Presbyterian Health Plan, Inc. is pleased to be a health partner with the State of New Mexico.
As a Presbyterian Health Plan member, you get superior coverage, access to excellent healthcare facilities all over New Mexico, and the quality care you expect to get and stay healthy.
- Annual preventive screening reminders and periodic wellness newsletters sent directly to you
- Help with managing chronic conditions through Presbyterian Healthy Solutions, an innovative disease management program
- Direct access to medical advice 24 hours a day, 365 days a year through NurseAdvicesm New Mexico
- Discounts from select providers for acupuncture, massage therapy, chiropractic care, vision services, and more
- Convenient Web-based services available through myPRES any time, day or night
- Our friendly, locally based Presbyterian Customer Service Center is completely dedicated to you and available to answer your benefit questions
Schedule of Benefits
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.
High Deductible Health Plan
Summary Plan Description – SONM NMHIP Subscriber 2014
Summary Plan Description - SONM HDHP Family 2014
Summary of Benefit and Coverage - SONM HMO Plan 2014
Summary of Benefit and Coverage - SONM NMHIP Subscriber 2014
Summary of Benefit and Coverage - SONM NMHIP Family 2014
Summary Plan Description - SONM HMO Medical Plan 2014
Prescription Drug Benefits
HMO Prescription drug benefits are administered through Express Scripts
HDHP Presbyterian Pharmacy Locations
HDHP Presbyterian Pharmacy Formulary
HDHP Presbyterian Mail Order Pharmacy Program
Formulary List - Therapeutic Class
Drugs Requiring Prior Authorization
Specialty Pharmaceuticals/ Medical Drug List
Pharmacy Prior Authorization Form
Fax completed Prior Authorization forms to Presbyterian Pharmacy Services at (505) 923-5540 or 1-800-724-6953.
Suboxone/Subutex Prior Authorization Form for Commercial and Medicare Plans
What if my drug is not covered?
Presbyterian Pharmacy Network Listing
Mail Service Pharmacy Benefit
Presbyterian is pleased to offer mail-order prescriptions in partnership with Walgreens. Order up to a 90-day supply of maintenance drugs (as prescribed by your physician) and get free delivery to your home with Walgreens Mail Service.
Walgreens Mail Service Tips and Forms
Walgreens En Español
Service Outside of New Mexico
To secure health service outside of New Mexico, find a doctor through our MultiPlan service.
- High Deductible Health Plan members are eligible to participate in a Health Savings Plan administered by HealthEquity
Contact Presbyterian's friendly Customer Service Center
Weekdays, 7:00 a.m. - 6:00 p.m.