Using Your Health Plan Coverage
Always show your ID card when you need healthcare at medical facilities or pharmacies. You can print a temporary ID card on myPRES.
Sign up for myPRES
Secure, 24-hour access to health plan tools and resources just for Presbyterian members. Through myPRES you can:
- Find your plan materials so you know what is covered
- Review your claims history
- Request a new Member ID card
- Email your care team and access test results (only a Presbyterian Medical Group patient benefit)
Register for myPRES
Learn Key Information About Your Healthcare Coverage and Costs
Healthcare costs don't stop after you pay your monthly plan premium—there may be copays, coinsurance and deductibles to keep in mind. Presbyterian wants to help you avoid the stressful surprise of unexpected healthcare costs by helping you to understand the basics.
It's easy to learn about cost sharing by viewing this 5 minute video.
Carefully review any plan materials that were mailed to your home.
Login to myPRES to review or download your plan materials.
Login to myPRES
Review your plan's drug formulary (drug list) to see if and how your prescription drugs are covered. After you know the tier level of your drug, use the plan materials found in myPRES to determine the cost sharing for that drug tier.
View Formularies in the Prescription Drugs Section of Forms & Documents
Choose a Primary Care Provider (PCP)
Having a Presbyterian Health Plan PCP who you like and trust is essential to your good health. Your PCP is a doctor, nurse practitioner or other health professional who will provide most of your care. He or she will also help arrange or coordinate your other covered healthcare services.
Choosing an in-network provider whenever you can will help you to avoid paying unnecessary out-of-pocket costs.
To get started, you must select a Plan/Network from the dropdown list. Search for a PCP, by selecting "All Primary Care Providers" from the Specialty dropdown list of options. Tool tips are available to guide you each step of the way.
Find a Doctor Now
Getting Care When Outside of New Mexico
All plans cover urgent care and emergency care services wherever you are—it doesn't matter if you are in New Mexico or outside of New Mexico.
However, your plan may or may not have coverage for non-emergency care outside of New Mexico. Please call customer service or review your plan materials to learn more about your plan's out-of-state coverage.
Whether you have out-of-state coverage or if you are paying out-of-pocket, it's a good idea to use our national healthcare provider network. To receive services outside of New Mexico, members can search for a doctor through our national network of medical providers or our national network of behavioral health providers.
National Network of Medical Providers
National Network of Behavioral Health Providers
- You will pay the smallest copayment if you choose generic drugs over brand name drugs. Ask your doctor or pharmacist if a generic version of your prescription is available.
- You may buy a 90-day supply of maintenance medications as prescribed by your doctor and have them delivered to your home or workplace. These mail order prescriptions typically cost less than ordering them from a local pharmacy one month at a time. You can find pharmacy order forms in Forms & Documents
- Review your Explanation of Benefits (EOB) documents carefully. EOBs tell you what your plan has paid on your behalf and exactly what you should be paying for healthcare services.
Paying Your Premiums
- We accept Visa, MasterCard, and Discover. Make your premium payment online
- If you are on a Presbyterian Individual Health Plan, you can make your monthly payment using a credit card, debit or pre-paid debit card over the phone 24 hours a day, 7 days a week with our automated phone service. Call 505-923-5678.
- Set up automatic recurring payments (Electronic Funds Transfer) by speaking to a Customer Service representative at 505-923-5678.
- Pay your premium by mail with a personal check, cashier's check or money order. Make your check out to Presbyterian Health Plan and write your member ID number on your check or include the payment coupon that was sent with your bill. Be sure to send your payment at least 5 business days before the payment due date to make sure it is posted to your account on time.
Health Plan Education Videos
Presbyterian offers a series of educational videos, including "Making Your Health Plan Benefits Work for You".
See All Videos