Welcome to Your Health Plan (2024)

Know Your Health Plan

Here are some details to know about your health plan. Remember, when you visit a doctor outside of your plan’s network, you may pay more or all of your bill.

  • HMO

Health Maintenance Organization (HMO)

Primary Care Provider (PCP)

You’ll need to select a PCP for your care. This is the one doctor who arranges your care and refers you to specialists.Find an in-network doctor.

Prior Authorization

Some services may require prior authorization (pre-approval).1Ask your doctor about this so you’re sure who handles this step.Get details on prior authorization.

Plan Network

It's best to visit health care providers in your plan’s network. If you don’t, you’ll pay for most of or the full cost of your care.Review cost examples.

Preventive Care Services

Some screenings, like your Annual Exam, are included with your health plan at no additional cost.Schedule your annual exam.

Find the Right CareWhen You Need It

Your primary care provider (PCP) should be your first call when you don't feel well. But, based on your symptoms, you have options for where to get care.

Welcome to Your Health Plan (1)

Your Doctor

Your doctor can help when you need regular checkups or minor sickness.

Examples:Fever, colds and flu

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24/7 Nurseline

The 24/7 Nurseline is a toll-free number to call for general health-related questions and advice on care options.2

Examples:Headaches, dizziness or what to do if your child is sick

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Virtual Visits

Virtual visits connect you with a doctor for live, non-emergency medical or behavioral health help by phone, online video or mobile app.3

Examples:Allergies, depression or pink eye

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Retail Clinic

If your doctor isn't available and you want to get walk-in, non-emergency care for common symptoms, you can visit a retail clinic.4

Examples:Minor injuries, pain or sore throat

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Urgent Care

When you visit an urgent care, you can get quick medical attention when your life or health isn't at risk.

Examples:Cuts that need stitches, sprains or animal bites

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Emergency Room (ER)

Emergency rooms should be visited for emergency care if your life or health is at risk.

Examples:Heart attack, heavy bleeding or broken bones

Get Annual Preventive Care

Know how to find problems early, set goals and track your progress.

Preventive Screenings

Keep your health information up-to-date each year with screens for:

  1. Diabetes
  2. Cholesterol
  3. Heart disease
  4. Body Mass Index (BMI)

Some screenings, like your annual exam, may be offered at no cost to you if you stay in-network.

How to find a PCP and schedule your annual exam

Preventive Services

Other preventive services that may have no out-of-pocket costs are:

  1. Immunizations and vaccines
  2. Weight loss programs
  3. Ways to stop smoking
  4. Maternity and well-child visits

Remember, its important to talk with your doctor about your lifestyle and any life changes.

Learn more about preventive care services

1Prior Authorization not required in certain circ*mstances, such as emergency or urgent situations.

2The 24/7 Bilingual Nurseline may not be available with all plans. Check your benefits booklet for details.

3Internet/Wi-Fi connection is needed for computer access. Data charges may apply. Check your cellular data or internet service provider’s plan for details. Non-emergency medical service in Idaho, Montana and New Mexico is limited to interactive audio/video (video only), along with the ability to prescribe. Non-emergency medical service in Arkansas is limited to interactive audio/video (video only) for initial consultation, along with the ability to prescribe. Behavioral Health service is limited to interactive audio/video (video only), along with the ability to prescribe in all states. Service availability depends on location at the time of consultation.

4Visiting a Retail Clinic may not be covered with all plans. Check your benefits booklet for details.

5Blue365 is only available to Blue Cross and Blue Shield of New Mexico (BCBSNM) members with active health plan coverage. Members who do not have an active health plan with BCBSNM will not be able to register on the Blue365 website.

The relationship between Blue365, its vendors and BCBSNM is that of independent contractors. Blue365 is a discount program available to BCBSNM members who have medical coverage with BCBSNM. This is NOT insurance. Some of the services offered through Blue365 may be covered under your health plan. Please refer to your benefit booklet or call the customer service number on the back of your ID card for specific benefit information under your health plan. Use of Blue365 does not affect your premium nor do costs of Blue365 services or products count toward your plan deductible, calendar year or lifetime maximums. Discounts are only available through participating vendors.

BCBSNM does not guarantee or make any claims or recommendations regarding the services or products offered by Blue365 and its vendors. You may want to consult with your physician prior to use of these services and products. Services and products are subject to availability by location. BCBSNM reserves the right to discontinue or change this discount program at any time without notice.

Welcome to Your Health Plan (2024)
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