New Mexico State University Preferred Provider Plan (PPO) State of New Mexico For a state of better health!

Why BCBSNM  Experience serving NMSU  Dedicated Service Unit  Extensive Texas Network  National PPO Network  BlueCard ® Worldwide Over 94 million Americans choose the Blues, including over 290,000 New Mexicans!  Brand Value and Stability - Over 94 million Americans choose the Blues, including over 290,000 New Mexicans!

BCBSNM 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 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 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 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

8 BlueCard ® Worldwide Call BlueCard toll free! 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 ProviderNonpreferred 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 Plan Brief Summary of Benefits

PPO Health Care Plan Benefits Member’s Share of Covered Charges Preferred ProviderNonpreferred Provider PPO Primary Provider (PPP) Office Visit/Exam Charge $15 (Deductible Waived) 30% Specialist Visit $2530% 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 Inpatient Hospital/ Facility Services (Physician Services Included) $30030% Outpatient Surgery MRI, PET Scan, and CT Scan 10%30% PPO Plan Brief Summary of Benefits

Preventive 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 Always call Mesa Mental Health before receiving services Mental Health and Substance Abuse

13 bcbsnm.com  your customer service area  Link to health and wellness sites  Link to the SONM web site  Access Blue Access for Members

14  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

15  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

16 Blue Care Connection SM Disease 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 Connection SM i s 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.

17 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 Connection SM Prenatal Program Blue Care Connection SM Prenatal Program It is important to enroll in Special Beginnings early in your pregnancy! BABY (2229) bcbsnm.com/specialbeginnings

18  Search A.D.A.M. (health encyclopedia)  Link to personal exercise guides  Link to the area of Questions/Feedback –Ask a Nurse –Ask a Trainer –Ask a Dietitian –Ask a Life Coach  Create a personal health record for you and your family! Password protected: giving you immediate, secure access to your own information. Blue Care Connection SM Personal Health Manager

19 BCBSNM 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?

20 Customer Service Hours 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 State 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 BLUES