Important note: Any plan coverage information here is intended to provide an overview. For more complete coverage specifics and limitations of each plan you are considering, view the Summary of Benefits, or view the full Benefit Booklet.
- BlueDirect Basic Summary of Benefits
- BlueDirect Enhanced Summary of Benefits
- BlueDirect Premier Summary of Benefits
For preventive care services delivered by Non-preferred providers, yes, you are covered. However, some services are not covered if you receive them from Non-preferred Providers. Also, benefits for some services are limited if you receive them from Non-preferred Providers, but are not limited if received from Preferred Providers. For emergency room visits, copayment covers both facility and provider charges.
Chiropractic services are covered the same as services from any other licensed provider, and some services, such as routine office visits and X-rays, are not limited. However, other limits may apply. These include coverage for certain types of services, such as spinal manipulation and physical therapy. Your deductible and copayments for therapy and office visits may also apply.
Yes, a variety of technical procedures for treatment or diagnosis of disease or injury are covered. Some coverage highlights:
- Microsurgery (use of scopes), laser procedures, treatment of fractures and dislocations, and endoscopic examinations
- Surgical services such as usual and related local anesthesia, and pre- and post-operative care, including recasting
- Outpatient procedures may be covered, but generally require prior authorization
- Outpatient and other services may also be covered for the treatment of illness or accidental injury, depending on type and special circumstances (for example, an emergency)
Are there separate charges when visiting a provider?
- Except for preventive care services, members always pay an office visit copayment.
- There may be separate charges for any therapies or diagnostic tests, based on type and place of services (e.g., surgery performed in a provider's office or X-rays at an outpatient facility).
- You may be responsible for paying additional coinsurance and deductible amounts for these services.
Prescription Drug Plan for Basic, Enhanced, and Premier
The prescription drug plans found in BlueDirect Basic, Enhanced and Premier plans are structured the same and vary only in copayment amounts. This means your copayment will vary depending on four categories of prescription drugs based on your specific plan.
|Tier 1||Generic drugs||$15||$10||$7|
|Tier 2||Brand-name drugs on our drug list*||$45||$40||$35|
|Tier 3||Brand-name not on our drug list with no generic available*||$75||$70||$65|
|Tier 4||Specialty drugs||15% of covered charges or $250 maximum||15% of covered charges or $250 maximum||15% of covered charges or $250 maximum|
*If you or your doctor prefer that you receive a brand-name drug when a generic equivalent is available, you'll pay the Tier 1 copayment PLUS the difference in cost between the generic and brand-name drug.
- The copayments above are based on the following tier structure for a 30-day supply or 120 units, whichever is less at a retail pharmacy.
- Coverage is always subject to the limitations of your health care plan.
- For some medications, prior approval requirements, generic substitution, or quantity limits may apply.
- Prime, our mail-order pharmacy, combines cost savings with the convenience of mail delivery
See the Prescription Drug Plan Rider for details, limitations, exclusions.
If you are applying for BlueDirect and have benefit questions, please call 1-866-445-1396.
If you are a BlueDirect member and have questions, call BCBSNM Customer Service at the toll-free number on the back of your BCBSNM member ID card.