Frequently Asked Questions

Your New Mexico Public Schools Insurance Authority (NMPSIA) Dual Option PPO health plan allows you to see the providers you want to see. You can choose either the EPO Option Plan, High Option Plan or the Low Option Plan. For these Plans, you do not have to choose a primary care provider and do not need a referral to see a specialist. Providers are classified as "Preferred" (in-network) or "Nonpreferred" (out-of-network). You'll generally pay more if you receive services from Nonpreferred Providers, but it is your choice to receive most covered health care services from any licensed provider. Transplant services are only covered if you receive them from a Preferred Provider.

If you have the Blue Preferred EPO Option Plan, you will need to meet a deductible for some services from Preferred Providers. You will pay a copayment for most services you receive from Preferred Providers. You will need to meet a deductible and then pay coinsurance. Under the EPO Plan, you will receive benefits for non-Emergency services only if you use a BCBSNM Preferred Provider. No coverage from Out-of-Network Providers, except in an emergency situation.

If you have the High Option Plan, you will need to meet a deductible for some services from Preferred Providers. You will pay a copayment for most services you receive from Preferred Providers. Generally, for services from Nonpreferred Providers, you will need to first meet a deductible and then pay coinsurance.

If you have the Low Option Plan, you will first need to meet a deductible before the Plan pays for most services from both Preferred and Nonpreferred Providers. Generally, after the deductible is met, you will pay coinsurance for most services from Preferred Providers. For office visits to Preferred Providers you will pay a copayment. Any services performed during or as a result of the office visit are subject to deductible and coinsurance amounts.

Some services are not covered if you receive them from Nonpreferred Providers. For example, you must receive human organ transplants from Preferred Providers in order for the services to be covered. Also, some benefits for services are limited if you receive them from Nonpreferred Providers, but are not limited if received from Preferred Providers.

If you receive preventive services from Preferred Providers, both the High Option and Low Option pay 100 percent of the charges. If you receive preventive services from Nonpreferred Providers, High Option Plan members pay 30 percent coinsurance and Low Option Plan members pay 50 percent coinsurance. You do not need to meet a deductible for covered preventive services. Preventive services include: routine adult physicals and gynecologic exams, well-child care, routine vision or hearing screenings; related testing including routine Pap tests, mammograms, cholesterol tests, urinalysis; and immunizations.

BCBSNM's customer service representatives are available to answer your questions 6 a.m. to 8 p.m. MT, Monday through Friday, and 8 a.m. to 5 p.m. MT on weekends and holidays (closed Thanksgiving and Christmas Day). If you call after hours, you can leave a message and we will return your call by the next business day. Call the NMPSIA Designated Service Unit toll-free at 1-888-9NMPSIA (1-888-966-7742); the number is also printed on the back of your member ID card. Please have your ID card available when you call. You can also contact Customer Service with a secure message through Blue Access for Members.