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