Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.

Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.bcbsnm.com.

	In-Network
Deductible (Individual/Family)	$4,000 / $8,000
Out-of-Pocket Max (Individual/Family)	$4,000 / $8,000
Member Coinsurance (BCBS/Member)	100% / 0%
Physician Visits
Primary Care	Deductible
Routine Preventive	No Charge
Specialist	Deductible
Hospital Services
Physician Services	Deductible
Inpatient Hospital	Deductible
Outpatient Surgery	Deductible
Basic Outpatient Diagnostics
Diagnostic: X-Ray, Blood work	Deductible
Imaging: CT/PET scan, MRI's	Deductible
Urgent Care	Deductible
Emergency Room	Deductible
Retail Prescriptions (30-Day Supply)
Generic	Deductible
Preferred Brand	Deductible
Non-Preferred Brand	Deductible
Mail Order Prescriptions (90-Day Supply)
Generic	Deductible
Preferred Brand	Deductible
Non-Preferred Brand	Deductible

	Per 26 Pay Period Cost
Employee Only	$80.01
Employee + Spouse	$158.43
Employee + Child(ren)	$158.43
Employee + Family	$209.64

Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.

Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.bcbsnm.com.

	In-Network
Deductible (Individual/Family)	$1,000 / $3,000
Out-of-Pocket Max (Individual/Family)	$3,000 / $6,000
Member Coinsurance (BCBS/Member)	70% / 30%
Physician Visits
Primary Care	$30 Copay
Routine Preventive	No Charge
Specialist	$45 Copay
Hospital Services
Physician Services	30% after Deductible
Inpatient Hospital	30% after Deductible
Outpatient Surgery	30% after Deductible
Basic Outpatient Diagnostics
Diagnostic: X-Ray, Blood work	No Charge for services at GRMC/30% Coinsurance at Non-GRMC facility
Imaging: CT/PET scan, MRI's	30% Coinsurance
Urgent Care	$150 Copay
Emergency Room	$100 Copay at GRMC $240 Copay at Non-GRMC Facility
Retail Prescriptions (30-Day Supply)
Generic	Preferred Retail: $10 Copay Non-Preferred Retail: $15 Copay
Preferred Brand	Preferred Retail: $35 Copay Non-Preferred Retail: $45 Copay
Non-Preferred Brand	Preferred Retail: $75 Copay Non-Preferred Retail: $85 Copay
Mail Order Prescriptions (90-Day Supply)
Generic	$25 Copay
Preferred Brand	$88 Copay
Non-Preferred Brand	$188 Copay

	Per 26 Pay Period Cost
Employee Only	$96.59
Employee + Spouse	$178.90
Employee + Child(ren)	$178.90
Employee + Family	$220.41

Downloads

Summary of Benefits

Plan Highlights

Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.

Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.bcbsnm.com.

	In-Network
Deductible (Individual/Family)	$1,000 / $3,000
Out-of-Pocket Max (Individual/Family)	$3,000 / $6,000
Coinsurance (BCBS/Member)	70% / 30%
Physician Visits
Primary Care	$30 Copay
Preventive Care	No Charge
Specialist	$45 Copay
Hospital Services
Physician Services	30% after Deductible
Inpatient Hospital	30% after Deductible
Outpatient Surgery	30% after Deductible
Basic Outpatient Diagnostics
Diagnostic: X-Ray, Blood work	No Charge
Imaging: CT/PET scan, MRI's	$50 Copay/Imaging Test
Urgent Care	$150 Copay
Emergency Room	$100 Copay at GRMC $240 Copay at Non-GRMC Facility
Retail Prescriptions (30-Day Supply)
Generic	Preferred Retail: $10 Copay Non-Preferred Retail: $15 Copay
Preferred Brand	Preferred Retail: $35 Copay Non-Preferred Retail: $45 Copay
Non-Preferred Brand	Preferred Retail: $75 Copay Non-Preferred Retail: $85 Copay
Mail Order Prescriptions (90-Day Supply)
Generic	$25 Copay
Preferred Brand	$88 Copay
Non-Preferred Brand	$188 Copay

	Per 26 Pay Period Cost
Employee Only	$103.89
Employee + Spouse	$205.29
Employee + Child(ren)	$205.29
Employee + Family	$271.65

Downloads

Summary of Benefits

Plan Highlights

Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.

Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.bcbsnm.com.

	In-Network
Deductible (Individual/Family)	$500 / $1,500
Out-of-Pocket Max (Individual/Family)	$5,500 / $11,000
Coinsurance (BCBS/Member)	None
Physician Visits
Primary Care	$35 Copay
Preventive Care	No Charge
Specialist	$50 Copay
Hospital Services
Physician Services	No Charge
Inpatient Hospital	$1,000 Copay/Admit
Outpatient Surgery	$350 Copay/Visit
Basic Outpatient Diagnostics
Diagnostic: X-Ray, Blood work	No Charge
Imaging: CT/PET scan, MRI's	$50 Copay/Imaging Test
Urgent Care	$150 Copay
Emergency Room	$200 Copay
Retail Prescriptions (30-Day Supply)
Generic	Preferred Retail: $15 Copay Non-Preferred Retail: $20 Copay
Preferred Brand	Preferred Retail: $25 Copay Non-Preferred Retail: $30 Copay
Non-Preferred Brand	Preferred Retail: $40 Copay Non-Preferred Retail: $45 Copay
Mail Order Prescriptions (90-Day Supply)
Generic	$30 Copay
Preferred Brand	$50 Copay
Non-Preferred Brand	$80 Copay

	Per 26 Pay Period Cost
Employee Only	$110.84
Employee + Spouse	$219.01
Employee + Child(ren)	$219.01
Employee + Family	$289.81

Downloads

Summary of Benefits

Plan Highlights

Medical Benefits