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Medical Plan Comparison Information

Tables comparing the APS medical insurance plans and an explanation of the two types of medical plan options available.

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.

Open/Switch Enrollment is October 5-19.  Benefit-eligible employees will receive emails from the Human Resources/Benefits Department with instructions on the enrollment process through WinOcular Workspace. 

 Important Note About True Health New Mexico (THNM) Coverage: Due to THNM exiting the New Mexico marketplace, APS will no longer offer THNM for employees beginning January 1, 2023. All employees and dependents have complete coverage through December 31, 2022. If you currently have THNM, you must go through the open enrollment process and choose another medical plan option for benefits starting Jan. 1, 2023. If you do not, you will not have APS medical benefits starting January 1, 2023.

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 providers are generally contracted with each plan.

What is an EPO?

Presbyterian Health Plan is the EPO provider 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. 

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.
  • Your and your family (if applicable) are willing to receive healthcare services from contracted Presbyterian Health Plan providers and facilities. 

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 nationwide 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.
  • You have dependents living out of state or you want the flexibility of receiving care outside of New Mexico.

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

EPO and PPO Medical Cost Comparison Grids

*THNM is not a medical/insurance plan option for 2023. If you have THNM you must pick another medical/insurance plan option for in order to have APS coverage in 2023. 

Table 1: Copay and Deductible Cost Comparison
EPO option is Presbyterian Health Plan. PPO options are Cigna and BlueCross BlueShield (BCBS). 

Presbyterian
(In-Network)

BCBS/Cigna (In-Network) 

BCBS/Cigna    (Out-of-Network)
Primary Care Copay $20 $30 Deductible / Coinsurance
Specialist Copay $50 $60 Deductible / Coinsurance
Video Visit No Charge 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 option is Presbyterian Health Plan. PPO options are Cigna and BlueCross BlueShield (BCBS).
Presbyterian
(In-Network)
BCBS/Cigna (In-Network)  BCBS/Cigna (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 option is Presbyterian Health Plan. PPO options are Cigna and BlueCross BlueShield (BCBS).
Presbyterian
(In-Network)

BCBS/Cigna (In-Network) 

BCBS/Cigna (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 option is Presbyterian Health Plan. PPO options are Cigna and BlueCross BlueShield (BCBS).
Presbyterian
(In-Network)
BCBS/Cigna (In-Network)BCBS/Cigna (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 option is Presbyterian. PPO options are Cigna and BlueCross BlueShield (BCBS).
Presbyterian
(In-Network)
BCBS/CIGNA (In-Network)

BCBS/Cigna (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, as of January 1, 2022, the APS medical plans shall not impose patient cost-sharing on behavioral health services. This means that in-network services and prescription medications for treatment, rehabilitation, prevention, and identification of mental illnesses, substance abuse disorders, and trauma spectrum disorders are not subject to copayments, deductibles, 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).

Express Scripts Prescription Drug Benefits

By enrolling in one of the APS medical plans, you are automatically covered under the prescription medication program - Express Scripts. This program offers benefits through participating retail pharmacies and home delivery from Express Scripts Pharmacy and Accredo. 

Grid of prescription drug payments for coinsurance, copayments for generic, brand and preferred brand medications.

If you fill a prescription for a brand-name medication when a generic equivalent is available, you will pay the applicable copayment/coinsurance plus the difference in cost between the brand and the generic. The difference in cost will apply toward the out-of-pocket maximum.  Starting January 1, 2023, the out-of-pocket maximum for an employee only is $2,500 and $3,500 for employee +1 or employee + family coverage. 

If you need long-term medication, you are allowed two fills at an in-network retail pharmacy before you must move your prescription to a 90-day supply through ExpressScripts® Pharmacy or Walgreens. 

For more information about your Express Scripts benefits go to express-scripts.com/aps.nm

Presbyterian/BCBS/Cigna Provider Access Breakdown

In-network providers for BCBS (PPO)

  • 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
  • Optum Medical Group in Albuquerque 
  • Cigna - UNM Hospital/UNM Children’s Hospital
  • In addition, Cigna contracts with providers across the U.S. and you have out-of-network access