New MexicoNew MexicoState UniversityState University

Preferred Provider Preferred Provider Plan (PPO)Plan (PPO)

State of State of New MexicoNew Mexico

For a state of better health!For a state of better health!

Why BCBSNMWhy BCBSNM

Experience serving NMSU Dedicated Service Unit Extensive Texas Network National PPO Network BlueCard® Worldwide Brand Value and Stability - Over 94 Over 94

million Americans choose the Blues, million Americans choose the Blues, including over 290,000 New Mexicans!including over 290,000 New Mexicans!

BCBSNM PPO PlanBCBSNM PPO Plan

No need to designate a Primary Care Physician (PCP) - but always a good idea to have one.

You can choose any physician without a referral!

You have the option to go to Preferred (In-Network) or Nonpreferred (Out-of-Network) Providers.

Preferred ProvidersPreferred Providers

Providers contracted with Blue Cross and Blue Shield who agree to accept a predetermined maximum allowable fee as payment in full; no balance billing.

No need to change providers Claims filed for you Covered preventive services at 100% Worldwide access

Nonpreferred ProvidersNonpreferred Providers

Providers not contracted with a Blue Cross and Blue Shield Plan.

Access licensed providers for covered services and receive benefits.

No service area restrictions. You may be charged more than the

PPO plan’s maximum allowable charges.

You may have to file your own claims.

Over 8,700 providers statewide BCBSNM network includes the only:

Gamma Knife technology center in NM for treatment of brain tumors and malformations; Women’s Hospital; heart hospital dedicated to cardiology treatment/surgery; Level 1 Trauma Center; children’s hospital

Award-winning cancer and cardiology programs

BCBSNM’s Provider NetworkBCBSNM’s Provider Network

BCBSNM’s Provider NetworkBCBSNM’s Provider Network

An extensive network for El Paso providers

Continued access for members living in Palestine, TX

Access to the entire PPO provider network throughout the state of Texas

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BlueCardBlueCard®® WorldwideWorldwide

Call BlueCard toll free!1-800-810-BLUE (2583)

Or go on-line!bcbs.com

BCBSNM is the only local health plan that can offer this unique out-of-area coverage

Access to health care nationwide and in over 200 countries

Access to 97% of hospitals and over 90% of physicians nationwide

The program enables members who are traveling or living outside of New Mexico the ability to receive in-network benefits through BlueCard providers

Member’s Share of Covered Charges

Preferred Provider Nonpreferred Provider

Deductible$100 (single)

$200 (two-party)

$300 (family)

$ 500 (single)

$1,000 (two-party)

$1,500 (family)

Out-of-Pocket Limit

$2,000

$5,000 (two-party/family)

$4,000

$10,000 (two-party/family)

PPO PlanPPO PlanBrief Summary of BenefitsBrief Summary of Benefits

PPO Health Care Plan BenefitsMember’s Share of Covered Charges

Preferred Provider Nonpreferred Provider

PPO Primary Provider (PPP) Office Visit/Exam Charge

$15(Deductible Waived)

30%

Specialist Visit $25 30%

Other Lab/Diagnostic Tests $0(Deductible Waived)

30%

Preventive Services $0(Deductible Waived)

30%(Deductible Waived)

Emergency Ambulance Services 20% 30%

Emergency Room $150(Deductible Waived)

$150(Deductible Waived)

Urgent Care Facility $35 $35Inpatient Hospital/

Facility Services(Physician Services Included)

$300 30%

Outpatient Surgery

MRI, PET Scan, and CT Scan10% 30%

PPO PlanPPO PlanBrief Summary of BenefitsBrief Summary of Benefits

Preventive CarePreventive Care

Preferred Provider:– No copay, plan pays 100%– Establish a relationship with your doctor

Nonpreferred Provider:– Deductible waived

Your BCBSNM mental health and substance abuse benefits are administered by Mesa Mental Health

Call Mesa Mental Health at 1-800-583-6372

Always call Mesa Mental Health before receiving services

Mental Health and Substance AbuseMental Health and Substance Abuse

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bcbsnmbcbsnm.com.com

E-mailE-mail your your customer service customer service areaarea

LinkLink to health and to health and wellness siteswellness sites

LinkLink to the SONM to the SONM web siteweb site

AccessAccess Blue Blue Access for MembersAccess for Members

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Confirm who is covered under your plan

Check the status of claims View your explanation of

benefits Request a replacement and

temporary ID card Direct access to Mayo

Clinic’s Web site

Password protected: giving you immediate, secure access to your account information.

Need Information?

You’re just a click away with the Blue Cross and Blue Shield of New Mexico

Web site.

bcbsnm.com

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Extensive library of health information from the Mayo Clinic, customized for BCBSNM members

Online Health-Risk Assessment– Receive an immediate, individualized,

and confidential health report Interactive tools:

– Health management programs for weight loss, smoking cessation, etc.

– Manage a chronic condition– Prepare for a specific medical treatment– Assess/improve your overall health

Password protected: giving you immediate, secure access to your account information.

Need Information?

You’re just a click away with the Blue Cross and Blue Shield of New Mexico

Web site.

bcbsnm.com

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Blue Care ConnectionBlue Care ConnectionSMSM Disease Management ProgramsDisease Management Programs

Care enhancement programs for members with chronic conditions

Includes educational materials and RN telephonic care calls for these conditions:– Asthma– Diabetes– Cardiac, including CHF and

Hypertension– COPD– Other impact conditions

Blue Care ConnectionSM is our complete care package to help members working with their physicians to

discover “How healthy can you get?” It is all available

to you at no additional cost!

RN Case Managers provide services to members who may need extra help with life and social issues.

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Special Beginnings BabyLine – lets you speak with

a maternity nurse 24 hours a day 7 days a week

Customized OB newsletter Educational materials specific

to your individual needs Coordination of care with your

doctor

Blue Care ConnectionBlue Care ConnectionSMSM Prenatal ProgramPrenatal Program

Blue Care ConnectionSM

Prenatal Program

It is important to enroll in Special

Beginnings early in your pregnancy!

1-800-395-BABY(2229)bcbsnm.com/specialbeginnings

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Search Search A.D.A.M. A.D.A.M. (health encyclopedia)(health encyclopedia)

LinkLink to personal to personal exercise guidesexercise guides

LinkLink to the area of to the area of Questions/FeedbacQuestions/Feedbackk– Ask a NurseAsk a Nurse– Ask a TrainerAsk a Trainer– Ask a DietitianAsk a Dietitian– Ask a Life CoachAsk a Life Coach

Create Create a personal a personal health record for you health record for you and your family!and your family!

Password protected: giving you immediate, secure access to your own information.

Blue Care ConnectionBlue Care ConnectionSMSM Personal Health ManagerPersonal Health Manager

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BCBSNM 24/7 NurselineBCBSNM 24/7 Nurseline

Registered nurses available to you 24 hours a day, 7 days a week

Triage, coach, and provide information to assist members with their own medical decision-making process

Personal education and support Information to facilitate

communication with your doctor Access to an audio library of more

than 1,200 health topics (over 500 topics available in Spanish)

Our 24/7 Nurseline is another feature of our Integrated Total Health

Management approach to health care.

How healthy can you get?

1-800-973-6329

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Customer Service Hours

1-877-994-BLUE (2583)1-877-994-BLUE (2583)

Dedicated Reps: Mon-Fri 6:00 am - 6:00 pm

After Hour Reps: Mon-Fri 6:00 pm -10:00 pm and Sat, Sun, and Holidays 8:00 am-5:00 pm

Dedicated Service Unit for Dedicated Service Unit for State of New MexicoState of New Mexico

Local, experienced employees dedicated to serving you – they know you, they know your plan!

Our dedicated service unit includes:– Customer service

– Membership

– Claims

Local, dedicated case managers –

nurses who help you and your family when you need them the most!

NMSU Choose the BLUESNMSU Choose the BLUES