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NMSU PPO & Medicare Carve-out. bcbsnm.com. NMSU Retirees. Two Plans are available:. NMSU Preferred Provider Option PPO Plan Non-Medicare Eligible Retirees NMSU Carveout Plan Medicare Eligible Retirees. nationwide network. more than 896,000 providers. more than 5,300 hospitals.
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NMSU PPO & Medicare Carve-out bcbsnm.com
NMSU Retirees Two Plans are available: • NMSU Preferred Provider Option PPO Plan • Non-Medicare Eligible Retirees • NMSU Carveout Plan • Medicare Eligible Retirees
nationwidenetwork more than 896,000 providers more than 5,300 hospitals Preferred Providers Nationwide, more than 95%of hospitals and 85% of doctors Over20,000 contracted providers in New Mexico Nationwide coveragewhen traveling or living outside of home state Worldwide® coveragewhen traveling in more than 195 countries
In-network You receive the highest level of benefits: Pay less for services received No balance billing No claim forms Providers file claims for you PPO Network Providers…. Always verify provider network status • Out of Network: • You pay more of the cost Higher deductibles, coinsurance • You may need to file your own claim • You could be balance billed for amounts over allowed amount
Log on: bcbsnm.comClick on ‘Find A Doctor” Call Customer Service1-866-369-NMSU (6678) Call BlueCard Access 24/7800-810-BLUE(2583) How to Find a PPO Provider OR Contact your physician and ask if they belong to the BCBS PPO Network
Self Service: Blue Access® for Members Log on to bcbsnm.comand click the “Log In” tab to get started
24/7 Nurseline • Our 24/7 Nurseline is here to help • Nurses provide health advice and information • AudioHealth Library® includes topics such as kicking the smoking habit • Available in English and Spanish Advice anytime – • Round-the-clock health and wellness advice from licensed professionals • 1-800-973-6329
Well OnTarget – A New Way to Experience Wellness! Personalized tools and resources to help all members on the path to health and wellness. These will be replacing the current wellness tools. LiveOn Member Wellness Portal OnMyTime Self-directed Courses Health & Wellness Content Tools & Trackers OnMyTeam Wellness Coaching Improved and user friendly Health Assessment Life Points Program will be replacing the Blue Points program Fitness program that offers membership to a national network of leading national, regional and local fitness centers for one low monthly price of $25 and no contract. Premiering January 2013!
The New and Improved National Provider Finder on bcbsnm.com: National View provider profiles Ability to compare 3 providers/facilities side by side Rate a Provider Google map feature Premiering 2nd Quarter 2013!
NMSUMedicare CarveoutPlan – No changes • Low or no out-of-pocket costs • Freedom to choose your providers • No referrals required • No claims to file • Worldwide Coverage for Emergency • Many non-Medicare covered services provided
NMSU Medicare CarveoutPlan When a Provider Accepts Medicare Assignment: • NoDeductible • NoCoinsurance • NoCo-payments • Noreferrals required
Medicare CarveoutPlan When provider does NOT accept Medicare assignment When services are NOT covered by Medicare, but ARE plan benefits OR • Example: Acupuncture is not covered by Medicare. • $100 Calendar year deductible • 20% Coinsurance • $1500 Annual out-of-pocket maximum • Prior Authorization from BCBS applies
What if I Have Questions? Personalized Service • Claim questions/status • Network provider information • Membership and eligibility • Medical coverage questions • Inquiries (telephone and e-mail) • Transition of Care information • ID card requests • Help with online tools Call your customer service team for: 1-866-369-NMSU (6678) Toll-free Customer Service
NMSU eligible retiree Entitled to Part A and Enrolled in Part B. Under your NMSU employer sponsored program you must be enrolled in Medicare Part A and Part B in order to be eligible for the Medicare Carveout plan. Not enrolled in any other Medicare Prescription Drug Plan (PDP). If you elect to not be enrolled in NMSU’s Blue MedicareRX Plan, you will not be eligible for NMSU’s Medicare Carveout plan. Eligibility – Medicare
Enhanced Plus Blue MedicareRX ** Copayments shown are per 30-day supply at an in-network pharmacy. For more detailed information on this benefit plan, please refer to your Summary of Benefit.
Non-Medicare Retirees – Aging in • NMSU will mail you a packet containing the Medicare Part D information at least forty-five days prior to your birthday month. • NMSU will automatically enroll you in Blue Medicare Rx and Medicare Carveout program once they have received confirmation of Medicare Part A and Medicare Part B enrollment from you. • NMSU sends a letter 2 months prior to the 65th birthday to obtain this information.
NMSU Mentally or Physically impaired Dependents • If your dependent child loses Medicaid eligibility as secondary coverage (Dependent has Medicare as the primary coverage) you may add them to the NMSU medical and Blue MedicareRX within 31 days of the loss of coverage. • You must provide proof of loss to NMSU’s Benefits Office
Termination • NMSU allows you to terminate your Blue MedicareRX group plan at any time during the year with proof of enrollment in another plan. • Remember if you disenroll from NMSU’s Blue MedicareRX or enroll in another Medicare Part D plan you will not be eligible for the NMSU medical plan.
Pharmacy(continued) What pharmacy can I use? • For a complete list of our retail, network and preferred network pharmacies • Mail order option • Call 1-877-838-3877, 7 days a week, 7 a.m. – 7 p.m., Local time. For the hearing or speech impaired, please call • 1-888-285-2252 • Or visit www.bcbsnm.com - You can also save on copayments with our convenient mail-order program administered by Prime Therapeutics^.
Resources • Medicare Blue RX • Medicare • Call 1-877-838-3877, 7 days a week, 7 a.m. – 7 p.m., CST • For the hearing or speech impaired, please call 1-888-285-2252 days a week, 7 a.m. – 7 p.m., CST • Visit www.bcbsnm.com • Call 1-800-MEDICARE (1-800-633-4227) 24 hours a day • TTY/TDD Users: 1-877-486-2048, 24 hours a day • Visit www.medicare.gov
Resources (continued) • Social Security • Call 1-877-772-1213, 7 a.m. – 7 p.m. Monday- Friday • TTY/TDD Users: 1-800-325-0778, 7 a.m. – 7 p.m. Monday-Friday • Visit www.socialsecurity.gov
Nearly 100 million Americans choose the Blues… including over 400,000 New Mexicans. Administered by: Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
