2024 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.
Watch informational videos explaining each health insurance plan offered on the APS Employee Wellness YouTube channel.
What is an EPO?
- 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. The exception is in the care of emergency/ER circumstances and a copay will apply. 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?
- A PPO, or Preferred Provider Organization, is a type of health plan that offers a local and national 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 healthcare 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.
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 |
EPO and PPO Medical Cost Comparison Grids
Presbyterian (In-Network) | BCBS/Cigna (In-Network) | BCBS/Cigna (Out-of-Network) | |
---|---|---|---|
Primary Care Copay | $20 | $30 | Deductible / Coinsurance 50% |
Specialist Copay | $50 | $60 | Deductible / Coinsurance 50% |
Virtual or Telehealth Visit | $20 | No Charge | Not Covered |
Preventive Care Services | Plan pays 100% | Plan pays 100% | Deductible / Coinsurance 50% |
Lab / X-Rays / Ultrasound / Other Basic Diagnostic Testing | $20 copay per day | $30 copay per day | Deductible / Coinsurance 50% |
Advanced Radiology (MRI, PET, CT scan) |
$120 copay per day at a free-standing facility, or deductible and coinsurance (20%) at hospital |
|
Deductible / Coinsurance 50% |
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 50% |
Inpatient Hospitalization | Deductible / Coinsurance 20% |
Deductible / Coinsurance 20% |
Deductible / Coinsurance 50% |
Urgent Care | $50 | $75 | $75 |
Emergency Room | $350 copay | $450 copay | $450 copay |
Ambulance | Subject to deductible and coinsurance 20% | Subject to in-network deductible and coinsurance 20% |
Subject to in-network deductible and coinsurance 20% |
Autism Spectrum Disorder Services | No Charge | No Charge | Deductible / Coinsurance 50% |
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 50% |
Acupuncture, Chiropractic, Massage Therapy (Refer to complete Summary of Benefits) | $20 | $30 | Deductible / Coinsurance 50% |
Office visit for allergy testing and treatment | $50 | $60 | Deductible / Coinsurance 50% |
Allergy extract preparation, allergy serum, and allergy injections | $10 | $10 | Deductible / Coinsurance 50% |
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 50% |
Hospital Admission |
Deductible and coinsurance 20% |
Deductible and coinsurance 20% |
Deductible and coinsurance 50% |
*If a newborn stays in the hospital after the mother is released, a separate deductible and 20% coinsurance applies to that extended stay for the baby.
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 50% |
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 50% |
Presbyterian (In-Network) | BCBS/Cigna (In-Network) | BCBS/Cigna (Out-of-Network) | |
---|---|---|---|
Outpatient Services | No Charge | No Charge | Deductible and coinsurance 50% |
Inpatient Services | No Charge | No Charge | Deductible and coinsurance 50% |
Express Scripts Prescription Drug Benefits
By enrolling in one of the APS medical plans, employees and dependents 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.
Copayments/Coinsurance
Retail
34-day supply
- Generic: 20% ($10 maximum)
- Preferred Brand: 30% ($35 minimum, $75 maximum)
- Nonpreferred Brand: 40% ($70 minimum, $150 maximum)
90-day supply
- Generic: $20
- Preferred Brand: $90
- Nonpreferred Brand: $180
Walgreens
90-day supply
- Generic: $20
- Preferred Brand: $90
- Nonpreferred Brand: $180
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.
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. Please refer to the complete Express Scripts Summary of Benefits for more detailed information, and for information and copayment amounts specific to specialty medications. Specialty medications must be filled through Accredo, the Express Scripts specialty pharmacy.
Express Scripts | Out-of-Pocket Maximum |
Employee | $2,500 |
Employee+1 | $3,500 |
Family | $3,500 |
EPO/PPO Hospital and Physician Groups
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)
- Presbyterian Health System & Presbyterian Medical Group
- Presbyterian Health Plan - Optum Medical Group in Albuquerque
In-network providers for Cigna (PPO)
- Presbyterian Health System & Presbyterian Medical Group
- Presbyterian Health Plan
- UNM Hospital/UNM Children’s Hospital
- In addition, Cigna contracts with providers across the U.S. and you have out-of-network access