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Medical Plan Comparison Information

Tables comparing the EPO medical plans with the PPO medical plans.

Which Health Plans does APS Offer?

Albuquerque Public Schools offers two types of health insurance plans: EPO and PPO. The tables below compare EPO In-Network, PPO In-Network, and PPO Out-of-Network costs. Please read the information carefully and choose the plan that best fits you and your family's needs.

Note: If you have out-of-state dependents it is important to choose the right health plan for your family. Read more detail on the differences between EPO and PPO plans as well as what hospital and medical network providers are generally contracted with each plan.

What is an EPO?

True Health (THNM) and Presbyterian are the EPO providers for APS.
  • An EPO, or Exclusive Provider Organization, is a type of health plan that offers a local network of doctors and hospitals for you to choose from, with few to no out-of-state options. 
  • If you choose to get care outside of your EPO plan’s network, it usually will not be covered (except in an emergency/ER circumstance), less the copay. However, other charges may apply if out of state and admitted to a hospital facility.

When to Consider an EPO

  • If you’re looking for slightly lower copays with higher monthly premiums.
  • Deductibles and out-of-pocket maximums are slightly lower.

What is a PPO?

Cigna and BlueCross Blue Shield (BCBS) are the PPO providers for APS.
  • A PPO, or Preferred Provider Organization, is a type of health plan that offers a larger network of doctors and hospitals, for more choice.
  • PPOs have different costs for in-network services and out-of-network services. An out-of-network provider and services will be more expensive.

When to Consider a PPO

  • If you're willing to pay slightly higher copays but lower monthly premiums to get more choice and flexibility in choosing your physician and health care options.
  • Deductibles and out-of-pocket maximums are slightly higher.

Note: If you have out-of-state dependants – it is important to choose the right health plan.

EPO and PPO Medical Cost Comparison Grids

Table 1: Copay and Deductible Cost Comparison.
EPO providers are True Health (THNM) and Presbyterian. PPO providers are Cigna and BlueCross BlueShield (BCBS).
EPO Provider
(In-Network)
PPO Provider
(In-Network)
PPO Provider 
(Out-of Network)
Primary Care Copay $20 $30 Deductible / Coinsurance
Specialist Copay $50 $60 Deductible / Coinsurance
Virtual or Telehealth Visit $20 No Charge Not Covered
Preventive Care Services Plan pays 100% Plan pays 100% Deductible / Coinsurance
Lab / X-Rays / Ultrasound / Other Basic Diagnostic Testing $20 copay per day $30 copay per day Deductible / Coinsurance
Advanced Radiology
(MRI, PET, CT scan)
$120 copay per day
at a free-standing facility, or deductible and coinsurance at hospital
  • Cigna: $175 copay per day
  • BCBS: $120 copay per day
    at a 
    free-standing facility, or deductible and coinsurance at hospital
Deductible / Coinsurance
Physical, Occupational and Speech Therapy (refer to complete Summary of Benefits) $20 copay per visit
up to $320 annual
maximum
$30 copay per visit
up to $480 annual
maximum
Deductible / Coinsurance
Inpatient Hospitalization Deductible /
Coinsurance
Deductible /
Coinsurance
Deductible / Coinsurance
Urgent Care $50 $75 $75
Emergency Room $350 copay $450 copay $450 copay
Ambulance Subject to deductible and coinsurance Subject to
in-network deductible
and coinsurance
Subject to in-network
deductible and coinsurance
Autism Spectrum Disorder Services No Charge No Charge Deductible / Coinsurance
Durable Medical Equipment, Supplies, Prosthetics (refer to complete Summary of Benefits) 20% coinsurance,
the deductible
does not apply
20% coinsurance,
the deductible
does not apply
Deductible / Coinsurance
Acupuncture, Chiropractic, Massage Therapy  (Refer to complete Summary of Benefits) $20 $30 Deductible / Coinsurance
Office visit for allergy testing and treatment $50 $60 Deductible / Coinsurance
Allergy extract preparation, allergy serum, and allergy injections $10 $10 Deductible / Coinsurance
Table 2: Deductible and Coinsurance Comparison.
EPO providers are True Health (THNM) and Presbyterian. PPO providers are Cigna and BlueCross BlueShield (BCBS).
EPO Provider
(In-Network)
PPO Provider
(In-Network)
 PPO Provider
(Out-of-Network)
Single Deductible $500 $1,000 $5,000
Two-party Deductible $1,000 $2,000 $10,000
Family Deductible $1,250 $2,500 $15,000
Coinsurance 20% 20% 50%
Single Out of Pocket Maximum $4,000 $5,000 $8,500
Two-party Out of Pocket Maximum $8,000 $10,000 $14,875
Family Out of Pocket Maximum $12,000 $12,500 $21,250
Table 3: Maternity Service Cost Comparison.
EPO providers are True Health (THNM) and Presbyterian. PPO providers are Cigna and BlueCross BlueShield (BCBS).
EPO Provider
(In-Network)
PPO Provider
(In-Network)
PPO Provider
(Out-of-Network)
Prenatal,
postnatal care
$50 copay for the
initial visit only,
then plan pays 100%
$60 copay for the
initial visit only,
then plan pays 100%
Deductible and
coinsurance
Hospital
Admission
Deductible and
coinsurance
Deductible and
coinsurance
Deductible and
coinsurance
Table 4: Diabetic Coverage Cost Comparison.
EPO providers are True Health (THNM) and Presbyterian. PPO providers are Cigna and BlueCross BlueShield (BCBS).
EPO Provider
(In-Network)
PPO Provider
(In-Network)
PPO Provider
(Out-of-Network)
Office visit and
diabetes education
$10 copay/visit
up to $260
annual max.
$10 copay/visit
up to $260
annual max.
Deductible and
coinsurance
Diabetic medications Refer to
Prescription
Drug Plan
Refer to
Prescription
Drug Plan
Refer to
Prescription
Drug Plan
Diabetic supplies,
equipment, appliances, 
and services
Plan pays 100% Plan pays 100% Deductible and
coinsurance
Table 5: Behavioral, Mental Health, and Substance Abuse
Service Cost Comparison.
EPO providers are True Health (THNM) and Presbyterian. PPO providers are Cigna and BlueCross BlueShield (BCBS).
EPO Provider
(In-Network)
PPO Provider
(In-Network)
PPO Provider
(Out-of-Network)
Outpatient Services No Charge No Charge Deductible and
coinsurance
Inpatient Services No Charge No Charge Deductible and
coinsurance

About Senate Bill 317

House Bill 317 as passed by the New Mexico Legislature in 2021 provides that, effective January 1, 2022, for the APS medical plan options, our plans shall not impose patient cost-sharing on behavioral health services. This means that in-network services and prescription medications for treatment, habilitation, prevention, and identification of mental illnesses, substance abuse disorders, and trauma spectrum disorders are not subject to copayments, deductible, and/or coinsurance. Under HB317, the APS plan is required to cover these in-network services at 100% paid by the plan (no charge to the patient).

Prescription Drugs

Administered by Express Scripts. Call Express Scripts at 1-866-563-9297.

EPO/PPO Breakdown

In-network providers for BCBS (PPO) and THNM (EPO)

  • Lovelace Medical System & Lovelace Medical Group
  • UNM Hospital & UNM Medical Group
  • Optum Medical Group
  • In addition, BCBS contracts with providers across the U.S. and you have out of network access

In-network providers for Presbyterian (EPO) and Cigna (PPO)

  • Presbyterian Health System & Presbyterian Medical Group
  • Presbyterian Health Plan - Optum Medical Group in Albuquerque (Cigna is not contracted with Optum)
  • Cigna - UNM Hospital/UNM Children’s Hospital
  • In addition, Cigna contracts with providers across the U.S. and you have out-of-network access