2022 individual and small group plans

2022 Individual and Small Group Plans

SEPTEMBER 29, 2021

Lenore Foreman, Individual PlansLisa Droelle, Small Group Plans

2022_BeWell_Presentation_Presbyterian

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Who We Are

2022 Individual Plans


• Founded in New Mexico in 1908, Presbyterian Healthcare Services is a locally owned, not-for-profithealthcare system of nine hospitals, a medical group, and a health plan.

• Presbyterian’s health system serves one in three New Mexico residents in our clinics, hospitals and asmembers of our health plan.

• Owned by Presbyterian Healthcare Services, Presbyterian Health Plan, Inc. was formed in 1985 and nowhas more than 600,000 enrolled in Medicare Advantage, Medicaid, and Commercial/Individual plans

• *Numbers included are taken from internal Presbyterian data

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Announcement



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On and Off Exchange Medical Plans



• 3 Gold plans (Both On and Off)

• 6 Silver plans (4 plans both On and Off and 2 Off only)

• 2 Bronze plans (Both On and Off)

• 9 Silver Cost Share Reduction (CSR) plans for each Silver plan on exchange

• 1 Native American Cost Share Reduction (CSR) plan for each metal level plan on exchange

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Plan Highlights



• Presbyterian Network

• Telehealth services (video, telephone, or online visit) with an in-network provider is $0*, including Primary Care, Specialist, Urgent Care, or Mental Health*

• Two qualified HDHP plans

• Plans with $0 deductibles

• All mental health services are covered at 100%*

• PCP, Urgent Care, Acupuncture, Chiro and Rehab all have the same copay/coinsurance

• Vision for Children • *except HDHP plans

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Provider Networks



*Off exchange plan

Visit www.phs.org/directory to create a personalized provider directory.

Network Name County PlansIndividual and Family or Group HMO/POS

For residents of any New Mexico county

Gold 3Silver 1*Silver 6*Bronze 2

Individual Select HMO

For residents of Bernalillo, Sandoval, Valencia,

Torrance, and Santa Fe counties

Gold 1Gold 2

Silver 5*Bronze 1

Individual Select Silver HMO

For residents of Bernalillo, Sandoval, Valencia,

Torrance, and Santa Fe counties

Silver 2Silver 3Silver 4

http://www.phs.org/directory

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Member Resources 2022 Individual Plan


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Member Resources

2022 Individual Plan


Small Group Product UpdateBenefits for 2022 Plans

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Presbyterian Health Plan - Small Group Update • Presbyterian will offer 22 unique plan offerings (13 HMO, 9 PPO)• Presbyterian will expand the Engage plan offering to 5 products• Optum providers gives even more access • Emergency and Urgent Care coverage nationwide• Emergency Room copayment for most plans• Copayments for Chiropractic and Acupuncture• Copayments for Rehabilitation Therapy (PT, OT & ST) same as

PCP copayments

• Receive more when enrolling with PHPFree Gym Membership Vision Benefits Video Visits

Preferred Generic Tier is $0 or 0% Online Visits 24 Hour Nurse Advice Line (PresRN)

Assist America

Engage Network Product Overview

Engage Product Expansion

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Engage products provide an affordable alternative to traditional health plan offerings. By focusing care to the Engage providers, PHP can offer an attractive health plan option at a better price.

High-Performance, High-Value Network• All Presbyterian facilities and Providers• Complete Network by Specialty• Preferred provider contracting

arrangements to keep prices low• Consistently chosen as the most

preferred providers and facilities by our members

• Create a custom directory at www.phs.org/directory and selecting Engage in the Network Selection field

http://www.phs.org/directory

Engage Product ExpansionPHP now offers 5 Engage plans across a range of benefits and rates

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Benefit Gold 1 Engage Gold 5 Engage Silver 5 Engage Silver 6 Engage Silver 7 EngageDeductible Sub/Family $1,200/$2,400 $3,500/$7,000 $4,000/$8,000 $7,000/$14,000 $0/$0

OOP Max Sub/Family $8,700/$17,400 $8,700/$17,400 $8,700/$17,400 $8,700/$17,400 $8,700/$17,400

Primary Care Office Visit $30 Copay $40 Copay $35 Copay $40 Copay $35 Copay

Specialist Office Visit $90 Copay $90 Copay $90 Copay $90 Copay $90 Copay

IP Hospital Deductible + 20% Deductible + 20% Deductible + 30% Deductible + 30% $1,200/day, $2,400 max

Outpatient Hospital Deductible + 20% Deductible + 20% Deductible + 30% Deductible + 30%$1,000 Hospital

$1,000 Professional

Urgent Care $30 Copay $35 Copay $35 Copay $40 Copay $35 Copay

Emergency Room $500 Copay $500 Copay $750 Copay Deductible + 30% $1,000 Copay

Lab/X-Ray $0 Copay $0 Copay $50/$100 Copay $50/$100 Copay $50/$100 Copay

Preferred Generic $0 Copay $0 Copay $0 Copay $0 Copay $0 Copay

Non-preferred Generic $15 Copay $15 Copay $15 Copay $15 Copay $15 Copay

Preferred Brand $50 Copay $50 Copay $130 Copay Deductible + 30% $75 Copay

Non-Preferred Brand $125 Copay $125 Copay $150 Copay Deductible + 30% $150 Copay

Specialty Drugs Deductible + 20% Deductible + 20% Deductible + 30% Deductible + 30% Deductible + 30%

Product ExpansionPHP now offers the Silver 3 HMO/PPO Plans Statewide

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In-Network Benefit Silver 3 HMO/PPODeductible Sub/Family $2,500/$5,000

OOP Max Sub/Family $8,700/$17,400

Primary Care Office Visit $40 Copay

Specialist Office Visit $90 Copay

IP Hospital Deductible + 30%

Outpatient Hospital Deductible + 30%

Urgent Care $40 Copay

Emergency Room $1,000 Copay

Acupuncture $40 Copay - 20 visit limit/yr

Chiropractic $40 Copay - 20 visit limit/yr

Lab/X-Ray $50/$100 Copay

Preferred Generic $0 Copay

Non-preferred Generic $15 Copay

Preferred Brand $130 Copay

Non-Preferred Brand $150 Copay

Specialty Drugs Deductible + 30%

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To receive plan costs and complete details of coverage including schedules of benefits, limitations, or exclusions, please use the contact information below:

2022 Small Group & Individual Plans


Lenore Foreman, Individual Plans Account ManagerPhone: (505) 923-8537Email: [email protected]

Small Group Team Phone: (505) 923-5807Email: [email protected]

Inside Sales Team, Individual PlansPhone: 866-869-7737, option 4Email: [email protected]

Employer/Broker Team Phone: 866-246-9877Email: [email protected]

Thank you!.

mailto:[email protected]




2022 individual and small group plans

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