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

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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

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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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