Medical, Dental, Vision, Life and Disability Insurance

Santa Fe County  offers the following Medical Provider Plans:

  • Presbyterian Health Plan – Statewide (HMO) plan
  • Lovelace Health Plan – Statewide (HMO) plan
  • Blue Cross Blue Shield of New Mexico – Nationwide (PPO) plan

Presbyterian Health Plan - Under the Presbyterian Plan, employees are not required to select a Primary Care Physician, simply see one of the contracted providers in either the statewide Presbyterian Network or a provider in a the nationwide PHCS/Multiplan Network. Presbyterian provides a Healthy Advantage Wellness Program through personal health assessments, onsite screenings, flu-shot clinics, health fairs, and more for members, access to the Nurse Advice Hotline where registered nurses are available 24 hours a day, 7 days a week to answer questions about specific health problems and provide assistance with self-care of minor illnesses or injuries. Summary of Benefits (PDF)

Lovelace Health Plan - Under the Lovelace Health Plan, employees are not required to select a primary Care Physician, simply see one of the contracted providers in either the statewide NM Lovelace Network or a provider in the nationwide PHCS/Multiplan network. Referrals are not required for initial consultation with a specialist. Inpatient and some outpatient services require a prior authorization. Lovelace provides no-cost Healthy Steps programs to help you take charge of your health by supporting various treatment options and disease management services. Summary of Benefits (PDF)

Blue Cross Blue Shield - The Blue Cross/Blue Shield of NM PPO plan provides choice and flexibility in benefits on a nationwide basis. Members do not need a referral to access specialist care. Employees are not required to select a Primary Care Physician (PCP). When visiting a Blue Cross/Blue Shield contracted PPO Primary Provider (PCP or OB-Gyn) employees have access to that care at the lowest out of pocket costs. This plan includes the flexibility to visit any licensed provider outside the Blue Cross/Blue Shield network at any time. Summary of Benefits (PDF)  

Express Scripts - By enrolling in one of the medical plans, employees are automatically covered under the prescription drug program administered through Express Scripts. This program offers employees the flexibility to purchase medications either at a local pharmacy, through mail order or through the internet. The program has a 3-tier co-pay to provide employees the choice when filling prescriptions, while encouraging use of generics and formulary brand-name medications to better manage the plan's pharmacy costs. The three tiers are Generic, Formulary Brand Name, and Non-Formulary Brand Name. Summary of Benefits (PDF)

Delta Dental - Employees are guaranteed the lowest cost when selecting a PPO New Mexico Dentist, who agrees to accept Delta Dental's discounted fees and charge you only the applicable co-payment, deductible and tax. Delta Dental of New Mexico is a statewide PPO network offering employees full benefits under the plan with no hidden costs or surprises. In fact, Delta Dental of New Mexico dentists will give employees an out-of-pocket cost estimate prior to treatment. Employees may visit a dentist who does not participate in PPO New Mexico or any Delta network. However, your costs may be higher when you visit a non-Delta dentist.

Vision Service Plan (VSP) - By selecting a VSP Signature Doctor, VSP Plan offers affordable eye care discounts and low cost services. The plan allows employees to receive $110 allowance for a wide selection of frames or contact lenses with an additional 20 percent off the amount over your allowance. Other discounts and savings include, an average of 35 percent to 40 percent savings on all non-covered lens options, 30 percent off additional glasses and sunglasses, and an average of 15 percent off the regular price or 5 percent off the promotional price, for Laser Vision Correction (only available from contracted facilities.) Summary of Benefits (PDF)

Basic Life and AD&D and Family Dependent Term Life Insurance - This is a basic term life and accidental death and dismemberment insurance package. This package is offered to employee, spouses, domestic partners, dependents, and domestic partner children.

  • Employees are covered in the amount of $50,000
  • Spouses/Domestic Partners are covered in the amount of $10,000
  • Dependent(s)/Domestic Partner child(ren) are covered in the amount of $5,000

Optional Term Life Insurance - Supplemental Term Life coverage is offered to employees who wish to elect an amount in excess of the basic life $50,000 package. The cost for coverage is based upon age, employee’s salary, and the amount of supplemental coverage elected. As a new hire employees may elect an amount up to three times their annual salary without Evidence of Insurability (not to exceed $150,000 in coverage amount). Employees can elect four times and five times their annual salary after completing an Evidence of Insurability Form and having it approved by Standard Life. The maximum amount of coverage is $400,000. If employees do not elect the Basic Life/AD&D or Supplemental Life as a new hire you may be subject to underwriting and denial.

Disability – State of New Mexico General Services Department Risk Management Division Administers the State of New Mexico Short/Long Term Disability program.

Short Term Disability - If you enroll in the Basic Term Life Package you will automatically be enrolled in the Short Term Disability/Long Term Disability program. If you become disabled and apply for benefits under this plan you must complete a period of 28 days during which no Short Term Disability benefit is paid. This is called the elimination period. The Short Term Disability payments will be calculated at 60 percent of your weekly earnings to a maximum of $500 per week. If the combination of your benefits plus sick leave exceeds 100 percent of pre-disability earnings, your Short Term Disability benefit payment will be reduced to the level that does not exceed 100 percent of your pre-disability earnings. The maximum period of payments is 24 weeks.

Long Term Disability - After exhausting your Short Term Disability benefits, you will automatically be eligible for Long Term Disability coverage if you are still disabled at the end of your STD benefit. The weekly benefit of 60 percent of your weekly earnings under Short Term Disability will transition to a single monthly payment of 40 percent of your monthly earnings to a maximum of $2,000.
NOTE: Under the long-term disability portion of the plan, once you are eligible for Social Security Disability or PERA retirement you will no longer be eligible for the State of New Mexico disability.

For more information on Short-Term and Long-Term Disability coverage please visit www.generalservices.state.nm.us/rmd/disability.html.