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State of New Mexico

Presbyterian Health Plan, Inc. is pleased to be a health partner with the State of New Mexico.

Two Tiered Nationwide Plan

Benefit Guide

Provider Directory

Virta: Type 2 diabetes reversal, fully covered by the SONM

Virta: Type 2 diabetes reversal, fully covered by the SONM

Virta reverses type 2 diabetes and prediabetes, and helps with weight loss.

  • Fully covered by the SoNM
  • Type 2 diabetes/prediabetes reversal
  • Control blood sugar, and weight loss

Learn more about Virta

Service Outside of New Mexico

To receive services outside of New Mexico, members can search for a doctor through our national network of medical providers or our national network of behavioral health providers.

National Network of Medical Providers
National Network of Behavioral Health Providers

Fitness Pass

Access to more than 10,000 national, regional and local fitness, recreation and community centers for you and your enrolled dependents 18 and over for only $17.50/mo. per member.
Learn more about the Fitness Pass
Login to myPRES to enroll in Fitness Pass

Dedicated Member Service Team

You now have access to a highly trained, dedicated customer service team that can help:

  • Navigate you to the most cost-effective level of medical care, whether it’s a virtual visit, outpatient options, or urgent or emergency care.
  • Find in-network primary care providers (PCPs) and specialists and schedule appointments.
  • Answer questions about your benefits and help coordinate benefits for your personalized needs.
  • Assist with follow-up care and claims resolution.

Contact us at (505) 923-5600 or 1-888-ASK-PRES (1-888-275-7737), TTY 711, Monday through Friday from 7 a.m. to 6 p.m.

Community Health Worker Program

Our community health workers work and live in the same communities as you and are specially trained to help you get what you need to stay as healthy as possible. They can help you find housing, food, utility assistance, transportation and translation services, and they will help you schedule a visit with a healthcare provider. They can also help you better manage other health conditions such as pregnancy, asthma, diabetes, high blood pressure, behavioral health, and substance use problems.

This service is confidential and provided at no additional cost to you. For more information, call (505) 923-8567.

Disease Management Programs

As a member, you have access to several comprehensive disease management programs at no additional cost to you. If you have diabetes, asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), or coronary artery disease (CAD), our licensed nurses will work collaboratively with your healthcare provider to provide you with coaching and self-management tools.

To enroll in one or more of these Healthy Solutions programs, call 1-800-841-9705 or email Our care coordinators also provide support for managing cancer or low back pain/musculoskeletal conditions.

To enroll in one or more of the care coordination programs, call 1-866-672-1242 or email

Assist America

You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles or more away from a permanent residence or in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 1-800-872-1414 (or +1-609-986-1234 outside of the USA).

Access Healthcare Services

As a Presbyterian Health Plan member, you will have peace of mind knowing that you have access to the care and services you need.

  • PresRN nurse advice line is an easy way to speak with a registered Presbyterian nurse 24 hours a day, 7 days a week including holidays. Learn more about PresRN
  • Video Visits offer a new way to see a medical provider for non-emergency medical conditions via secure video through a smartphone, tablet or computer webcam. Schedule a video visit now
  • Online visit Powered by SmartExam, is an online service for members 18 years and older. This online questionnaire takes about 10 minutes for most conditions with a treatment plan ready in an hour or less. The service is available 24/7 with Presbyterian Medical Group providers responding between 7 a.m. and 6 p.m. weekdays and 8 a.m. and 3 p.m. weekends.
  • Access to medical care 24 hours a day, 365 days a year through Get Care Today

Understand Your Coverage

Specific information on each of the two plans is included in the detailed plan information in the following documents. Important information to check out includes:

  • Copayments required for the types of care visits you usually make.
  • Whether the plan covers your specific conditions or circumstances.
  • Prescription coverage, especially if you are on an unusual drug.

Summary of Benefits and Coverage

Summary Plan Description

Prescription Drug Benefits

HMO Prescription drug benefits are administered through CVS Caremark.
Login to your account at
CVS Caremark Phone: 1-877-744-5313

Need Help?

505-923-5600 or 1-888-275-7737
Weekdays 7:00 a.m. - 6:00 p.m.

Issues or Concerns?

Have you had a problem with your coverage?