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Blue Cross Blue Shield
New Mexico |
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• BlueDirect® Plan A Benefit Information
BlueDirect® Plan A offers the benefits that your clients need most. Special features of this plan include:
- preventive care
- wide range of covered services, including emergency and urgent care, specialist services, hospitalization, surgery, acupuncture, chiropractic, prescription drug benefits, diagnostic tests, and organ transplants
- 24/7 Nurseline
- coverage when traveling, including the unique BlueCard® program
Summary of BlueDirect
Medical Benefits
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MEMBER'S SHARE OF COVERED CHARGES |
|
Blue Direct Plan A1 |
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Preferred Provider |
Nonpreferred Provider |
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High lights of Member Costs |
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Life time Maximum Benefit (Some services have annual or lifetime limits.) |
$5,000,000 |
$5,000,000 |
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Calendar Year Deductible Options (Family deductible is three times individual amount chosen.) |
$100
$250
$500
$1,000 |
$200
$500
$1,000
$2,000 |
|
Annual Out-of-Pocket Limit (Does not include deductible, pena lty a mounts, and noncovered cha rges; copayments for Plans A and B are not included. Family limit is three times individual a mount chosen.) |
$1,000 |
$2,000 |
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Highlights of Benefits |
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Office Visits (for nonroutine; other services received during an office visit a re subject to deductible and coinsurance as listed.) |
$20 copay/visit |
30% |
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Office Surgery (including casts, splints, and dressings)3 |
10% |
30% |
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Lab Tests, X-Rays, EKGs, and other Diagnostic Tests3 |
10% |
30% |
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Allergy Services (injections, tests, serum) |
10% |
30% |
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Preventive Care (Routine a dult exa ms a nd screenings; well-child care and immuniz ations; vision/ hearing screenings through age 17) |
Pays 100% (no deductible) for first $400 in covered charges, including related testing. Thereafter, subject to deductible and coinsurance. |
30% |
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Emergency Services |
$100 copay/visit |
$100 copay/visit |
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Urgent Care Facility |
$30 copay/visit |
30% |
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Hospital & Inpatient and Outpatient 3 , 4 |
10% |
30% |
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Surgery & In patient and Outpatient 3, 4 |
10% |
30% |
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Organ Transplants 5 |
10% 3, 4 |
No benefit |
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Other Covered Services6 |
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· Out-of-Area Care ·Acupuncture Services ($ 1,500 / calendar year max.) · Spinal Manipulation ($ 1,500 / calendar year max.) · Supplies and Durable Medical Equipment · Therapy: C hemotherapy, Dialysis, and Radiation · Lab Tests, X-Rays, and Other Diagnostic Tests · Prescription Drug Benefits (see following page) · TMJ Services and Dental/Facial Accidents · Prosthetics and Orthotics · Ambulance Services · Home Health Care/ Home I.V. Services/Hospice (100 visits/ calendar year max.) · Short-Term Rehabilitation (Occupational, Physical, and Speech Therapy; 30 days inpatient and $3500 outpatient/calendar year max.) |
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Important note: BlueDirect does not provide benefits for ma ternity care (including any pregnancy-related condition), behavioral health conditions, or chemical dependency (alcoholism or drug abuse). |
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This is only a brief description of benefits. Some services require Admission Review and/or Prior Approval. Some services have annual or lifetime limits. Please refer to the Plan Benefit Booklets and Prescription Drug Plan R iders for more complete benefit information. |
A Division of Health Care Services Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the
Blue Cross and Blue Shield Association |
View and print benefit information:
 Or call Toll Free: 1-800-831-3270 , contact or email us!
Or download our Individual Health Insurance Application  in Acrobat PDF format.
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USA-HealthInsurance® offers affordable medical coverage from Blue Cross Blue Shield and other nationwide insurance companies to provide you with your health insurance needs.
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