What you need to know
When you enroll in a Sandia medical plan, you choose your benefit administrator for your plan: Blue Cross Blue Shield of New Mexico (BCBSNM), UnitedHealthcare, or Kaiser Permanente (offered to Total Health PPO Plan participants in California only).
Your out-of-pocket healthcare costs are determined by your doctor’s or provider’s network tier, as negotiated with the plan’s benefit administrator: Tier 1 (specific contracted in-network providers), Tier 2 (contracted local, regional, and nation-wide in-network providers), or Tier 3 (out-of-network providers).
This page provides details on using each benefit administrator’s networks and resources.
Network Tiers
Access to Tier 1 providers is based on location (per our plan administrators’ contractual relationships):
- New Mexico — Tier 1 providers included in Blue Preferred Plus and UnitedHealthcare Choice Plus provider networks
- California — No Tier 1 providers available
- Other states — Tier 1 providers included in UnitedHealthcare Choice Plus provider network
After you meet your annual deductible, your medical plan will share the cost of your care until you reach the annual out-of-pocket limit. You’ll pay the following share for medical services:
- 10% coinsurance for Tier 1 (in-network) providers
- 20% coinsurance for Tier 2 (in-network) providers
- 40% coinsurance for Tier 3 (out-of-network) providers
You’ll pay coinsurance until you meet your annual out-of-pocket limit.
Note: If you receive out-of-network care (Tier 3 providers), the plan bases its 60% share of the cost on the allowed charge for a given service. At times, the cost billed by the provider is more than the allowed charge. If this happens, you’ll be responsible for your 40% share of the allowed charge plus any balance due, except for services covered by the No Surprises Act described in the medical plan program summary.
Need to Find Primary Care Provider?
Regardless of which health plan you choose, you should establish with a primary care provider in your network and learn about your medical plan’s programs and resources designed to support your overall well-being.
This document contains information about finding a PCP and how to engage with your health plan’s services.
BCBSNM Featured Benefits and Resources
Tier 1 — Blue Preferred Plus provider network: Your share of costs is lowest when you use providers in Tier 1. Tier 1 includes hospitals, doctors, as well as an expanded network of other providers in New Mexico.
Tier 2 — Other BCBS in-network providers: Through Tier 2 providers, you have access to a nationwide network of healthcare providers and facilities. The deductible, coinsurance, and out-of-pocket maximums are much lower when compared with out-of-network providers.
Tier 3 — Out-of-network providers: You can use any out-of-network provider or facility; however, benefits are paid at a lower level, which means you can expect to pay more. In addition, you are responsible for any charges above the plan’s allowed cost for a given healthcare service. This is known as balance billing. Balance billing does not apply for services covered under the No Surprises Act as described in the medical plan program summary.
Go to bcbsnm.com/sandia > Search our Provider Finder
Tier 1 providers are listed as Blue Preferred Plus.
If you need help finding a primary doctor, call one of the support lines below.
Optum Concierge Line
505-262-7100
Lovelace Concierge Line
505-727-2727
Sandia’s medical plans cover a wide range of in-network preventive care services at no cost to you:
- Well-baby, well-child, well-woman exam
- Bone density test (osteoporosis screening)
- Colon cancer screening
- Diabetes screening
- Immunizations / vaccines
- Mammogram
- Prostate-specific antigen (PSA) test
All in-network preventive care is subject to the U.S. Preventive Services Task Force recommendations and BCBSNM administration guidelines. Frequency and age restrictions may apply.
You’re covered when you need care outside of doctor office hours or while traveling.
Virtual visits
This option lets you use your smartphone, tablet, or computer for secure, online visits with a board-certified doctor.
You pay a $10 copay for virtual visits when you use MDLIVE. Employees enrolled in the Health Savings Plan must meet their annual deductible before the $10 copay applies. Download the MDLIVE mobile app and be sure to register before you need care.
Nurseline
Registered nurses are on call to answer your health questions and provide general health tips anytime, anywhere, 24/7.
Call the Blue Cross Blue Shield of New Mexico Nurseline at 800-973-6329.
You’ll receive a medical ID card when you enroll with BCBSNM for the first time (or if you switch medical plans during an enrollment period). If you need another card, you can use the mobile app, go online and log in, or call 877-498-7652. You can view your virtual ID card any time through the mobile app or member portal.
Go to the Get to Know Our Benefit Providers page for details.
UnitedHealthcare Featured Benefits and Resources
Tier 1 — UnitedHealthcare Choice Plus Premier Provider Network: When you choose a provider or facility affiliated with the Tier 1 network, you save the most money.
Tier 2 — Other UHC providers: With UHC, you also have access to an extensive network of physicians and health care facilities.
Tier 3 — Out-of-network providers: You can receive care from any provider or facility, but you’ll pay more if the provider is not affiliated with UHC. In addition, you are responsible for any charges above the plan’s allowed cost for a given healthcare service. This is known as balance billing. Balance billing does not apply for services covered under the No Surprises Act as described in the medical plan program summary.
Go to welcometouhc.com/tieredbenefits > Benefits > Find a Doctor or Facility
Tier 1 providers are flagged with a blue dot that says, “Tier 1” and are also referred to as Choice Plus Premier Providers.
If you need help finding a primary doctor, call one of the support lines below.
Optum Conceirge Line
505-262-7100
Presbyterian Customer Service Center
505-923-7300
The plan covers a wide range of in-network preventive care services at no cost to you:
- Well-baby, well-child, well-woman exam
- Bone density test (osteoporosis screening)
- Colon cancer screening
- Diabetes screening
- Immunizations/vaccines
- Mammogram
- Prostate-specific antigen (PSA) test
All in-network preventive care is subject to U.S. Preventive Services Task Force recommendations and UHC administration guidelines. Frequency and age restrictions may apply.
UnitedHealthcare offers a service through Naviguard™ to help you understand and navigate bills from out-of-network providers. When you receive an unexpected out-of-network bill, call the number on the back of your member ID card. UnitedHealthcare member services will initiate your case with Naviguard and a Naviguard Patient Advisor will help you from there.
Visit naviguard.com to learn more.
You’re covered when you need care outside of doctor office hours or while traveling.
This option lets you use your smartphone, tablet, or computer for secure, online visits with a board-certified doctor anytime, anywhere, 24/7.
You pay a $10 copay for virtual visits when you use Amwell, Doctor on Demand, or Teladoc. Employees enrolled in the Health Savings Plan must meet their annual deductible before the $10 copay applies. Download these apps through myuhc.com or the UHC mobile app. Be sure to register and create an account before you need care.
You’ll receive a medical ID card when you enroll with UHC for the first time (or if you switch medical plans during an enrollment period). A medical ID card will automatically be sent to you after you enroll. If you need another card, you can use the mobile app, go online and log in, or call 877-835-9855. You can view your virtual ID card any time through the mobile app or member portal.
Go to the Get to Know Our Benefit Providers page for details.
Kaiser Permanente
Kaiser Permanente is available only to California residents who participate in the Total Health PPO Plan.
To find a Kaiser Permanente provider or facility, use the Kaiser Permanente online search tool.
The plan covers a wide range of in-network preventive care services at no cost to you:
- Well-baby, well-child, well-woman exam
- Bone density test (osteoporosis screening)
- Colon cancer screening
- Diabetes screening
- Immunizations/vaccines
- Mammogram
- Prostate-specific antigen (PSA) test
All in-network preventive care is subject to U.S. Preventive Services Task Force recommendations and Kaiser Permanente administration guidelines. Frequency and age restrictions may apply.
You’re covered when you need care outside of doctor office hours or while traveling.
Video Visits
This option lets you use your smartphone, tablet, or computer for secure, online visits with a Kaiser doctor.
You can schedule a video visit online or call 866-454-8855 to make an appointment.
Be sure to register for video visits and create an account before you need care.
Nurse Advice
Registered nurses are on call to answer your health questions and provide general health tips anytime, anywhere, 24/7.
Call Kaiser Permanente at 866-454-8855.
You’ll receive a medical ID card when you enroll with Kaiser Permanente for the first time (or if you switch medical plans during an enrollment period). If you need a replacement card, go online and log in, or call 800-663-1771. You can view your virtual ID card any time through the mobile app or member portal.
Go to the Get to Know Our Benefit Providers page for details.
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