + Spouse/DP $ 285.00 $ 393.00

Employee + Child(ren) $ 136.00 $ 244.00

Employee + Family $ 312.00 $ 420.00

Extended Network

COVERAGE TYPEEE COST Full Time

EE COST Part Time

Employee $ 488.00 $ 556.00

Employee + Spouse/DP $1,200.00 $1,308.00

Employee + Child(ren) $ 805.00 $ 913.00

Employee + Family $ l,273.00 $ 1,381.00

UNMH pays $540.00 per month for health plan coverage for each enrolled full time employee. ($324.00 for part time)

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Questions?