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Understanding Your Health Plan

Insurance can be one of the most confusing parts of healthcare. We want you to feel confident in your choice for insurance and to understand how to best use your plan benefits. That’s why Presbyterian Health Plan provides resources to help you make the most informed decisions for you and your family.

  • Why Choose a Presbyterian Health Plan?

    Presbyterian Health Plan offers you a choice of many types of health coverage with unique benefits and services, as well as a wide network of providers.

  • How to Shop for Insurance

    Are you ready to enroll in a health plan but aren’t sure where to start? Our simple guide helps you understand basic terms, costs and other healthcare topics, so you can select the plan that best fits your situation and budget.

  • Types of Insurance

    We are here to help you understand the different types of insurance (both private and public), so you can make the most informed choice.

  • Understanding Healthcare Costs

    Healthcare costs don’t stop after you pay your monthly plan premium—there may be copays, coinsurance and deductibles to consider. Presbyterian wants to help you avoid the stressful surprise of unexpected healthcare costs by helping you to understand the basics of healthcare expenses.

  • Understanding Formularies

    Formularies are lists of prescription drugs (both brand name and generic) that your plan covers. The drugs fall into different categories and may cost different amounts. Here, we help you understand how these lists work.

  • Does the Affordable Care Act (ACA) Affect Me?

    Also known as Obamacare, the Affordable Care Act changed a lot of the rules about health insurance—from the eligibility of plans to the elimination of lifetime maximums. Learn how these new laws could affect you and your coverage.

  • Glossary of Terms

    Not sure what a certain word means? Look it up in our glossary, filled with helpful terms and meanings.

  • FAQs

    Find answers to frequently asked health insurance questions including information on prescriptions, Medicare, Medicaid, financial assistance and more.

  • Fraud & Abuse

    Report an incident here by contacting our Special Investigative Unit, available 24 hours a day. If you’re uncertain about what fraud and abuse incidents entail, we provide defined examples of each individual case.

  • Appeals, Grievances & Exception Process

    If you have concerns or complaints regarding your coverage or care, file an official complaint using these simple steps. Not sure what type of complaint applies to your situation? We can help with that, too.


Need Help?

505-923-5678 or 1-800-356-2219
7:00 a.m. - 6:00 p.m.
myPRES Assistance
505-923-5590 or 1-866-861-7444

We have free interpreter services to answer any questions you may have about our health or drug plan. Call us at 1-855-592-7737 (TTY 711).