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Health Plan Forms & Documents

Use the filters below to find important forms and documents related to your Presbyterian health insurance plan.

Frequently Accessed Documents

.2016 Bronze 1 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Bronze 2 HDHP - Summary of Benefits and Coverage (SBC).

This is a High Deductible plan with an HSA. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement - HDHP for details.

.2016 Catastrophic - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Gold 1 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Gold 2 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Gold 3 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Gold 4 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 HMO Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 HMO Summary Plan Description (SPD).

Brief summary of benefits, limits and/or exclusions.

.2016 Manual para miembros en Español.

Este documento resume los beneficios y la cobertura de su plan de Medicaid Centenario Care. En él se explica cómo utilizar su atención médica, medicamentos recetados, y cualquier costo que usted puede necesitar pagar.

.2016 MediCare PPO Provider Directory.

List of the providers in your network. Note: providers may have changed since printing. Call the Presbyterian Customer Service Center at 1-800-797-5343 to confirm Provider availability and if a Provider is accepting New Patients

.2016 Member Handbook.

This document summarizes the benefits and Coverage of your Medicaid Centennial Care plan. It explains how to use your health care, how to get prescription drugs you may need and out-of-pocket expenses that may apply.

.2016 Platinum - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Senior Care (HMO) Provider Directory.

List of the providers available in your network. Note: providers may have changed since printing. Call the Presbyterian Customer Service Center at 1-800-797-5343 to confirm Provider availability and if a Provider is accepting New Patients

.2016 Silver 1 HDHP - Summary of Benefits and Coverage (SBC).

This is a High Deductible plan with an HSA. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement - HDHP for details.

.2016 Silver 2 HDHP - Summary of Benefits and Coverage (SBC).

This is a High Deductible plan with an HSA. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement - HDHP for details.

.2016 Silver 3 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 4 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 5 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Subscriber Agreement.

This legal document explains benefits and features for: PLATINUM 1; GOLD 1, 2, 3 4; SILVER 3, 4; and BRONZE 1. This agreement and the Summary of Benefits and Coverage describe how to use services, covered benefits, out-of-pocket costs etc

.2016 Subscriber Agreement - HDHP.

This legal document explains benefits and features as a Member of High Deductible Plans (HDHP): SILVER 1, 2; BRONZE 2. This agreement and the Summary of Benefits and Coverage describe how to use services, covered benefits, out-of-pocket costs etc

.2017 Subscriber Agreement.

This legal document explains benefits and features for: PLATINUM; GOLD 1, 2, 3, 4, 5; SILVER 3, 4, 5; BRONZE 1 and Catastrophic. This agreement and the Summary of Benefits and Coverage describe how to use services, covered benefits, out-of-pocket costs etc

.2017 Subscriber Agreement - HDHP.

This legal document explains benefits and features as a Member of High Deductible Plans (HDHP): SILVER 1, 2; BRONZE 2. This agreement and the Summary of Benefits and Coverage describe how to use services, covered benefits, out-of-pocket costs etc

.2016 Application for Individual & Family Plan.

Form to enroll in an Individual & Family Plan by fax or mail.

.2016 Medicare Formulary (List of Covered Drugs).

Lists the prescription drugs that Medicare Advantage (HMO and PPO) cover,alphabetically and by drug class (what the medicine does), and the out-of-pocket expense to you. See your Evidence of Coverage for more detail.

.Drug Formulary - by Drug Class.

List of the prescription drugs - by drug class - that are covered by your plan. Explains if Prior Authorizations are needed, what the Quantity Limits are, and other conditions to have the drug.

.2016 Formulario de Medicamentos de Medicare Advantage.

Lista de los medicamentos recetados que el plan Medicare Advantage cubre, organizada alfabéticamente y por clase de medicamento (lo que el medicamento logra), y del gasto correspondiente de su bolsillo. Para más detalles, consulte la Evidencia de Cobertura.

Benefits & Coverage

.2014 - 2015 Non-Medicare Participant Benefit Booklet.

Summary of the UNM plan and the associated out-of-pocket expenses for services and prescriptions

.2014 - 2015 Non-Medicare PPO Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2014 Benefits Summary.

Summary of the UFCW plan and the associated out-of-pocket expenses for services and prescriptions

.2015 - 2016 Non-Medicare Participant Benefit Booklet.

Summary of the UNM plan and the associated out-of-pocket expenses for services and prescriptions

.2015 - 2016 Non-Medicare PPO Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2015 Albuquerque Public Schools Summary of Benefits and Coverage (SBC), Family.

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2015 Albuquerque Public Schools Summary of Benefits and Coverage (SBC), Subscriber.

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2015 Benefits Handbook.

This brochure is the official statement of benefits that are available to Federal Employee. It explains how the plan works, your benefits and out-of-pocket costs.

.2015 Group Metal HDHP (HMO) Group Subscriber Agreement (GSA).

This legal document, along with the Summary of Benefits and Coverage, describes the Benefits and plan features you are eligible to receive.

.2015 Group Metal HDHP (PPO) Group Subscriber Agreement (GSA).

This legal document, along with the Summary of Benefits and Coverage, describes the Benefits and plan features you are eligible to receive.

.2015 Group Metal HMO Group Subscriber Agreement (GSA).

This legal document, along with the Summary of Benefits and Coverage, describes the Benefits and plan features you are eligible to receive.

.2015 Intel Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2015 Isleta HDHP Summary of Benefits and Coverage (SBC), Family.

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2015 Isleta HDHP Summary of Benefits and Coverage (SBC), Subscriber.

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2015 Isleta HMO Summary of Benefits and Coverage (SBC), Family.

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2015 Isleta HMO Summary of Benefits and Coverage (SBC), Subscriber.

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2015 Isleta PPO Summary of Benefits and Coverage (SBC), Family.

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2015 Isleta PPO Summary of Benefits and Coverage (SBC), Subscriber.

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2015 Summary of Benefits & Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 Benefits Handbook.

This brochure is the official statement of benefits that are available to Federal Employee. It explains how the plan works, your benefits and out-of-pocket costs.

.2016 Bronze 1 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Bronze 1 Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange plan for Native American or Tribal Member under 300% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Bronze 2 HDHP - Summary of Benefits and Coverage (SBC).

This is a High Deductible plan with an HSA. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement - HDHP for details.

.2016 Bronze 2 Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange plan for Native American or Tribal Member under 300% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Catastrophic - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Employer Group Plan 4 Senior Care (HMO) Summary of Benefits.

Summary of the Senior Care plan and the associated out-of-pocket expenses for services and prescriptions

.2016 Employer Group Plan 4 Senior Care (HMO-POS) Summary of Benefits.

Summary of the Senior Care plan and the associated out-of-pocket expenses for services and prescriptions

.2016 Gold 1 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Gold 1 Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange plan for Native American or Tribal Member under 300% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Gold 2 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Gold 2 Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange plan for Native American or Tribal Member under 300% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Gold 3 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Gold 3 Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange plan for Native American or Tribal Member under 300% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Gold 4 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Gold 4 Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange plan for Native American or Tribal Member under 300% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 HDHP Family Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 HDHP Individual Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 High Option Plan Summary of Benefits & Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 HMO Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 HMO Summary Plan Description (SPD).

Brief summary of benefits, limits and/or exclusions.

.2016 Isleta HDHP Summary of Benefits and Coverage (SBC), Family.

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 Isleta HDHP Summary of Benefits and Coverage (SBC), Subscriber.

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 Isleta HMO Summary of Benefits and Coverage (SBC), Family.

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 Isleta HMO Summary of Benefits and Coverage (SBC), Subscriber.

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 Isleta PPO Summary of Benefits and Coverage (SBC), Family.

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 Isleta PPO Summary of Benefits and Coverage (SBC), Subscriber.

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 Manual para miembros en Español.

Este documento resume los beneficios y la cobertura de su plan de Medicaid Centenario Care. En él se explica cómo utilizar su atención médica, medicamentos recetados, y cualquier costo que usted puede necesitar pagar.

.2016 MediCare PPO Provider Directory.

List of the providers in your network. Note: providers may have changed since printing. Call the Presbyterian Customer Service Center at 1-800-797-5343 to confirm Provider availability and if a Provider is accepting New Patients

.2016 Member Handbook.

This document summarizes the benefits and Coverage of your Medicaid Centennial Care plan. It explains how to use your health care, how to get prescription drugs you may need and out-of-pocket expenses that may apply.

.2016 NMPSIA High Option Plan Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 NMPSIA Low Option Plan Summary of Benefits and Coverage (SBC), Family.

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 NMPSIA Low Option Plan Summary of Benefits and Coverage (SBC), Subscriber.

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 Platinum - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Platinum 1 Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange plan for Native American or Tribal Member under 300% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Preferred Care PPO Family Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 Preferred Care PPO Individual Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 Senior Care (HMO) Provider Directory.

List of the providers available in your network. Note: providers may have changed since printing. Call the Presbyterian Customer Service Center at 1-800-797-5343 to confirm Provider availability and if a Provider is accepting New Patients

.2016 Silver 1 HDHP - Summary of Benefits and Coverage (SBC).

This is a High Deductible plan with an HSA. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement - HDHP for details.

.2016 Silver 1 Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange plan for Native American or Tribal Member under 300% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 1A Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange cost share reduction plan for incomes between 100-150% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 1B Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange cost share reduction plan for incomes between 151-200% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 1C Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange cost share reduction plan for incomes between 201-250% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 2 HDHP - Summary of Benefits and Coverage (SBC).

This is a High Deductible plan with an HSA. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement - HDHP for details.

.2016 Silver 2 Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange plan for Native American or Tribal Member under 300% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 2A Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange cost share reduction plan for incomes between 100-150% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 2B Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange cost share reduction plan for incomes between 151-200% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 2C Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange cost share reduction plan for incomes between 201-250% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 3 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 3 Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange plan for Native American or Tribal Member under 300% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 3A Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange cost share reduction plan for incomes between 100-150% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 3B Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange cost share reduction plan for incomes between 151-200% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 3C Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange cost share reduction plan for incomes between 201-250% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 4 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 4 Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange plan for Native American or Tribal Member under 300% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 4A Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange cost share reduction plan for incomes between 100-150% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 4B Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange cost share reduction plan for incomes between 151-200% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 4C Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange cost share reduction plan for incomes between 201-250% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 5 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 5 Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange plan for Native American or Tribal Member under 300% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 5A Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange cost share reduction plan for incomes between 100-150% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 5B Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange cost share reduction plan for incomes between 151-200% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Silver 5C Zero Cost Share Reduction - Summary of Benefits and Coverage (SBC).

On exchange cost share reduction plan for incomes between 201-250% of FPL. Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2016 Smart Care HMO Family Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 Smart Care HMO Individual Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 Standard Option Plan Summary of Benefits & Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.2016 Subscriber Agreement.

This legal document explains benefits and features for: PLATINUM 1; GOLD 1, 2, 3 4; SILVER 3, 4; and BRONZE 1. This agreement and the Summary of Benefits and Coverage describe how to use services, covered benefits, out-of-pocket costs etc

.2016 Subscriber Agreement - HDHP.

This legal document explains benefits and features as a Member of High Deductible Plans (HDHP): SILVER 1, 2; BRONZE 2. This agreement and the Summary of Benefits and Coverage describe how to use services, covered benefits, out-of-pocket costs etc

.2016 University of New Mexico Senior Care (HMO-POS) Summary of Benefits.

Summary of the Senior Care plan and the associated out-of-pocket expenses for services and prescriptions

.2016 Western Teamsters Welfare Trust Plan Senior Care (HMO) Summary of Benefits.

Summary of the Senior Care plan and the associated out-of-pocket expenses for services and prescriptions

.2017 Benefits Handbook.

This brochure is the official statement of benefits that are available to Federal Employee. It explains how the plan works, your benefits and out-of-pocket costs.

.2017 Bronze 1 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2017 Bronze 2 HDHP - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2017 Catastrophic - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2017 Gold 1 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2017 Gold 2 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2017 Gold 3 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2017 Gold 4 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2017 Gold 5 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2017 MediCare PPO Plans Summary of Benefits.

Summary of Benefits for PPO Plans and the associated out-of-pocket expenses for services. See Evidence of Coverage for details

.2017 Platinum - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2017 Rate Sheet for Albuquerque Area.

Rates for Bernalillo, Torrance, Sandoval & Valencia Counties and the 87015 ZIP. Plans listed are Platinum, Gold, Silver, Bronze, and Catastrophic. Rates are based on age and plan chosen. Note: Premium may change in member birthday month

.2017 Rate Sheet for All Areas.

Rates for all New Mexico Counties. Plans listed are Gold, Silver, Bronze, and Catastrophic. Rates are based on age and plan chosen. Note: Premium may change in member birthday month

.2017 Rate Sheet for Counties other than Bernalillo, Torrance, Sandoval, Valencia, Santa Fe, Las Cruces, and Farmington.

Rates for Counties other than Bernalillo, Torrance, Sandoval, Valencia, Santa Fe, Las Cruces, and Farmington. Plans listed are Gold, Silver, Bronze, and Catastrophic. Rates are based on age and plan chosen. Note: Premium may change in member birthday month

.2017 Rate Sheet for Las Cruces and Farmington Counties.

Rates for Las Cruces & Farmington Counties. Plans listed are Platinum, Gold, Silver, Bronze, and Catastrophic. Rates are based on age and plan chosen. Note: Premium may change in member birthday month

.2017 Rate Sheet for Santa Fe County.

Rates for Santa Fe County. Benefit Plans listed are Platinum, Gold, Silver, Bronze, and Catastrophic. Rates are based on age and plan chosen. Note: Premium may change in member birthday month

.2017 Senior Care (HMO) Plans Summary of Benefits.

Summary of Benefits for HMO Plans and the associated out-of-pocket expenses for services. See Evidence of Coverage for details

.2017 Silver 1 HDHP - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2017 Silver 2 HDHP - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2017 Silver 3 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2017 Silver 4 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2017 Silver 5 - Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. See the Subscriber Agreement for details.

.2017 Subscriber Agreement.

This legal document explains benefits and features for: PLATINUM; GOLD 1, 2, 3, 4, 5; SILVER 3, 4, 5; BRONZE 1 and Catastrophic. This agreement and the Summary of Benefits and Coverage describe how to use services, covered benefits, out-of-pocket costs etc

.2017 Subscriber Agreement - HDHP.

This legal document explains benefits and features as a Member of High Deductible Plans (HDHP): SILVER 1, 2; BRONZE 2. This agreement and the Summary of Benefits and Coverage describe how to use services, covered benefits, out-of-pocket costs etc

.Albuquerque Public Schools Benefit Guide.

Brief summary of benefits, limits and/or exclusions.

.APS Benefit Guide.

Brief summary of benefits, limits and/or exclusions.

.APS Preferred Network Provider Directory.

List of the providers available in your APS Preferred Network. Note: providers may have changed since printing. Call the Presbyterian Customer Service Center at 1-800-797-5343 to confirm Provider availability and if a Provider is accepting New Patients

.APS Three-Tiered Network FAQ.

Use this brochure to learn more about the new three-tiered health plan.

.Benefits Summary (Current).

Summary of the Intel HMO plan and the associated out-of-pocket expenses for services and prescriptions

.CABQ Medical Plan Decision Tool.

Use this Medical Plan Decision Tool to help determine which plan is right for you.

.Covered Preventive Care Services with No Co-Pay.

List of preventive care services available at no cost when you are seen by an in-network provider.

.EPO Family Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.EPO Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.EPO Summary Plan Description.

Document describing the details of your plan.

.Federal Employees Benefit Guide.

Brief summary of benefits, limits and/or exclusions.

.Form for Coordination of Benefits.

Form to provide information about your other health plan coverage.

.HDHP Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.HDHP Summary Plan Description.

Description of your group Plan medical benefits and limitations.

.Intel Benefit Guide.

Brief summary of benefits, limits and/or exclusions.

.Isleta Benefit Guide.

Brief summary of benefits, limits and/or exclusions.

.Large Group HDHP Group Subscriber Agreement (GSA).

This legal document, along with the Summary of Benefits and Coverage, describes the Benefits and plan features you are eligible to receive.

.Large Group HMO Group Subscriber Agreement (GSA).

This legal document, along with the Summary of Benefits and Coverage, describes the Benefits and plan features you are eligible to receive.

.Large Group PPO Group Subscriber Agreement (GSA).

This legal document, along with the Summary of Benefits and Coverage, describes the Benefits and plan features you are eligible to receive.

.Member Benefit Booklet.

Summary of the Copayment amounts for specific services your plan. For detailed descriptions, see Your Group Subscriber Agreement

.Multi-Language Interpeter Services.

Free interpreter services to answer health plan questions. Available in Spanish, Navajo, Vietnamese, German, Chinese, Arabic, Korean, Tagalog-Filipino, Japanese, French, Italian, Russian, Hindi, Farsi, and Thai.

.My Care Active and Family Group Subscriber Agreement.

Document describing the details of your plan

.My Care Active and Family with Gym Group Subscriber Agreement.

Document describing the details of your plan

.My Care Active Plan Benefit Guide.

Summary of benefits about your plan

.My Care Active Plan Summary of Benefits & Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.My Care Active Plan with Dependents and Gym Summary of Benefits & Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.My Care Active Plan with Dependents Summary of Benefits & Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.My Care Active Plan with Gym Summary of Benefits & Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.My Care Family Plan Benefit Guide.

Summary of benefits about your plan

.My Care Family Plan Summary of Benefits & Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.My Care Family Plan with Dependents and Gym Summary of Benefits & Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.My Care Family Plan with Dependents Summary of Benefits & Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.My Care Family Plan with Gym Summary of Benefits & Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.My Care Independent Group Subscriber Agreement.

Document describing the details of your plan

.My Care Independent Plan Benefit Guide.

Summary of benefits about your plan

.My Care Independent Plan Summary of Benefits & Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.My Care Independent Plan with Dependents and Gym Summary of Benefits & Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.My Care Independent Plan with Dependents Summary of Benefits & Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.My Care Independent Plan with Gym Summary of Benefits & Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.My Care Independent with Gym Group Subscriber Agreement.

Document describing the details of your plan

.New Mexico Retiree Health Care Member Benefit Booklet.

Summary of the New Mexico Retiree Health Cares plan and the associated out-of-pocket expenses for services and prescriptions

.New Mexico Retiree Health Care Premium Benefit Guide.

Brief summary of benefits, limits and/or exclusions.

.New Mexico Retiree Health Care Premium Plus Benefit Guide.

Brief summary of benefits, limits and/or exclusions.

.Plan B Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.Plan B Summary Plan Description.

Description of your group Plan medical benefits and limitations.

.PPO Family Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.PPO Summary of Benefits and Coverage (SBC).

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

.PPO Summary Plan Description.

Document describing the details of your plan.

.Preferred Care PPO Group Subscriber Agreement (GSA).

This legal document, along with the Summary of Benefits and Coverage, describes the Benefits and plan features you are eligible to receive.

.Premier and Premier Plus Member Benefits Summary.

Summary of the NMRHCA Premier and Premier Plus plans and the associated out-of-pocket expenses for services and prescriptions

.Smart Care HMO Group Subscriber Agreement (GSA).

This legal document, along with the Summary of Benefits and Coverage, describes the Benefits and plan features you are eligible to receive.

.State of New Mexico Benefit Guide.

Brief summary of benefits, limits and/or exclusions.

.2016 Application for Individual & Family Plan.

Form to enroll in an Individual & Family Plan by fax or mail.

.2016 Senior Care (HMO) Directorio de Proveedores.

Lista de los proveedores disponibles en su red. Nota: Es posible que haya habido cambios desde que el directorio se imprimió. Llame al Centro de Servicio al Cliente de Presbyterian al 1-800-797-5343 para confirmar la disponibilidad del Proveedor y saber si el Proveedor está aceptando Pacientes Nuevos

.Contact Information for Benefits Departments.

Phone numbers for the benefit offices of the towns that are part of the City of Albuquerque plan

.Form for Unique Services Reimbursement.

Unique Services Reimbursement Program applies to Independent and Active plans only. Benefits are on a calendar year, have limitiations, and requests must be submitted within one year from the date of service.

.Herramientas en línea para los miembros de Presbyterian Centennial Care.

Folleto enumerando las formas de obtener ayuda con su cuidado de Centennial en línea - www.phs.org / centennialcare o por teléfono 1-888-977-2333

.Online Tools for Presbyterian Centennial Care Members.

Brochure listing the ways to get help with your Centennial Care online - www.phs.org/centennialcare or over the phone 1-888-977-2333

.Understand Your Health Benefits on Foreign Travel.

Participant benefits for urgent and emergency services received outside of the United States

Enrollment & Renewal

.2016 Dental Plan Authorization Form.

Form to authorize payment for Dental Plans.

.2016 Rate Sheet for Albuquerque Counties.

Rates for Bernalillo, Torrance, Sandoval & Valencia Counties and the 87015 ZIP. Plans listed are Platinum, Gold, Silver, Bronze, and Catastrophic. Rates are based on age and plan chosen. Note: Premium may change in member birthday month

.2016 Rate Sheet for All Areas.

Rates for all New Mexico Counties. Plans listed are Gold, Silver, Bronze, and Catastrophic. Rates are based on age and plan chosen. Note: Premium may change in member birthday month

.2016 Rate Sheet for Counties other than Bernalillo, Torrance, Sandoval, Valencia, Santa Fe, Las Cruces, and Farmington.

Rates for Counties other than Bernalillo, Torrance, Sandoval, Valencia, Santa Fe, Las Cruces, and Farmington. Plans listed are Gold, Silver, Bronze, and Catastrophic. Rates are based on age and plan chosen. Note: Premium may change in member birthday month

.2016 Rate Sheet for Las Cruces and Farmington Counties.

Rates for Las Cruces & Farmington Counties. Plans listed are Platinum, Gold, Silver, Bronze, and Catastrophic. Rates are based on age and plan chosen. Note: Premium may change in member birthday month

.2016 Rate Sheet for Santa Fe County.

Rates for Santa Fe County. Benefit Plans listed are Platinum, Gold, Silver, Bronze, and Catastrophic. Rates are based on age and plan chosen. Note: Premium may change in member birthday month

.2017 Application for Individual & Family Plan.

Form to enroll in an Individual & Family Plan by fax or mail.

.2017 Individual and Family Plan Dental Benefit Summary and Authorization Form.

Summary and Authorization Form for Dental Plans available to Individual and Family Plan members

.2017 Individual and Family Plan Vision Benefit Summary and Authorization Form.

Summary and Authorization form for Vision Plans available to Individual and Family Plan members.

.Change Authorization Agreement for Prepayments.

Use this form to change the method of subsequent premium payments by completing this form or contacting Presbyterian Customer Service Center by phone at (505) 923-5678 or toll-free at 1-800-356-2219, Monday through Friday from 7:00 a.m. to 6:00 p.m. TTY 711

.Form to Transition Care Services.

Form to help you transition you or your family's health care to Presbyterian

.Form to Add a Dependent to Your Individual & Family Plan.

Form to add or move a Dependent to or from a Member's plan

.Form to Cancel Your Plan.

Form to end plan coverage by cancelling some or all members on a Presbyterian Health Plan

Prescription Drugs

.2016 Medicare Drug Formulary Changes.

List of the drugs that have been added, changed or removed on the Medicare drug list

.2016 Medicare Drug Prior Authorization Criteria.

Explanation of Prior Authorization requirements as well as a list of drugs that require prior authorization.

.2016 Medicare Formulary (List of Covered Drugs).

Lists the prescription drugs that Medicare Advantage (HMO and PPO) cover,alphabetically and by drug class (what the medicine does), and the out-of-pocket expense to you. See your Evidence of Coverage for more detail.

.2016 Medicare Quantity Limits Criteria.

Lists the drug Quantity Limits permitted by product for Medicare Advantage plans.

.2016 Medicare Step Therapy Criteria.

List of drugs that require Step Therapy. Step Therapy is simply a type of prior authorization. You must try a less expensive drug first that has been proven effective for other people before the more expensive drug is prescribed.

.2017 Formulario de Medicamentos de Medicare Advantage.

Lista de los medicamentos recetados que el plan Medicare Advantage cubre, organizada alfabéticamente y por clase de medicamento (lo que el medicamento logra), y del gasto correspondiente de su bolsillo. Para más detalles, consulte la Evidencia de Cobertura.

.2017 Medicare Drug Formulary Changes.

List of the drugs that have been added, changed or removed on the Medicare drug list

.2017 Medicare Drug Prior Authorization Criteria.

Explanation of Prior Authorization requirements as well as a list of drugs that require prior authorization.

.2017 Medicare Formulary (List of Covered Drugs).

Lists the prescription drugs that Medicare Advantage (HMO and PPO) cover,alphabetically and by drug class (what the medicine does), and the out-of-pocket expense to you. See your Evidence of Coverage for more detail.

.2017 Medicare Part D Drug Prescription Transition Letter - Example.

Example of the Presbyterian letter to you that explains changes to your drug prescriptions due to changes in what your plan covers, need for prior authorization, etc

.2017 Medicare Part D Transition Letter for Long Term Care Facility Residents - Example.

Example of the Presbyterian letter to you that explains changes to your drug prescriptions as a resident in a long term care facility, due to changes in what your plan covers, need for prior authorization, etc

.2017 Medicare Quantity Limits Criteria.

Lists the drug Quantity Limits permitted by product for Medicare Advantage plans.

.2017 Medicare Step Therapy Criteria.

List of drugs that require Step Therapy. Step Therapy is simply a type of prior authorization. You must try a less expensive drug first that has been proven effective for other people before the more expensive drug is prescribed.

.2017 Part D carta de transición - Ejemplo Medicare.

Ejemplo de la carta Presbyterian a usted que explica los cambios en sus prescriptions drogas debido a los cambios en lo que cubre su plan, la necesidad de autorización previa, etc

.2017 Part D carta de transición para Residentes facility de cuidado a largo plazo Medicare.

Ejemplo de la carta Presbyterian a usted que explica los cambios en sus prescriptions drogas como residente en un centro de atención a largo plazo, debido a los cambios en lo que cubre su plan, la necesidad de autorización previa, etc

.Contraceptives Covered with No Co-Pay.

Lists contraception available at no co-pay nor deductible, if your plan includes a Women's preventive medication coverage feature.

.Drug Formulary - By Drug Class.

List of the prescription drugs - by drug class - that are covered by your plan. Explains if Prior Authorizations are needed, what the Quantity Limits are, and other conditions to have the drug.

.Drug Formulary - Alphabetical.

List of the prescription drugs - by alphabetical order - that are covered by your plan. Explains if Prior Authorizations are needed, what the Quantity Limits are, and other conditions to have the drug.

.Drug Formulary - Alphabetical.

List of the prescription drugs - by alphabetical order - that are covered by Presbyterian Centennial Care Medicaid. Explains if Prior Authorizations are needed, what the Quantity Limits are, and other conditions to have the drug. (Updated 6/1/14)

.Drug Formulary - by Drug Class.

List of the prescription drugs - by drug class - that are covered by your plan. Explains if Prior Authorizations are needed, what the Quantity Limits are, and other conditions to have the drug.

.Drug Formulary - by Drug Class.

List of the prescription drugs - by drug class - that are covered by your plan. Explains if Prior Authorizations are needed, what the Quantity Limits are, and other conditions to have the drug.

.Drugs Requiring Prior Authorization.

Explanation of Prior Authorization requirements as well as a list of drugs that require prior authorization

.Form for Current Medication List.

Form to identify current medications that may not be included on the Presbyterian Formulary.

.Form for OptumRx Mail Order Prescriptions.

Form to register for 3 months of prescriptions to be mailed to you. This service is available for most drugs.

.Form Requesting Prior Authorization for Drugs.

Form for a member, prescriber or a pharmacy to request authorization for a drug listed on the Drugs Requiring Prior Authorization List.

.Personal Medication List.

Blank list to help you keep track of your medications.

.Pharmacy Locations.

List of all the Pharmacies available on Presbyterian Health Plans. Note that some drugs are required to be obtained through a specialty pharmacy provider.

.Pharmacy Locations.

List of all the Pharmacies available for Presbyterian Centennial Care Medicaid. Note that some drugs are required to be obtained through a specialty pharmacy provider.

.Policy for Medicare Part D Drug Transitions.

Explanation of the Transition Policy for prescribed drugs from other Plan D providers to the Presbyterian Medicare Advantage Plans

.What If My Drug Is Not on the Formulary?.

If the prescribed drug you need is not covered by your plan, call the PCSC for help or ask your doctor for a different drug that is covered

.2016 Formulario de Medicamentos de Medicare Advantage.

Lista de los medicamentos recetados que el plan Medicare Advantage cubre, organizada alfabéticamente y por clase de medicamento (lo que el medicamento logra), y del gasto correspondiente de su bolsillo. Para más detalles, consulte la Evidencia de Cobertura.

.La lista de medicamentos preferidos en orden alfabetica.

Este formulario de medicamentos está en orden alfabética.Revise el documento para asegurarse de que aún incluya los medicamentos que toma. En general, debe utilizar las farmacias de la red para utilizar su beneficio de medicamentos con receta médica.

.Las farmacias de la red de Presbyterian.

Utilice esta lista para encontrar las farmacias de la red de Presbyterian. Esta lista está sujeta a cambios.

.Lista Personal de Medicamentos.

Lista en blanco para ayudar a mantener un registro de sus medicamentos.

.Specialty Pharmacy & Medical Drugs Coverage.

List of drugs that are Specialty (given by self) and Medical (given by doctor). Some of the drugs on the list must be provided by a Specialty Care Pharmacy. There may also be Prior Authorizations or Medical Exceptions needed.

Claims, Appeals, Releases and Other

.2016 Multi-idioma insertar.

Tenemos servicios de intérprete sin costo alguno para responder cualquier pregunta que pueda tener sobre nuestro plan de salud o medicamentos.

.2016 Multi-Language Interpeter Services.

Free interpreter services to answer health plan questions. Available in Spanish, Chinese Mandarin, Chinese Cantonese, Tagalog, French, Vietnamese, German, Korean, Russian, and Arabic

.2016 Senior Care (HMO) Plan Rating.

All Medicare health and prescription drug programs are rated each year based on the plan's quality and performance. This can be used to compare one plans. Ratings are done each year and may change from one year to the next.

.Aviso de no discriminación.

Presbyterian Health Services (Presbyterian) cumple con todas las ley es de derechos civiles federales aplicables y no discrimina sobre la base de la raza, color, naciona lidad, edad, discapacidad o sexo. Presbyterian no excluye a las personas ni las trata de manera diferente en base a la raza, color, nacionalidad, edad, discapacidad o sexo.

.Form to Reimburse (Direct Deposit) Traditional Healer Benefit Expense.

Form to request direct deposit reimbursement for services completed by a Traditional Healer. Receive up to $200 back each year.

.Form to Release General Health Records.

Form to authorize Presbyterian to disclose your healh records to another group.

.Form to Request an Initial Appeal.

Form to begin an appeal process for dissatisfaction with a service.

.Nondiscrimination Notice.

Presbyterian Health Plan, Inc./Presbyterian Insurance Company, Inc. (Presbyterian) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Presbyterian does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

.Online Form to Submit a Complaint or Appeal.

Online form to submit a complaint or an appeal.

.Form to Acknowledge Traditional Healer Benefit.

Form to indicate you will be receiving services by a Traditional Healer. Use the reimbursement form after the services are received for repayment (up to $200 per year)

.Form to Make a Medical or Pharmacy Reimbursement Claim.

Form to submit receipts for reimbursement of covered out-of-pocket expenses.

.Form to Reimburse Traditional Healer Benefit Expense.

Form to request reimbursement for services completed by a Traditional Healer. Receive up to $200 back each year.

.Transportation, Lodging & Meals FAQs.

Information to request transportation to an appointment, lodging request for member traveling more than 4 hours one way, and other benefits for members. Call the Presbyterian Customer Service Center at 1-800-977-2333 for more information.

Health & Wellness Information

.Create an Advanced Healthcare Directive.

Instructions to help you create a legal document about two important healthcare choices: Who you will speak for you if you become ill and what medical support you may want if you become seriously ill.

.MediCare PPO Health Assessment.

Survey to allow us to better assess your healthcare needs.

.Presbyterian Senior Care (HMO) Health Assessment.

Survey to allow us to better assess your healthcare needs.

.Adult Preventive Healthcare Guidelines.

Suggestions for adults of tests and screenings to have done and how often.

.Asthma Resource Guide - Adults.

List of simple steps for asthma control and phone numbers and websites to help you understand and manage asthma.

.Asthma Resource Guide - Children.

List of simple steps for asthma control and phone numbers and websites to help you understand and manage asthma.

.Comer bien: beba más agua.

Tome agua en vez de bebidas con azúcar.

.Comer bien: coma más proteínas.

Presbyterian sugiere fibra y proteína que se sienta lleno, lo que significa que va a comer menos calorías.

.Comer bien: el control de las porciones.

Presbyterian sugiere consejos para una alimentación más consciente y mejor control de las porciones

.Comer bien: frutas y vegetales.

Presbyterian sugiere estos consejos prácticos para gradualmente llegar a comer una dieta más fundada en las plantas:

.Cómo mantener a los adolescentes saludables mediante consultas de niño sano..

Guía para el cuidado de los adolescentes con un pozo de visita obligada. Haga una cita con el médico de su hijo adolescente

.Diabetes Resource Guide.

Summary of programs and tests recommended to understand diabetes and how to ask for care.

.Eating Right Tip: Drink More Water.

Presbyterian suggests more water for better health.

.Eating Right Tip: Eat More Protein.

Presbyterian suggests fiber and protein make you feel full, which means you?ll eat fewer calories.

.Eating Right Tip: Fruits & Vegetables.

Presbyterian suggests you Try these practical tips to ease into eating a more plant-based diet:

.Eating Right Tip: Portion Control.

Presbyterian suggests tips for more mindful eating and better portion control.

.Es el cuidado intregal de la diabetes?.

Presbyterian recomienda cinco pruebas cada año para ayudar a controlar su diabetes. ¿Tienes una prueba de HbA1c, un examen de colesterol, un examen de la vista de la retina, pruebas de función renal o presión arterial de este año!

.Form to Enroll in Baby Benefits.

Presbyterian Baby Benefits is a free program that offers tools to help you, the Centennial Care member, with the care you need during your pregnancy and after your baby is born.

.Guía del Presbyterian de recursos del asma para los adultos.

Lista de pasos simples para el control del asma y los números de teléfono y sitios web para ayudar a comprender y tratar el asma.

.Guía del Presbyterian de recursos del asma para los niños.

Lista de pasos simples para el control del asma y los números de teléfono y sitios web para ayudar a comprender y tratar el asma.

.Inscríbase en Beneficios de Presbyterian para Bebés.

Beneficios de Presbyterian para Bebés es un programa gratuito que ofrece herramientas para ayudarle con la atención que usted necesita durante el embarazo y después del nacimiento de su bebé.

.Keeping Teens Healthy with Well-Child Visits.

Guidance for caring for teens with a well-visit. Make an appointment with your teen's doctor.

.La importancia de la salud dental en los niños.

Visitas dentales anuales son muy importantes en el buen crecimiento y desarrollo de los dientes de su hijo. Sírvase llamar al Centro de Atención a los Clientes del Presbyterian al 1-888-977-2333 para programar una cita anual.

.Medicare Nombramiento de un Representante.

Autorización para que un representante para tomar decisiones en nombre de usted, el beneficiario de Medicare

.Non-emergency Care Options.

Chart to help you decide the best care in non-emergency situations. Print a copy and keep nearby.

.Opciones de atención que no constituyen una emergencia..

Gráfico para ayudarle a decidir la mejor atención en situaciones que no son de emergencia. Imprima una copia y tener cerca.

.Paso 1 - Certificado de atención prenatal temprana.

Certificado de atención prenatal temprana

.Paso 2 - Atención prenatal regular.

Certificado de Atención prenatal regular

.Pautas sobre atención médica preventiva de adultos..

Las pruebas médicas los adultos deben tener y con qué frecuencia deben tenerlos.

.Pautas sobre atención médica preventiva en embarazos..

Orientación para las mujeres embarazadas. Horarios de visita al médico, qué esperar durante el embarazo, y las pruebas y exámenes sugeridos.

.Pautas sobre atención médica preventiva pediátrica.

Guía para el cuidado de los niños, agrupados por niño hasta la edad de 1; 2-10; 11-20. Explica cuándo tener las vacunas, prueba y consejería de desarrollo

.Pediatric Preventive Healthcare Guidelines.

Guidance for caring for children, grouped by infant to age 1, ages 2-10, and ages 11-20. Explains when to have vaccinations, tests, and development counseling.

.Por qué usted se debe hacer hoy mismo una mamografía.

Folleto que enumera los beneficios de tener una mamografía - rayos X de los senos

.Pregnancy Preventive Healthcare Guidelines.

Guidance for pregnant women. Doctor visit schedules, what to expect during the pregnancy, and suggested tests and screenings.

.Pruebas recomendadas para la detección de diabetes.

Pruebas recomendadas para la detección de diabetes

.Recommended Diabetes Care Screenings.

Presbyterian recommends five tests each year to help manage your diabetes. Have an HbA1c test, a cholesterol screening, a retinal eye exam, kidney function test or blood pressure checked this year!

.Recursos recomendados sobre la diabetes.

Recursos recomendados sobre la diabetes

.Step 1 - Early Prenatal Visit Certificate.

Form to show you had a prenatal office visit within the first 12 weeks of pregnancy.

.Step 2 - Regular Prenatal Visit Certificate.

Form to show you had a regular prenatal care visits throughout your pregnancy

.The Importance of Dental Health in Children.

Annual dental visits are very important in the good growth and development of your child?s teeth. Call the Presbyterian Customer Service Center at 1-800-797-5343 to schedule an annual appointment.

.Tips & Time Tracker for Staying More Active.

Chart to help you keep track of food and activities a week at a time.

.Why You Should Get a Mammogram Today.

Brochure listing the benefits of having a mammogram - an X-ray of your breasts