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 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
SERVICE OUTSIDE OF NEW MEXICO
Presbyterian members receive in-network benefits outside of New Mexico with our collaboration with Aetna Signature Administrators® to offer access to Aetna’s PPO network with more than 1.5 million participating physicians and ancillary providers, including over 6,000 hospitals. To search for providers in the national network please use the link below.
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 $22.50/mo. per member.
*Some gyms may charge a registration or annual fee.
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 healthysolutions@phs.org. 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 phpreferral@phs.org
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.
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.
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 www.caremark.com CVS Caremark Phone: 1-877-744-5313