BlueDirect® Comparison Chart
|Benefit Highlight||Basic Plan||Enhanced Plan||Premier Plan|
|PPO Preferred Provider||NonPPO Nonpreferred Provider||PPO Preferred Provider||NonPPO Nonpreferred Provider||PPO Preferred Provider||NonPPO Nonpreferred Provider|
|Lifetime Maximum Benefit||Unlimited||Unlimited||Unlimited|
|Deductible Options — NonPPO Deductible is double (2x) the PPO deductible|
|Individual Out-of-Pocket Expense Limit *||$7,000||$14,000||$4,000||$8,000||$3,000||$6,000|
|Coinsurance||You pay 30%||You pay 50%||You pay 20%||You pay 40%||You pay 15%||You pay 30%|
|Preventive Care**||No Charge||No Charge||No Charge||No Charge||No Charge||No Charge|
|Prescription Drugs||4-Tier Rx Plan — you pay copayment for retail/mail-order prescriptions||4-Tier Rx Plan — you pay copayment for retail/mail-order prescriptions||4-Tier Rx Plan — you pay copayment for retail/mail-order prescriptions|
|Prescription Drug Utilization/ Benefit Management Programs||Dispensing Limits: Benefits include coverage limits on certain medications. These limits are based on approved guidelines.
Prior Authorization/Step Therapy Requirements: Before receiving coverage for some medications, your doctor will need to receive authorization from BCBSNM and/or certain criteria must be met.
Specialty Pharmacy Program: Specialty medications must be received through the preferred Specialty Pharmacy Provider.
Reminder about coverage for self-administered specialty medications .
Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay the share plus the difference in cost.
Note: The above chart highlights key plan differences and is not intended to be a comprehensive benefit summary. For more information, please click on each plan’s Benefit Summary.
*Includes coinsurance only; does not include deductible, copays, penalty amounts, or non-covered charges.
**Includes well-child care, immunizations, routine physicals, mammograms, colonoscopy, prostate exams.