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  • Insurance Plans Accepted at Presbyterian

    If you’re not covered by a Presbyterian Health Plan, rest assured that Presbyterian works with most major insurers. Learn more about how to confirm whether your insurance covers your care at one of our hospitals.

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  • Health Insurance Starter Guide

    Our Coverage Connector is a quick interactive tool that helps you determine where you should start looking for health insurance for you and your family's needs.

    Learn More.
  • Enroll Online for Your Presbyterian Health Plan

    From comprehensive to basic essential coverage, Presbyterian Individual and Family Health Plans fit just about any situation and any budget. Enroll now for coverage.

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Individual & Family Plans Details

Health Insurance For You and Your Family.
Presbyterian Health Plan's Individual and Family Plans fit just about any situation and any budget. From comprehensive to basic essential coverage, we've got you covered.

Your situation is unique, and Presbyterian wants you to have all the information you need to make good individual and family healthcare insurance decisions.

  • Choose from 11 different plans including high deductible health plan options.
  • Yearly out-of-pocket maximums include deductible, copayments, coinsurance and any prescription drug costs.
  • Free fitness memberships included at Defined Fitness locations in New Mexico and the nationwide Prime network. Learn more
  • All plan options include prescription drug benefits.
  • Prenatal and postnatal maternity care is built-in.
  • Our plans give you access to more than 9,000 healthcare providers in more than 500 locations in New Mexico and border communities. This includes more than 2,200 primary care providers and 6,300 specialists.
  • You also gain access to Presbyterian's system of more than 600 doctors and 8 hospitals across New Mexico.

Benefits and Coverage

The Summary of Benefits Coverage (SBC) provides an overview of the coverage and copayments required at each specific deductible level. Important information to check out includes:

  • Copayments required for the types of care visits you usually make.
  • Whether the plan covers the specific conditions or circumstances your family faces.

Summary of Benefits Coverage


Subscriber Agreement

The Subscriber Agreement provides a complete overview of the terms and conditions of the coverage.

Subscriber Agreement


Prescription Drug Coverage

Presbyterian's Individual and Family Plans include prescription drug coverage. The amount of coverage depends on the type of drug.

Individual and Family Plans Formulary List (12/01/2013 – 11/30/2014)
Individual and Family Plan Health Insurance Exchange Formulary List (effective January 2014-December 2014)
Formulary List - Therapeutic Class
Drugs Requiring Prior Authorization
Specialty Pharmaceuticals/ Medical Drug List
Prior Authorization Form
Fax completed Prior Authorization forms to Presbyterian Pharmacy Services at (505) 923-5540 or 1-800-724-6953.
Important Information about Women's Preventive Services
What if my drug is not covered?
Presbyterian Pharmacy Network Listing
U.S. Food and Drug Administration (FDA) Safety Alerts
U.S. Food and Drug Administration (FDA) Drug Recalls

For more information on prescription drug benefits, see Understanding Formularies and Formulary Terms.


Rate Sheet

The rate sheet lists the monthly premium you can expect to pay for the plan. To accurately calculate your total premium cost,

  • Select your area of coverage
  • Determine the age of each person to be covered
  • Add together the monthly payment amounts associated with each individual
  • Premiums for 4 or more dependents under age 21 will not apply

Rate Sheet for Albuquerque Counties
Rate Sheet for Santa Fe Counties
Rate Sheet for Las Cruces and Farmington Counties
Rate Sheet for All Other NM Counties


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

Selected a plan?
You're ready to enroll

Enroll Online Now or:
  • Mail to: Presbyterian Health Plan,
    P. O. Box 27489, Albuquerque, NM 87125
    Download application
  • Fax to: 505-923-8252 or scan and email to enrollmentdept@phs.org
  • Call for a Quote: 1-866-869-7737, Weekdays, 8:00 a.m. – 5:00 p.m.