Benefits » Health Insurance » Core
LANS also offers Lab employees and retirees the Blue Cross of California Core Plan (Core New Mexico). This fee-for-service plan allows you to choose your own doctors and health care facilities, and there are no monthly premiums. Members who only want catastrophic coverage often use this plan. Blue Cross of California administers the Core New Mexico plan.
Employees appointed to work at least 43.75% time are eligible for Core New Mexico. The plan has a high deductible, which you must meet before it starts paying benefits. Once that occurs, you and the insurance company share the cost of the services you receive. Generally, the insurance company pays the larger part of the cost.
| Core New Mexico Basic Benefits Summary | ||
|---|---|---|
| Calendar Year Deductible | Annual Out-of-Pocket Maximum | Office Visit |
| Individual: $3,000 | Individual: $7,600 | 20% |
After you meet the $3,000 per person deductible, you are covered for 80% of costs and are responsible for paying the remaining 20%.
Your out-of-pocket costs in a calendar year may be limited. Once your share of the eligible medical expenses reaches a certain amount, called the annual out-of-pocket maximum, the plan pays 100% of most covered charges for the rest of the calendar year.
The Core plan covers prescriptions on a straight percentage reimbursement, once your deductible is met. There is no formulary and you can go to any pharmacy.
You can save money by using the Blue Cross Preferred Provider Organization (PPO) providers.
The Benefit Eligibility Level Codes (pdf) for Core NM are 1, 2, 3, and 4. The area covered is nationwide.
New Mexico does not recognize "common law" marriages; therefore, only a legal spouse or eligible domestic partner may be enrolled in LANS sponsored health and welfare plans.
You may enroll yourself or an eligible family member in a LANS-sponsored medical plan if you are a newly-hired employee, have a qualified change of status, or during Open Enrollment, which is held at the Lab each November, with coverage effective January 1st of the following year.
If you are newly hired, you have a period of initial eligibility (PIE) during which you may enroll yourself and your eligible family members. Your PIE starts the day you become eligible—usually on your date of hire—and ends approximately 31 days later.
To enroll, submit a completed insurance enrollment form (pdf) to the Lab’s Benefits Office within 31 days of your PIE.
You may become eligible for LANS-sponsored benefits if you change employment status (e.g., change from contractor to LANS or limited benefits to full benefits). When this happens, contact the Lab's Benefits Office immediately by calling 505-667-1806 or e-mail the Benefits Office to determine when your PIE begins and to register for a benefits presentation. You will have a 31-day PIE from the date your employment status was changed
Families change and grow due to marriage, birth or adoption of children, and other events. If enrolling in a medical plan because of a family status change (e.g., marriage or birth of a child), you must request enrollment within 31 days from the date of the qualifying event (e.g., date of marriage or date of the child's birth).
To enroll, contact the Lab’s Benefits Office at 505-667-1806 or e-mail the Benefits Office.
If you are not enrolled in a medical plan, you and your eligible family members may enroll during Open Enrollment, which is usually held in November for coverage effective January 1st of the following year.
If you and/or an eligible family member involuntarily lose other employer-sponsored medical insurance coverage, you may enroll in one of LANS’s medical plans. A new PIE starts the day you lose coverage. You must furnish proof that other employer group coverage was lost.
To enroll e-mail the Benefits Office or call 505-667-1806.
If you are going on or returning from a change of station or extended travel and will be moving in or out of a service area, you may be able to change your insurance plan. Contact the Lab’s Benefits Office at 505-667-1806 or e-mail the Benefits Office about this change.
If you missed your PIE, you can still enroll in medical coverage at any time by submitting an enrollment form to Benefits; however, your medical coverage won’t go into effect for 90 calendar days from the day you submit your form.
This is only an overview of the Core New Mexico medical insurance plan. For full details, refer to the Blue Cross of California Web site or the Core Benefit Summary Plan (pdf). If you are enrolled in Core NM but reside in California please refer to this Benefit Summary Plan (pdf).
Meidcare Part D Drug Formulary (pdf)
You submit medical claim forms for services you receive.
If you are enrolled in Core New Mexico and need information on submitting claims, contact Blue Cross of California at 1-888-209-7975.
Questions? Contact the Lab's Benefits Office at 505-667-1806.
