Santa Fe County offers the following Medical Provider Plans:
• Presbyterian Health Plan – HMO
• Presbyterian Health Plan – PPO
Presbyterian HMO Health Plan – Under the HMO Plan, employees are not required to select a Primary Care Physician, simply see one of the contracted providers in either the State wide Presbyterian Provider Network or a provider in the nationwide Multi-Plan Provider Network. Under the HMO plan, members are required to use in-network providers for all of their health care needs, nationwide. Summary of Benefits (PDF)
Presbyterian PPO Health Plan – The PPO Plan provides choice and flexibility in benefits on a nationwide basis. Members do not need a referral to access care. Members are not required to select a Primary Care Physician. When visiting a Presbyterian in-network provide whether in the State Wide Provider Network or a provider in the nationwide Multi-Plan Provider Network, members pay the lowest out-of-pocket costs. This plan allows members the flexibility to also utilize providers outside of the Presbyterian Network at any time.
With both medical plans comes the added benefit of a Prime Fitness membership. With Prime Fitness, all covered members over the age of 16 are eligible for a free gym membership at any participating gym or fitness center within the Prime Fitness Network. Simply visit Prime Fitness at https://www.primemember.com/ to locate a fitness center near you and become a member of that center. With Prime Fitness you also have the flexibility of utilizing participating fitness centers anywhere that accepts Prime Fitness. Whether on vacation, commuting, or you just like variety, you can access any participating fitness center at any time as long as you obtain a membership or visitor pass at that center.
Prescription benefits are handled directly through Presbyterian. To fill a prescription from the pharmacy members must give the Pharmacist their Presbyterian Health Insurance card. Mail order prescriptions can be filled using the Presbyterian Mail Order prescription program.
Delta Dental– Employees are guaranteed the lowest out of pocket 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% to 40% savings on all non-covered lens options, 30% off additional glasses and sunglasses, and an average of 15% off the regular price or 5% off the promotional price for Laser Vision Correction (only available from contracted facilities).
Basic Life and AD&D Life Insurance – This is a basic term life and Accidental Death and Dismemberment insurance package. This package is provided to all employees of Santa Fe County and paid for 100% of by Santa Fe County.
The Insurance carrier is Securian/Minnesota Life
• All Employees are covered in the amount of $50,000
• All Employees classified as Detention Officers are covered for an additional $25,000 (Line of Duty coverage)
Optional Supplemental Term Life Insurance – Employee Supplemental Term Life coverage is offered to employees who wish to elect an amount in excess of the basic life and AD&D package of $50,000. The cost for coverage is based upon the age of the employee, and the amount of supplemental Life coverage elected, and is paid for 100% by the employee. As a new hire, employees are eligible for a Guaranteed Issue (GI) amount of $150,000 without proving insurability. All employees can apply for coverage in $10,000 increments up-to $500,000 with an Evidence of Insurability (EOI) form for any amount above the GI of $150,000.
Spouse/Domestic Partner Term Life coverage is offered to employees who elect to purchase a term life policy on their spouse or domestic partner. The cost for coverage is based upon the age of the employee, and the amount of supplemental life coverage elected, and is paid for 100% by the employee. There is no GI for Spouse/Domestic Partner Supplemental Term Life coverage, therefore, all employees and their spouses/domestic partners shall complete an EOI form to be sent to Securian/Minnesota Life’s Underwriting Dept. for determination of eligibility. Employees and their Spouse/Domestic Partner may elect up-to $250,000 of coverage in $10,000 increments through the EOI process.
Dependent Term Life Coverageis offered to employees who elect to purchase a term life policy on their dependent children up-to the age of 26. The cost for coverage is .12cents per thousand and employees can elect up-to $15,000 of coverage in $5,000 increments. All dependent life coverage is Guaranteed Issue (GI) without underwriting. All dependents are covered for the total elected amount each at one price.
Short Term/Long Term Disability – Employees have the option to enroll in Disability coverage with MetLife. The premium for MetLife disability coverage is determined based on the employee’s salary and paid for 100% by the employee. If the employee covered on the disability plan becomes disabled for any reason and cannot work for a short term (up-to six months) they can submit a claim to MetLife, their disability insurance carrier. Under this plan, you must complete an elimination period of 28 days before submitting a claim for short term disability. If after 28 days the employee is unable to work due to this disability MetLife will begin to pay the employee an amount calculated at 60%of their salary per week, up-to $500. The employee may use sick or annual leave to supplement the other 40% of their weekly salary, however, the total income may not exceed 100%. If this does occur, the employee’s disability benefit will be reduced to a level that does not exceed 100% of their salary. The maximum amount of payments that are made to an employee under short term disability is 24 weeks. Long Term Disability coverage can be utilized in the event that an employee is unable to return to work due to a disability for more than six months. Once a Doctor has determined that the employee still cannot return to work after six months they are automatically eligible for Long Term Disability. The weekly benefit of 60% of your weekly earnings under Short Term Disability will transition to a single monthly payment of the employee’s monthly earnings to a maximum of $2,000.
NOTE: Under the long term disability portion of the plan, once an employee becomes eligible for Social Security Disability or PERA Disability Retirement, they are no longer eligible to utilize their MetLife disability option.