Blue Community Silver HMO 203 - On Exchange
BlueCross BlueShield of New Mexico
Plan overview
Medical deductible
Individual: $1800
Family: $3600
Per Person: $1800
Prescription drug deductible
Individual: $0
Family: $0
Per Person: $0
Combined medical and drug out of pocket maximum
Individual: $10150
Family: $20300
Per Person: $10150
Office visit
Primary Doctor
CoPay:
CoInsurance:
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Specialist
CoPay:
CoInsurance:
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Prescription drug information
Preferred brand drugs
CoPay:
CoInsurance:
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Non preferred brand drugs
CoPay:
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Generic drugs
CoPay:
CoInsurance:
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Specialty drugs
CoPay:
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Inpatient coverage
Hospital services
CoPay:
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Inpatient services
CoPay:
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Emergency and urgent care
Emergency room
CoPay:
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Urgent care facility
CoPay:
CoInsurance:
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Maternity
Labor and delivery hospital stay
CoPay:
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Pre and Postnatal office visit
CoPay:
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Vision
Routine Eye Exams for Children
CoPay:
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Major dental care
Routine dental checkups for children
CoPay:
CoInsurance:
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Routine dental checkups for adults
CoPay:
CoInsurance:
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Benefit Explanation:
These policies have exclusions, limitations, reduction of benefits, terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company (whichever is applicable).
- HealthMarkets Insurance Agency d/b/a Insphere Insurance Solutions, Inc is an independent, authorized agent for Blue Cross and Blue Shield of New Mexico.
- Blue Cross and Blue Shield of New Mexico: A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
- Effective dates are available on the first of the month only, unless otherwise required by law. Applications must be received by Blue Cross and Blue Shield of New Mexico within the defined enrollment period to be accepted.