New Mexico State University Preferred Provider Plan (PPO)
Transcript of New Mexico State University Preferred Provider Plan (PPO)
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