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Individual & Family Plans

 

Our Plan Types at a Glance

Whether you need full coverage or basic essential health care, there’s a Presbyterian Health Plan to fit both your health needs and your budget.

Our plans fall into four categories, which differ based on the way you and the health plan share your health care costs. The table below will help you learn more about the plan types we offer.

Ready to start shopping for plans? Get a Quote

Platinum

This plan often has the highest monthly premium and lower out-of-pocket costs for care.

Premium Price Range

The premium is the monthly cost you will pay for health care coverage for this plan. Because the premium is based on many things - including age, ZIP code, tobacco usage and number of family members - you’ll need to get a quote for a better example.
 
 
$
$$$

Healthcare Cost Sharing

This chart provides an example of the way paying more monthly (in premium payments) often means paying less out of pocket when you get help from a health care provider or other service.
10 %
90%
You Pay
Plan Pays

Office Visits

This is the amount of copayment or coinsurance you pay for a provider visit. PREVENTIVE SERVICES, like annual physical exams and routine immunizations are free.
$

Generic Drug Cost

This is the amount of copayment or coinsurance you pay for a generic (non-name brand) prescription drug on this plan. Name-brand and specialty medications are often more expensive. The amount may be a copay (a fixed amount) or a coinsurance (a portion of the total cost).
$

All Plans Include:

  • Free gym memberships
  • Free Video Visits
  • Access to more than 17,000 healthcare providers
  • Prescription drug benefits
  • Prenatal and postnatal maternity care

Gold

These 4 plans often have lower monthly premiums and higher out-of-pocket costs than Platinum.

Premium Price Range

The premium is the monthly cost you will pay for health care coverage for this plan. Because the premium is based on many things - including age, ZIP code, tobacco usage and number of family members - you’ll need to get a quote for a better example.
 
 
$
$$$

Healthcare Cost Sharing

This chart provides an example of the way paying more monthly (in premium payments) often means paying less out of pocket when you get help from a health care provider or other service.
20%
80%
You Pay
Plan Pays

Office Visits

This is the amount of copayment or coinsurance you pay for a provider visit. PREVENTIVE SERVICES, like annual physical exams and routine immunizations are free.
$ - $$

Generic Drug Cost

This is the amount of copayment or coinsurance you pay for a generic (non-name brand) prescription drug on this plan. Name-brand and specialty medications are often more expensive. The amount may be a copay (a fixed amount) or a coinsurance (a portion of the total cost).
$

All Plans Include:

  • Free gym memberships
  • Free Video Visits
  • Access to more than 17,000 healthcare providers
  • Prescription drug benefits
  • Prenatal and postnatal maternity care

Silver

These 5 plans often have lower monthly premiums and higher out-of-pocket costs than Gold.

Premium Price Range

The premium is the monthly cost you will pay for health care coverage for this plan. Because the premium is based on many things - including age, ZIP code, tobacco usage and number of family members - you’ll need to get a quote for a better example.
 
 
$
$$$

Healthcare Cost Sharing

This chart provides an example of the way paying more monthly (in premium payments) often means paying less out of pocket when you get help from a health care provider or other service.
30%
70%
You Pay
Plan Pays

Office Visits

This is the amount of copayment or coinsurance you pay for a provider visit. PREVENTIVE SERVICES, like annual physical exams and routine immunizations are free.
$$

Generic Drug Cost

This is the amount of copayment or coinsurance you pay for a generic (non-name brand) prescription drug on this plan. Name-brand and specialty medications are often more expensive. The amount may be a copay (a fixed amount) or a coinsurance (a portion of the total cost).
$$

All Plans Include:

  • Free gym memberships
  • Free Video Visits
  • Access to more than 17,000 healthcare providers
  • Prescription drug benefits
  • Prenatal and postnatal maternity care

Bronze

These 2 plans often have the lowest monthly premiums and highest out-of-pocket costs for care.

Premium Price Range

The premium is the monthly cost you will pay for health care coverage for this plan. Because the premium is based on many things - including age, ZIP code, tobacco usage and number of family members - you’ll need to get a quote for a better example.
 
 
$
$$$

Healthcare Cost Sharing

This chart provides an example of the way paying more monthly (in premium payments) often means paying less out of pocket when you get help from a health care provider or other service.
40%
60%
You Pay
Plan Pays

Office Visits

This is the amount of copayment or coinsurance you pay for a provider visit. PREVENTIVE SERVICES, like annual physical exams and routine immunizations are free.
$$$

Generic Drug Cost

This is the amount of copayment or coinsurance you pay for a generic (non-name brand) prescription drug on this plan. Name-brand and specialty medications are often more expensive. The amount may be a copay (a fixed amount) or a coinsurance (a portion of the total cost).
$$$

All Plans Include:

  • Free gym memberships
  • Free Video Visits
  • Access to more than 17,000 healthcare providers
  • Prescription drug benefits
  • Prenatal and postnatal maternity care

Under 30?

With a low monthly premium, the catastrophic plan type may be right for your budget.

Catastrophic Plan Type

This plan type features low monthly payments – but with a high deductible and higher out-of-pocket expenses for care, it is primarily used to protect against very high medical costs.

Already know which
plan you want?

If you’ve shopped before and are ready to enroll, begin your application online right away.

Enroll Online Now

Other ways to enroll:

2016 ENROLLMENT FORM
Send your completed form by mail or fax:

Presbyterian Health Plan
P.O. Box 27489
Albuquerque, NM 87125 | FAX: 505-923-8252

Call 866-869-7737 or TTY 711 to apply with one of our representatives.

Special Enrollment is available year-round.
If you have experienced a major life event within the past 60 days – such as loss of healthcare coverage from another plan, getting married, having a baby, or moving – you may qualify for special enrollment.

Note: To be eligible for health coverage, you and your dependents must be US citizens, US nationals, or lawfully present immigrants. For help, visit Healthcare.gov .