Presbyterian State Coverage Insurance (SCI)

The State Coverage Insurance (SCI) program has currently reached its maximum enrollment. If your application was not received or processed by November 2, 2009, you will be placed on the waiting list. You will be notified when your application is processed or when it has been placed on the waiting list.

SCI offers affordable healthcare coverage to low-income working adults who meet the SCI eligibility criteria, either through their employer or as an individual.

Eligibility Requirements

To become eligible for a State Coverage Insurance (SCI) Plan you must:

• Not have voluntarily dropped insurance coverage for 6 months (individual) or 12 months (group)
• Be a New Mexico resident between the ages of 19 and 64
• Earn a family income of up to 200% of the Federal Income Guidelines (see chart below)
• Not be eligible for certain government health insurance benefits, such as Medicaid (Title XIX), Medicare, CHAMPUS, and do not have other public or private health insurance  

To apply, please fill out the SCI Eligibility Application  (en Español) and return it to the correct Income Support Division office. If you need help, please contact the Presbyterian Sales Department at 1-866-606-7737, Monday through Friday, from 8 a.m. to 5 p.m.

State Coverage Insurance Benefits

Once you enroll in the Presbyterian State Coverage Insurance Plan, you will enjoy affordable health insurance that provides coverage for services such as:

• Preventive care visits
• Visits to your doctor (see the SCI Provider Directory )
• Prescription Drugs (see SCI Pharmacy Benefits (.pdf))
• Prenatal care
• Hospital visits, urgent care or emergency services
• Lab tests and x-rays
• No pre-existing condition limitations
• Out-of-pocket maximums that help protect you
• Medical benefits up to $100,000 per year
• And more  

Please refer to the Benefit Summary and the Member Handbook (.pdf) [also available in Spanish as the Manual para Los Miembros del Plan del Seguro de Cobertura Estatal [SCI] de Presbyterian (.pdf)] for more information about covered services with the SCI Plan.

SCI Plan Costs

The cost of the SCI Plan depends on the total household income of the person applying for coverage. Monthly premiums are determined by the total family income and whether the person will have the SCI Plan through an employer or as an individual. See chart below. 

If the SCI Plan is purchased through an employer, the employer pays the employer share of the premium as shown above, while the employee pays the employee share. If a person is self-employed, he or she pays both the employer and employee portions of the premium. Based on income level, there may be no cost for the SCI Plan.

 

The above chart is for illustration purposes only.

Total household incomes may be reduced by "income disregards." When an individual purchases an SCI Plan, he or she must pay both the employer and employee share of the premium, if any. Employers may elect to pay any portion of the employee premium and may also elect to pay any portion of the Adult Spouse premium.

What are the SCI benefits?

SCI is a limited insurance plan that will cover up to $100,000 per benefit year of medical services. There are three different plan designs, based on the income of the qualified individual.

• View a summary of those benefits
• SCI Provider Directory

Fraud and Abuse

The Presbyterian Health Plan and Presbyterian Insurance Company's Special Investigative Unit is responsible for the detection, investigation and reporting of potential fraud and abuse activity. We are required to cooperate with regulatory and law enforcement agencies in reporting any activity that appears to be suspicious in nature. According to the law, any information that we have concerning such matters must be turned over to the appropriate governmental agencies. Find out more.

Other Resources

• New Mexico State Coverage Insurance website