1. NMSU PPO & Medicare Carve-out
Blue Cross and Blue Shield of New Mexico (BCBSNM)

2. NMSU Retirees Two Plans are available:
NMSU Preferred Provider Option PPO Plan
Non-Medicare Eligible Retirees
NMSU Carveout Plan
Medicare Eligible Retirees

3. Preferred Providers - PPO
nationwide network
Nationwide, more than 95% of hospitals and 85% of doctors
Over 20,000 contracted
providers in New Mexico
Nationwide coverage when traveling or living outside of home state
more than
896,000
providers
more than
5,300 hospitals
Worldwide® coverage when traveling in more than 195 countries

4. When You Choose a Network Provider… PPO
You receive the highest level of benefits when you see a provider in the BCBSNM network of contracted providers
BCBS ID card accepted in lieu of payment in full
No balance billing
Provider files claim for you
You receive a lower level of benefits when you see an out-of-network provider
You are responsible for paying the provider up front
You will be billed for the remaining balance over the allowed amount
You are responsible for getting prior authorization

5. What’s New for January 1, 2014 - PPO
In-Network out-of-pocket maximum $3,500 Individual/$8,750 Family
Out-of-Network out-of-pocket maximum $5,500 Individual/$13,750 Family
Out-of-Network Deductible $1,000 Individual/$3,000 Family

6. Non-Preferred Provider
Benefits - PPO
Member Share
Preferred Provider
Non-Preferred Provider
Deductible
Individual
$ 500
$1,000
Family
$1,500
$3,000
Out-of-Pocket Maximum
$3,500
$5,500
$8,750
$13,750
Primary Provider Office Visit
$25 (deductible waived)
40%*
Specialist Visit
$35
Preventive Care / Well Visits
No Charge
Not Covered
Inpatient Admission
25%*
Emergency Room
Urgent Care
Pet Scans, CT Scans, MRIs, Lab Tests, X-rays, including EKGs
25%
*After deductible

7. Retail Pharmacy Program - PPO
Mail-order copay is 2 times the monthly cost

8. Self Service: Blue Access® for Members
Claims and Customer Service
Members can:
Check status of claims
View Explanations of Benefits
Communicate with Customer Advocates through
View provider selections
Order new ID cards or print temporary copy
Link to Wellness site (Well onTarget)
Blue Access for Members is a secure portion of our Web site that allows members to access their personal membership and claims information.
Members may:
check the status of a claim
view Explanations of Benefits; prevent EOB mailings
receive notification when claims are filed
view provider selections
confirm covered dependents
order replacement ID cards and print a temporary ID card
send an inquiry to Customer Service (Currently, members can send s to Customer Service, and a Customer Advocate can respond either by phone or U.S. mail. Later in 2006, two-way secure messaging capabilities will be rolled out enterprise-wide. Our Customer Advocates can actually correspond back and forth with members through their secure BAM mailbox. Currently in pilot phase.)
Blue Access is also the doorway to other health benefits tools, such as:
the Treatment Cost Advisor
hospital comparison tool
Personal health manager (only available with Blue Care Connection Program)
And health risk assessment (only available with Blue Care Connection Program)
Details on those tools are coming up.
FOR SPEAKER’S INFORMATION ONLY: [Blue Access is available 7 days a week, from 6 a.m. to 3 a.m.] Also, the Personal Health Manager and Health Risk Assessment are only available for members who are enrolled in Blue Care Connection. 8 8 8

9. The NEW Integrated Provider Finder®
Quick and Easy Ways to find Providers and Treatment Costs
Log-in to bcbsnm.com/BlueAccess for Members
National quality designations for facilities and physicians nationwide
Users can view patient reviews on physicians or submit one of their own
Enhanced provider demographics added
Estimate the cost of provider’s procedures, treatments and tests.
Cost estimates are based on real claims data of all BCBS plans and National.

13. Cost Estimator Features - PPO
Cost for over 300 specific procedures
Quality measurement information
“Learn More about this Treatment” (alternatives to surgery)
Alternative options:
Lower cost
Closer locations
Alternative to hospitals
COMING in November 2013
Member Liability Estimator - displays expected member out-of- pocket costs based on specific benefit plan, episodic contracted cost information, and real-time deductible and coinsurance

17. Blue Access for MembersSM
Quick Links to request replacement cards, download forms and more
My Coverage includes benefit highlights.
Form Finder easier to view and find specific forms for members
Review secure messages
My Claim Activity displays recent claims, or go to the Claims Center for all your claim details
BAM is password protected and gives you immediate, secure access to your account information.

18. Blue365® Member Discount Program
Weight Management – Discounts at Jenny Craig®´ on membership and food
Vision Care and Eyewear– Discounts on eyewear, contact
lenses and laser vision correction surgery
Dental Products – Discounts on Procter & Gamble oral care bundles.
Hearing Aids – Discounts
on hearing aids for members, parents and grandparents
Under the My Health tab

19. 24/7 Nurseline Advice anytime –
Round-the-clock health and wellness advice from licensed professionals
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

20. What if I Have Questions?
Personalized Service
Claim questions/status
Network provider information
Membership and eligibility
Medical coverage questions
Inquiries (telephone and )
Transition of Care information
ID card requests
Help with online tools
Call your customer service team for:
NMSU (6678)
Toll-free
Customer Service

21. NMSU Medicare Carveout Plan – 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

22. NMSU Medicare Carveout Plan
When a Provider Accepts Medicare Assignment:
No Deductible
No Coinsurance
No Co-payments
No referrals required

23. Medicare Carveout Plan
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.
$140 Calendar year deductible
20% Coinsurance
$1500 Annual out-of-pocket maximum
Prior Authorization from BCBS applies

24. What if I Have Questions? Medicare Carveout medical
Personalized Service
Claim questions/status
Network provider information
Membership and eligibility
Medical coverage questions
Inquiries (telephone and )
Transition of Care information
ID card requests
Help with online tools
Call your customer service team for:
NMSU (6678)
Toll-free
Customer Service

25. Medicare Blue RX (Medicare Part D Prescription Drug Plan)

26. Eligibility – Medicare
NMSU eligible retiree/spouse /dependent
Enrollment in the Medicare Carve Out (MCO) plan is required upon reaching Medicare eligibility to continue coverage through NMSU
Upon reaching Medicare eligibility, usually age 65.
Not enrolled in any other Medicare Prescription Drug Plan (PDP).
If the retiree/spouse/dependent is eligible for Medicare prior to reaching age 65, the retiree/spouse must contact NMSU Benefit Services and provide a copy of the Medicare A&B card
1. Membership/Enrollment Timeliness – Measures the timeliness and efficiency of the plans completion of subscribers application and, subscribers required enrollment materials.
2. Membership/Enrollment Accuracy – Measures the member and group enrollment quality and process.
3. Claims Timeliness – Measures the percent of non-investigated claims finalized within 14 days.
4. Claims Financial Accuracy – Determines the percent of claim dollars paid accurately.
5. Customer Service ASA – Measures the average answer time for member calls.
6. Customer Abandonment Rate – Measures the number of calls lost due to customer hanging up.

27. Non-Medicare Retirees – Aging in
MCO plan include Medicare Part D prescription plan
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 must have proof of Medicare Part A & B enrollment prior to the effective date of Medicare

28. New Enhanced Plus BlueMedicareRX- Medicare
Effective 1/1/2014 – Preferred and nonPreferred pharmacy copays.
Preferred Pharmacies – CVS, Albertson’s and WalMart.
All other pharmacies are considered nonPreferred.
1. Membership/Enrollment Timeliness – Measures the timeliness and efficiency of the plans completion of subscribers application and, subscribers required enrollment materials.
2. Membership/Enrollment Accuracy – Measures the member and group enrollment quality and process.
3. Claims Timeliness – Measures the percent of non-investigated claims finalized within 14 days.
4. Claims Financial Accuracy – Determines the percent of claim dollars paid accurately.
5. Customer Service ASA – Measures the average answer time for member calls.
6. Customer Abandonment Rate – Measures the number of calls lost due to customer hanging up.

29. NEW Enhanced Plus Blue MedicareRX – Preferred Pharmacies 5-tier
Benefit
Enhanced Plus Plan
Individual Deductible $0
Preferred Pharmacy
NonPreferred Pharmacy
Tier 1 - Preferred Generic
$0 copay
$5 copay – no change
Tier 2 - Non-Preferred Generic
$2 copay
$7 copay
Tier 3 – Preferred Brand
$25 copay
$30 copay- no change
Tier 4 – Non-Preferred Brand
$55 copay
$60 copay – no change
Tier 5 – Specialty
33%
33% - no change
After your total out-of-pocket costs exceed $4,550
You pay the greater of: $2.55 or 5%, whichever is greater, for Generic/NonPreferred Generic and $6.35 or 5% coinsurance, whichever is greater, for all other classes.
** 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.

30. Mentally or Physically impaired Dependents - Medicare
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

31. Termination - Medicare
You can terminate your coverage at Open Enrollment or terminate by enrolling under another Part D plan outside of NMSU and providing that proof of enrollment.
If you pick up another Medicare Part D prescription plan outside of NMSU, you will be dis-enrolled from the NMSU MCO and Blue Medicare Rx plan automatically, per CMS requirements.
Once you have been dis-enrolled from the NMSU plans, either voluntarily or involuntarily, you will not be eligible to re-enroll at a later date.

32. Pharmacy (continued) - Medicare
What pharmacy can I use?
For a complete list of our retail, network and preferred network pharmacies
Call , 7 days a week, 7 a.m. – 7 p.m., Local time. For the hearing or speech impaired, please call
Or visit

33. Resources - Medicare Medicare Blue RX Medicare
Call , 7 days a week, 7 a.m. – 7 p.m., CST
For the hearing or speech impaired, please call days a week, 7 a.m. – 7 p.m., CST
Visit
Medicare
Call MEDICARE ( ) 24 hours a day
TTY/TDD Users: , 24 hours a day
Visit

34. Resources (continued) – Medicare
Social Security
Call , 7 a.m. – 7 p.m. Monday- Friday
TTY/TDD Users: , 7 a.m. – 7 p.m. Monday-Friday
Visit

35. Blue365® Member Discount Program
Weight Management – Discounts at Jenny Craig®´ on membership and food
Vision Care and Eyewear– Discounts on eyewear, contact
lenses and laser vision correction surgery
Dental Products – Discounts on Procter & Gamble oral care bundles.
Hearing Aids – Discounts
on hearing aids for members, parents and grandparents
Under the My Health tab

36. 24/7 Nurseline Advice anytime –
Round-the-clock health and wellness advice from licensed professionals
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

37. 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 37