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Medical Plan

UNM Medical Plan Rates 2014-2015

UNM Medical Plan Third Party Administrators (TPAs)

UNM offers medical provider options through three Third Party Administrators (TPAs):

UNM Health

Blue Cross Blue Shield of New Mexico

Blue Cross Blue Shield of New Mexico

Presbyterian

Presbyterian

Preventative Services require no co-pay under UNM Health, LoboCare, BlueCross BlueShield of New Mexico, or Presbyterian Networks.

Networks of Coverage

Once you have enrolled with your chosen TPA, the network you choose at the time of service determines your out-of-pocket costs for services received. Please review the Schedule of Benefits for your chosen TPA for details on out-of-pocket costs.

UNM Health

Three Network Options:

  1. UNM Health network
    • UNM Health System, ABQ Health Partners, and First Choice Community Health Providers and Facilities. To find a provider go to UNM Health's Find a Doctor page.
    • Primary care locations throughout Albuquerque.
    • Coordinated Care Model: Primary Care Team coordinates care and facilitates referral process to UNM Health System specialty care, and requires prior authorization for services external to UNM Health System
    • LoboCare Clinic for same-day or next-day acute care appointments.
  2. In-Network: Aetna National (Presbyterian Locally) access requires prior authorization from LoboCare provider
  3. Out-of-Network: If Prior Authorization for Presbyterian/Aetna networks is not obtained, benefits are out-of-network
    • To find out if your doctor is on the list of providers:
      • To find a provider go to UNM Health's Find a Doctor page.
      • UNM Health Science Center/Meritain 1-866-328-2230
      • ABQ Health Partners local: (505) 262-7600, or toll-free: 1-888-354-496

BlueCross BlueShield of New Mexico (BCBSNM)

Three Network Options:

  1. LoboCare network
    • UNM Health System, ABQ Health Partners and First Choice Community Health Providers and Facilities.
    • Primary care locations throughout Albuquerque.
    • LoboCare Clinic for same-day or next-day acute care appointments.
    • Both BlueCross BlueShield of New Mexico and Presbyterian participants have the same access to the LoboCare Network.
  2. In-Network: Access to Lovelace Health System and BCBSNM providers and hospitals (list available on BCBSNM's website)
  3. Out-of-Network:
    • Providers and facilities not contracted with your TPA (note: if you use this option, notify your TPA first to receive the maximum available benefit).
    • Only usual and customary charges are covered.

Presbyterian

Three Network Options:

  1. LoboCare network
    • UNM Health System, ABQ Health Partners and First Choice Community Health Providers and Facilities.
    • Primary care locations throughout Albuquerque.
    • LoboCare Clinic for same-day or next-day acute care appointments.
    • Both BlueCross BlueShield of New Mexico and Presbyterian participants have the same access to the LoboCare Network.
    • LoboCare Network Flyer
  2. In-Network: Access to Presbyterian Health providers and hospitals (list available on Presbyterian's website)
  3. Out-of-Network:
    • Providers and facilities not contracted with your TPA (note: if you use this option, notify your TPA first to receive the maximum available benefit).
    • Only usual and customary charges are covered.

Medical ID Cards

Medical ID cards will be sent directly from the UNM Medical Plan Third Party Administrators (BlueCross BlueShield of New Mexico, Presbyterian Health Plan, and UNM Health).

If enrolled in BlueCross BlueShield of New Mexico or UNM Health, covered dependents will not receive a card with their names. Everyone covered will use the card with the primary member's name.

If enrolled in Presbyterian Health, covered dependents will receive a card with their name(s).

Note: Prescription Drug ID cards will be sent directly from Express Scripts. Dependents will not receive a card with their name(s). Everyone covered will use the card with the primary member's name. If you did not receive your ID card, please contact Express Scripts to have one sent to you. You must remember to provide your Express Scripts ID card to your pharmacist.

Contact Information

For additional information or questions, please contact:

UNM Health

  • UNM Health Sciences Center/Meritain Customer Service (for questions regarding network and care service access) 1-866-328-2230.
  • Meritain Health Medical Management (for precertification of diagnostic and inpatient/outpatient procedures): 1-800-242-1199
  • ABQ Health Partners local: (505) 262-7600, or toll-free: 1-888-354-4968
  • http://unmmg.org/unmhealth/

LoboCare Network

BlueCross BlueShield of New Mexico

Presbyterian