BlueEdge Comparison Chart

Benefit Highlight	BlueEdgeSM (Basic, Enhanced, Premier plans)		BlueEdgeSM 100
	PPO Preferred Provider	NonPPO Nonpreferred Provider	PPO Preferred Provider	NonPPO Nonpreferred Provider
Lifetime Maximum Benefit	Unlimited		Unlimited
Individual Deductible Options	$1,250 $1,700 $2,600		$3,500 $5,000	$5,000 $7,500
Family Deductible Options	$2,500 $3,450 $5,150		$7,000 $10,000	$10,000 $15,000
Individual Out-of-Pocket Expense Limit	$2,000 $3,000 $5,000	$3,000 $5,000 $6,000	$3,500 $5,000	$7,500 $10,000
Family Out-of-Pocket Expense Limit	$4,000 $6,000 $10,000	$6,000 $10,000 $12,000	$7,000 $10,000	$10,000 $20,000
Coinsurance	You pay 20%	You pay 40%	Plan pays 100% after you pay annual deductible	You pay 20%
Preventive Services and Wellness Visits for Adults and Children *	No Charge	No Charge	No Charge	No Charge
Prescription Drugs	You pay 25% or 50% after you pay annual deductible		Plan pays 100% after you pay annual deductible
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 . For policies with effective dates on or after 1/1/2012 Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay the share plus the difference in cost.
	BlueEdge Benefit Summary		BlueEdge 100 Benefit Summary

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 routine physicals, mammograms, colonoscopies, cholesterol tests, urinalysis, etc. For children, includes routine hearing or vision screening, (through age 17), routine testing, and immunizations.