PDF New Mexico Public Schools Insurance Authority - NMPSIA
New Mexico Public Schools Insurance Authority
JULY 2013 PROGRAM
GUIDE
Revised May 29, 2013
NMPSIA CUSTOMER SERVICE TELEPHONE NUMBERS & WEBSITES
MEDICAL New Mexico Blue Cross and Blue Shield Presbyterian
TOLL FREE 1-888-966-7742 1-888-275-7737
WEBSITE
PRESCRIPTION DRUGS Express Scripts
1-800-498-4904
express-
DENTAL United Concordia
1-888-898-0370
VISION Davis Vision
1-800-999-5431
LONG-TERM DISABILITY CLAIMS The Standard
1-888-609-9763
LIFE CLAIMS The Standard
1-888-609-9763
New Mexico Public Schools Insurance Authority
New Mexico Public Schools Insurance Authority 410 Old Taos Highway ? Santa Fe, NM 87501 1-800-548-3724 ? 505-988-2736 ? 505-983-8670 fax ?
NMPSIA ELIGIBILITY ADMINISTRATOR 1-800-233-3164 Customer Service
New Mexico Public Schools Insurance Authority
Greetings from the Executive Director This is our program guide to your employee benefits offered through the New Mexico Public Schools Insurance Authority (NMPSIA). NMPSIA was created by the Legislature in 1986 to purchase insurance benefits for all New Mexico public school districts (except for Albuquerque Public Schools). Other educational entities and charter schools participate in the NMPSIA program as well. As a participant in NMPSIA, you are entitled to FREE Basic Life Insurance if you work at least 15 hours per week. In most districts, you may buy additional life insurance at your own cost. You and your employer share the cost for the medical, dental, vision, and disability plans. Your payroll deduction represents only about one-third of the total cost to fund the plans. Our medical plans are self-insured. This means NMPSIA is responsible for the design of the plan and the setting of contributions. We set the contribution rates to be adequate to pay for the claims we all incur. When our claims exceed the contributions, the contribution rates have to go up. We pay less than 6% of the contribution towards the medical plan administration (claims payment, customer service, provider networking, ID cards, booklets). The balance pays for the cost of our medical care. Our plan now has a calendar year deductible of $300 per person which must be met before most services will be covered. We continue to offer free coverage for in-network routine physicals and screenings. Other services are covered at an 80% coinsurance, which means the plan will cover 80% of allowable expenses and you will be responsible for 20% of the cost. Most services will also have a copay. The medical plans have an out-of-pocket limit, which is the cap on the total expenses you pay in copays, deductibles, and coinsurance. It is important to know that these plans, while requiring more member costsharing in their medical care, still provide invaluable protection from catastrophic medical expenses. Please don't miss the opportunity to enroll for insurance. If you delay enrolling, there are only certain times you may have the chance to enroll again, and it may be too late.
Sincerely,
Sammy J. Quintana, Esq. Executive Director
New Mexico Public Schools Insurance Authority
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PROGRAM GUIDE JULY 2013 New Mexico Public Schools Insurance Authority
2
Table of Contents
GENERAL INFORMATION Employer Plan Matrix_________________________________________________ 4 NMPSIA Rules and Regulations Summary ______________________________ 10 Frequently Asked Questions___________________________________________ 14
LIFE & DISABILITY INSURANCE Basic Life Insurance (Free) __________________________________________ 15 Additional (Voluntary) Life __________________________________________ 16 Long Term Disability (LTD) _________________________________________ 19
Notice of Privacy Practices __________________________________________ 21
MEDICAL PLANS Blue Cross and Blue Shield of New Mexico (BCBSNM)_________________ 24 Presbyterian______________________________________________________ 28 High Option Plan (offered by both BCBSNM & Presbyterian)____________ 30 Low Option Plan (offered by both BCBSNM & Presbyterian)____________ 32 Exclusions and Limitations _________________________________________ 34
PRESCRIPTION DRUGS (Automatic with Medical Coverage) Express Scripts____________________________________________________ 35 Notice of Creditable Coverage _____________________________________ 38
OTHER PLANS (Your employer may or may not offer these NMPSIA Plans.) Dental: United Concordia__________________________________________ 40 Vision: Davis Vision________________________________________________ 44
Medical, Dental and Vision Deductions _______________________________ 46 The Standard Additional Life and Long Term Disability Worksheet ______ 47
New Mexico Public Schools Insurance Authority
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PROGRAM GUIDE JULY 2013
Employer Plan Matrix
EMPLOYER
Basic Disability Vol.
Life
Medical Plan Choices
Dental Vision Plan Life
Academia de Lengua y Cultura
$50,000 BCBS, Presbyterian
YES YES 30 days YES
Academy for Technology and the Classics $10,000 BCBS, Presbyterian
YES YES 30 days YES
Academy of Trades and Technology
$50,000 BCBS, Presbyterian
YES YES 30 days YES
ACE Leadership High School
$50,000 BCBS, Presbyterian
YES YES 60 days YES
AFT New Mexico
$10,000 BCBS, Presbyterian
YES YES 30 days n/a
Alamogordo Public Schools
$25,000 BCBS, Presbyterian
YES YES 90 days YES
Albuquerque Institute of Math & Science $50,000 BCBS, Presbyterian
YES YES 90 days YES
Albuquerque School of Excellence
$50,000 BCBS, Presbyterian
YES YES 30 days YES
Albuquerque Sign Language Academy $50,000 BCBS, Presbyterian
YES YES 60 days YES
Aldo Leopold Charter School
$50,000 BCBS, Presbyterian
YES YES 60 days YES
Alice King Community School
$25,000 BCBS, Presbyterian
YES YES 30 days YES
Alma D Arte Charter High School
$50,000 BCBS, Presbyterian
YES YES 30 days YES
Amy Biehl Charter High School
$50,000 BCBS, Presbyterian
YES YES 60 days YES
Anansi Charter School
$50,000 BCBS, Presbyterian
YES YES 30 days YES
Animas Public Schools
$50,000 BCBS, Presbyterian
YES YES 30 days YES
Anthony Charter School
$50,000 BCBS, Presbyterian
YES YES 30 days YES
Artesia Public Schools
$25,000 BCBS, Presbyterian
YES n/a
n/a YES
Aztec Municipal Schools
$25,000 BCBS, Presbyterian
YES YES 90 days YES
Bataan Military Academy
$50,000 BCBS, Presbyterian
YES YES 30 days YES
Belen Consolidated Schools
$50,000 BCBS, Presbyterian
n/a n/a
n/a YES
Bernalillo Public Schools
$25,000 BCBS, Presbyterian
YES YES 30 days YES
Bloomfield Municipal Schools
$25,000 BCBS, Presbyterian
YES YES
n/a YES
Capitan Municipal Schools
$10,000 BCBS, Presbyterian
YES YES
n/a YES
Carinos de los Ninos
$50,000 BCBS, Presbyterian
YES YES 30 days YES
Carlsbad Municipal Schools
$50,000 BCBS, Presbyterian
n/a n/a 30 days YES
Carrizozo Municipal Schools
$10,000 BCBS, Presbyterian
YES YES
n/a YES
Central Consolidated Schools
$50,000 BCBS, Presbyterian
YES YES 30 days YES
Central New Mexico Community College $50,000 BCBS, Presbyterian
YES YES 30 days YES
Cesar Chavez Community School
$25,000 BCBS, Presbyterian
YES YES 30 days YES
Chama Valley Independent Schools
$50,000 BCBS, Presbyterian
YES YES 90 days YES
Christine Duncan Community School
$50,000 BCBS, Presbyterian
YES YES 30 days YES
Cien Aguas International School
$50,000 BCBS, Presbyterian
YES YES 30 days YES
Cimarron Municipal Schools
$25,000 BCBS, Presbyterian
YES YES 60 days YES
Clayton Public Schools
$50,000 BCBS, Presbyterian
YES YES 30 days YES
Cloudcroft Municipal Schools
$50,000 BCBS, Presbyterian
YES YES
n/a YES
New Mexico Public Schools Insurance Authority
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Employer Plan Matrix
EMPLOYER
Basic Disability Vol.
Life
Medical Plan Choices
Dental Vision Plan Life
Clovis Municipal Schools Cobre Consolidated Schools Cooperative Educational Services (CES) Coral Community Charter School Corona Municipal Schools Corrales International School Cottonwood Classical Preparatory School Cottonwood Valley Charter School Creative Ed Prep Institute #1 Cuba Independent Schools Deming Cesar Chavez Charter High School
$50,000 $50,000 $50,000 $50,000 $50,000 $50,000 $50,000 $25,000 $50,000 $50,000 $25,000
BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian
n/a n/a 30 days YES
YES YES 30 days YES
YES YES
n/a YES
YES YES 60 days YES
YES YES 60 days n/a
YES YES 60 days YES
YES YES 30 days YES
YES YES 30 days YES
YES YES 90 days YES
YES YES 30 days YES
YES YES 60 days YES
Deming Public Schools
$50,000 BCBS, Presbyterian
YES n/a 60 days YES
Des Moines Municipal Schools
$50,000 BCBS, Presbyterian
YES YES
n/a YES
Dexter Consolidated Schools
$25,000 BCBS, Presbyterian
YES YES
n/a YES
Digital Arts and Technology Academy (DATA) Dora Consolidated Schools Dulce Independent Schools East Mountain High School El Camino Real Academy Elida Municipal Schools Eastern New Mexico University Espanola Public Schools Estancia Municipal Schools Estancia Valley Classical Academy Eunice Municipal Schools
$50,000 $25,000 $50,000 $10,000 $50,000 $25,000 $25,000 $50,000 $50,000 $50,000 $25,000
BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian
YES YES 90 days YES
YES YES
n/a YES
YES YES 30 days YES
YES YES
n/a YES
YES YES 60 days YES
n/a n/a
n/a YES
YES n/a 60 days YES
YES YES 30 days YES
YES YES
n/a YES
YES YES 30 days YES
YES YES 30 days YES
Farmington Municipal Schools
$25,000 BCBS, Presbyterian
YES YES
n/a n/a
Floyd Municipal Schools
$25,000 BCBS, Presbyterian
YES YES 30 days YES
Fort Sumner Municipal Schools Gadsden Independent Schools Gallup-McKinley County Public Schools Gilbert L. Sena Charter High School Gordon Bernell Charter School Grady Municipal Schools Grants/Cibola County Schools Hagerman Municipal Schools
$50,000 $50,000 $25,000 $50,000 $50,000 $25,000 $50,000 $25,000
BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian
YES YES 30 days YES
YES YES 30 days YES
YES YES
n/a YES
YES YES 90 days YES
YES YES 30 days YES
YES YES 60 days YES
YES YES 30 days YES
YES YES 30 days YES
New Mexico Public Schools Insurance Authority
5
PROGRAM GUIDE JULY 2013
Employer Plan Matrix
EMPLOYER
Basic Disability Vol.
Life
Medical Plan Choices
Dental Vision Plan Life
Hatch Valley Municipal Schools Hobbs Municipal Schools Hondo Valley Public Schools Horizon Academy West Charter School House Municipal Schools J Paul Taylor Academy Jal Public Schools Jefferson Montessori Academy Jemez Mountain Public Schools Jemez Valley Public Schools La Academia de Esperanza Charter School La Academia Dolores Huerta La Jicarita Community School La Promesa Early Learning Center La Resolana Leadership Academy La Tierra Montessori School of the Arts & Science Lake Arthur Municipal Schools Las Cruces Public Schools Las Montanas Charter School Las Vegas City Public Schools Lea Regional Educational Coop # 7 Lindrith Area Heritage Charter Logan Municipal Schools Lordsburg Municipal Schools Los Alamos Public Schools Los Alamos Schools Credit Union Los Lunas Public Schools Los Puentes Charter School Loving Municipal Schools Lovington Public Schools Luna Community College Magdalena Municipal Schools Maxwell Municipal Schools McCurdy Charter School Media Arts Collaborative Charter School
$50,000 $50,000 $10,000 $50,000 $25,000 $50,000 $50,000 $50,000 $50,000 $50,000 $25,000 $50,000 $50,000 $50,000 $50,000 $50,000 $50,000 $50,000 $50,000 $50,000 $50,000 $50,000 $50,000 $25,000 $10,000 $10,000 $25,000 $25,000 $50,000 $50,000 $50,000 $50,000 $25,000 $10,000 $50,000
BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian BCBS, Presbyterian
YES YES 30 days YES
YES YES
n/a YES
YES YES
n/a YES
YES YES 60 days YES
YES YES
n/a YES
n/a YES 30 days YES
YES n/a 30 days YES
YES YES 30 days YES
YES YES 30 days YES
YES YES 30 days YES
YES YES 60 days YES
YES YES 30 days YES
YES YES 30 days YES
YES YES 30 days YES
YES YES 30 days YES
YES YES 30 days YES
YES YES 30 days YES
YES YES 30 days YES
YES YES 30 days YES
YES YES 30 days YES
YES YES
n/a YES
YES YES 30 days YES
YES YES 30 days YES
YES YES
n/a YES
YES YES 90 days YES
YES YES
n/a YES
YES n/a 30 days YES
YES YES 30 days YES
YES YES 30 days YES
YES YES 60 days YES
YES YES 30 days YES
YES YES 90 days YES
YES YES 30 days YES
YES YES 30 days YES
YES YES 30 days YES
New Mexico Public Schools Insurance Authority
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