Enrollment Period: October 1 – 27, 2014
All requested changes effective 1/1/15.
NOTE: Employees who do not need to make changes do not need to take any action.
Vendor Informational Session
Please note that you may jump to a plan presentation of your choice by clicking on the down arrow (▼) to the left of the “Employee Benefits Bureau” label in the “Events Index” box along the left side of the presentation.
|Coverage Change Options Available:||Medical||Dental||Vision|
|Add coverage for yourself and/or your dependents- children can be covered up to at 26 (proof of dependency will be required for all new dependents)||Yes||Yes||Yes|
|Drop coverage for yourself and/or your dependents||Yes||Yes||Yes|
|Change coverage type (i.e. Family coverage to Employee only coverage, etc.)||Yes||Yes||Yes|
|Change coverage from your current carrier to another medical carrier||Yes|
- BCBSNM: Away from Home Program | PPO Summary of Benefits | HMO Summary of Benefits
- Presbyterian: Summary of Benefits | Schedule of Benefits Coverage
- Delta Dental: Summary of Benefits
- Express Scripts: Summary of Benefits
- VSP: Choice Plan Summary | VSP Diabetic Eye Care Program
- Medical Plan Comparison at a glance
Changes for 2015
Medical/Dental Plan Changes
The state Risk Management Division (RMD), the state office that administers the medical, prescription and dental plans, has confirmed there will be changes and improvements to the plans as of January 1, 2015, as listed below:
- Due to Blue Cross and Blue Shield of New Mexico’s recent acquisition of Lovelace Health Plan, the Lovelace HMO plan will transition into the BCBSNM HMO plan. All current participants in the Lovelace HMO plan (currently covered on BCBSNM PPO) will be covered on the BCBSNM HMO plan effective January 1, 2015 unless the participant changes to another medical plan during the open enrollment.
- Coverage in New Mexico, in network only.
- Emergency services outside New Mexico will be covered.
- Participants can apply for the “Away from Home” program to cover services outside the state of New Mexico to cover students attending school out of state and for other special circumstances where the member is out of state for at least 90 days. Coverage is not guaranteed.
- A new premium rate group, “Employee plus Child/Children,” is now available for employees who are covering one or more dependent children, without a spouse or domestic partner. This new group coverage will replace the current Employee plus Child category. There is also a new rate associated with this category.
- Currently, any employees who are covering multiple children and no spouse or domestic partner will need to change to the Employee+Child/Children category through open enrollment to take advantage of the reduced premium.
- Currently, any employees who are covering only one child and have the Employee+Child premium will have the new higher premium go into effect January 1, 2015 , unless the employee changes coverage through open enrollment.
- Deductibles for both Presbyterian and BCBSNM’s HMO plan will be decreased to $325 for employee only, $650 for employee+spouse, and $975 for family.
- Deductibles for BCBSNM’s PPO Plan (Preferred Provider) will be decreased to $500 for employee only, $1,000 for employee+spouse, and $1,500 for family.
- With an Autism diagnosis, the State Plan now covers Applied Behavioral Analysis therapy.
- Medical and Pharmacy Out-Of-Pocket (OOP) costs will now be combined. The combination of out of pocket expenses will assist those participants who utilize services more often, to reach the annual out of pocket maximum more quickly.
- Reminder the pharmacy benefit has a $50 deductible for single coverage and a $100 deductible for all other coverages, for non-generic prescriptions. The deductible must be met in its entirety before the pharmacy plan will revert to the co-pay/co-insurance payment structure. All deductible amounts will be counted toward the medical out of pocket maximum.
- Each time you pay a co-pay or co-insurance for prescriptions, the co-pay/co-insurance amount will go towards your medical out of pocket maximum.
- Reminder – all medical co-pays and co-insurance payments go toward the medical out of pocket maximum.
- The Specialty Drug co-pay has been decreased from $150 to $75 per specialty prescription. Also, there is no longer a $1,500 Specialty Drug OOP maximum. The specialty drug copayments will now go toward the combined Medical and Pharmacy OOP maximum.
- Dependent children will be covered through the end of the month in which they turn 26 years of age.
- There will be a 3% increase on medical premiums effective July 1, 2015.
Dental Plan Changes for 2015
New rate for new coverage type – Employee/Child(ren) – to be effective January 1, 2015.
Vision Plan Changes for 2015
The vision plan will have slight modifications to be effective January 1, 2015.
- The Out of Network reimbursement for materials will decrease.
- The In Network lens co-pays for progressive lenses will increase.
- The overall premiums will increase 2.5% due to taxes imposed on such plans as part of the Health Care Reform regulations.