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Blue Cross Blue Shield of New Mexico – BlueEdge 100 – NEW MEXICO
A comparison of the BlueEdge 100 offered by Blue Cross Blue Shield of New Mexico is detailed out below for both Network and Non-Network coverage.
| Network | Non-Network | |
|---|---|---|
|
||
| Network | See Provider | See Provider |
| Application | BlueEdge 100 Application | BlueEdge 100 Application |
| Brochure | BlueEdge 100 Brochure | BlueEdge 100 Brochure |
| Copay | Office Services (nonroutine):
|
Office Services (nonroutine):
|
| Office Visit | Office Services (nonroutine):
|
Office Services (nonroutine):
|
| Deductible | Individual: $5,000, Family: $10,000 | Individual: $7,500, Family: $15,000 |
| Coinsurance | 100% | 80% |
| Coinsurance Limit | N/A | N/A |
| Out-of-Pocket Maximum | Individual: $5,000, Family: $10,000 | Individual: $10,000, Family: $20,000 |
| Lifetime Maximum | $5,000,000 per member | $5,000,000 per member |
| Prescription Drugs | Prescription Drugs, Insulin, Diabetic Supplies, Enteral Nutritional Products, Special Medical Foods:
|
Prescription Drugs, Insulin, Diabetic Supplies, Enteral Nutritional Products, Special Medical Foods:
|
| Emergency Room | ||
| Adult Preventative Care | Routine Adult Physicals and Gynecological Exams (ages 18 and older), Related Testing (includes routine Pap tests, mammograms, preventive/routine colonoscopies, cholesterol tests, urinalysis, etc.), and Immunizations: Deductible waived up to first $400 in covered charges, thereafter services may be subject to member cost sharing | Well-Child Care; Routine Vision or Hearing Screenings (only through age 17); Routine Testing, and Immunizations: Plan pays 80% (limited to $250 and deductible is waived) |
| Child Preventative Care | Well-Child Care; Routine Vision or Hearing Screenings (only through age 17); Routine Testing, and Immunizations: Plan pays 100% (no deductible) | Well-Child Care; Routine Vision or Hearing Screenings (only through age 17); Routine Testing, and Immunizations: Plan pays 80% (limited to $250 and deductible is waived) |
| Lab / X-Ray | Plan pays 100% after deductible | Plan pays 80% |
| Maternity | BlueEdge 100 | BlueEdge 100 |
| Physical Therapy | Short-Term Rehabilitation (Occupational, Physical, and Speech Therapy; including Physical Rehabilitation and Skilled Nursing Facility; maximum benefit of up to $3,500/year for outpatient services and 30 days/year for inpatient services): Plan pays 100% after deductible | Short-Term Rehabilitation (Occupational, Physical, and Speech Therapy; including Physical Rehabilitation and Skilled Nursing Facility; maximum benefit of up to $3,500/year for outpatient services and 30 days/year for inpatient services): No benefit |
| Skilled Nursing | Plan pays 100% after deductible | No benefit |
| Home Health Care | ||
| Mental Health | BlueEdge 100 | BlueEdge 100 |
| Hospital Care | Inpatient Hospital/Facility Services:
|
Inpatient Hospital/Facility Services:
|
| Optional Benefits | BlueEdge 100 | BlueEdge 100 |