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
$500			√	2x	√	2x
$1,000	√	2x	√	2x	√	2x
$2,000	√	2x	√	2x	√	2x
$3,500	√	2x	√	2x	√	2x
$5,000	√	2x	√	2x	√	2x
$7,500	√	2x	√	2x
$10,000	√	2x
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.
	Basic Plan Benefit Summary Rx Drug Plan Rider		Enhanced Plan Benefit Summary Rx Drug Plan Rider		Premier Plan Benefit Summary Rx Drug Plan Rider

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.