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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.

 

What is an EPO?

Presbyterian Health Plan (PHP) 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. 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?

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 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.

Table 1: Deductible and Coinsurance Comparison.
EPO provider is Presbyterian Health Plan (PHP). PPO providers 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

EPO and PPO Medical Cost Comparison Grids

Table 2: Copay and Deductible Cost Comparison.
EPO provider is Presbyterian Health Plan (PHP). PPO providers 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 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
  • Cigna: $175 copay per day
  • BCBS: $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%
Table 3: Maternity Service Cost Comparison.
EPO provider is Presbyterian Health Plan (PHP). PPO providers 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 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.

Table 4: Diabetic Coverage Cost Comparison.
EPO provider is Presbyterian Health Plan (PHP). PPO providers 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 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%
Table 5: Behavioral, Mental Health, and Substance Abuse
Service Cost Comparison.
EPO provider is Presbyterian Health Plan (PHP). PPO providers 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 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)

Mail

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.nmPlease 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