Presbyterian
Plans for You
As a member enrolled on any of the four Presbyterian Plans listed below, you and your enrolled family members are eligible for various dental and vision plans. You are also automatically enrolled in the Presbyterian MemberPerks plan.
MemberPerks – exclusive Value-Added services for Presbyterian Health Plan and Insurance Company Members.
Click here for a copy of the MemberPerks ID Card which must be presented with your Presbyterian membership to the MemberPerks Provider at time of service.
Automatic Enrollment
All members of Presbyterian Health Plan and Insurance Company Members are automatically enrolled in the MemberPerks program.
Exclusive Savings
MemberPerks provide access to exclusive savings to some of the best spots around town to improve your well-being.
SMALL GROUP PLANS
FEDERAL MEMBERS
Includes MemberPerks, 3 Dental Plan Options, and Vision Materials Benefit Option
MEDICARE ADVANTAGE
You have a lot to smile about!
INDIVIDUAL & FAMILY PLANS
Oral health is an important part of overall health!
Presbyterian Health Plan and BenefitSource have partnered to provide dental coverage to all Presbyterian Individual and Family Plan members.
Small Group
Small Group Dental Plans
Presbyterian Health Plan has dental plans especially for their small groups, those with 50 or fewer employees. Included are two options – High Option and Standard Option – for comprehensive dental insurance.
To enroll, complete this application and return it to your Presbyterian representative.
Get started Download PHP Small Group Sales Kit
Small Group
Our Provider Network
We have a very broad dental provider network, almost 90% of all dental offices accepting insurance throughout New Mexico, participate. We credential additional providers and add them on a weekly basis.
For the most updated list of providers, go to the Provider Search and specify PPO when defining plan type.
High Option Benefit Summary
| Member Pays | ||
| In Network | Out of Network | |
| Class I: (Diagnostic/Preventive) • Oral Examinations • Cleanings • Fluoride Treatment • Space Maintainers • Sealants • Palliative Emergency Treatment • Dental X-rays | 0%* | 0% (MAC)*
|
| Class II: (Basic) • Oral Surgery • Extractions • Restorations (Composite white and silver fillings) • Anesthesia (in conjunction with oral surgery) | 20%* | 20% (MAC)*
|
| Class III: (Major) • Crowns • Bridges • Dentures • Inlays • Other prosthetic services • Endodontic Services • Periodontal Services • Implants | 50%* | 50% (MAC)* |
| Covered Expenses | Maximum Allowable Charge (MAC) |
| *Percentage of coverage is based on pre-negotiated fees. | |
| Maximum Benefit per contract year for all Class I, II and III expenses | $2,000 Per Person |
| Deductible applicable to Class II and III covered expenses | $50 Per Person |
| Deductible is based on contract year with a maximum of three (3) deductibles per family ($150) | |
2022 Monthly Premium
| Employee | $32.73 |
| Employee + Spouse | $73.05 |
| Employee + Child(ren) | $67.22 |
| Employee + Family | $99.88 |
Standard Option Benefit Summary
| Member Pays | ||
| In Network | Out of Network | |
| Class I: (Diagnostic/Preventive) • Oral Examinations • Cleanings • Fluoride Treatment • Space Maintainers • Sealants • Palliative Emergency Treatment • Dental X-rays | 0%* | 10% (MAC)*
|
| Class II: (Basic) • Oral Surgery • Extractions • Restorations (Composite white and silver fillings) • Anesthesia (in conjunction with oral surgery) | 20%* | 40% (MAC)*
|
| Class III: (Major) • Crowns • Bridges • Dentures • Inlays • Other prosthetic services • Endodontic Services • Periodontal Services • Implants | 50%* | 60% (MAC)* |
| Covered Expenses | Maximum Allowable Charge (MAC) |
| *Percentage of coverage is based on pre-negotiated fees. | |
| Maximum Benefit per contract year for all Class I, II and III expenses | $1,500 Per Person |
| Deductible applicable to Class II and III covered expenses | $50 Per Person |
| Deductible is based on contract year with a maximum of three (3) deductibles per family ($150) | |
2022 Monthly Premium
| Employee | $26.18 |
| Employee + Spouse | $56.44 |
| Employee + Child(ren) | $54.59 |
| Employee + Family | $82.90 |
This is only a brief description of the dental plan. Please refer to the policy for complete details including limitations and exclusions.
These dental plans are provided through BenefitSource, which is the local administrator and underwritten by Companion Life Insurance Company, an A.M. Best Rated A+ (Superior) rated company Jan 25, 2019. The rating represents an independent opinion from the leading provider of insurer ratings of a company’s financial strength and ability to meet its obligations to policyholders.
Federal Members
3 Dental Options
Federal Employees enrolled on Presbyterian Health Plan have three options to choose from for supplemental Dental Plan benefits.
Option 1: Sandia Plan
Join our Sandia Plan today and enjoy on the spot savings from 20% to 60% on more than 250 dental procedures like exams, cleanings, fillings, root canals, crowns and even braces! This is a dental membership referral plan designed to encourage proper dental care by promoting early detection and regular dental health maintenance.
Plan Advantages: No deductibles – No claim forms – No prior authorization requirements – No limits or exclusions on pre-existing conditions – No annual benefit maximum limits – No waiting periods – A broad dental provider network with almost 90% of all dental offices accepting insurance throughout New Mexico, participate
For a complete list of the discounted fee schedule you will enjoy on the Sandia Plan click here.
2022 Membership Fees
| Monthly | Annual | |
| Employee | $6.50 | $69.00 |
| Employee + 1 Dependent | $11.25 | $127.00 |
| Employee + Family | $16.50 | $184.00 |
Membership can be paid monthly through automatic bank draft or annually with a check or credit card. Simply complete the application (click here) and submit it to BenefitSource by dropping it at our office, regular mail, or email.
To find a Sandia Plan Participating Provider, go to the Search for Provider link and specify Sandia Plan when defining plan type.
Federal Members
Option 2: The Elite Dental Plan
This is a comprehensive dental insurance PPO plan. This means when you receive services from an in-network PPO dental office, there are no deductibles and lower out of pocket expenses for most dental services. When choosing non-participating PPO providers, there is still excellent coverage with no deductibles for diagnostic and preventive services and a low, $50 deductible for all other services.
Plan Features: Freedom to see any licensed dentist – A broad dental provider network with almost 90% of all dental offices accepting insurance throughout New Mexico, participate – No in-network deductibles – 6 month waiting period for major services – $1,200 annual maximum per person
For a complete list of the Elite Plan Membership Fee Schedule you will pay at the point of service click here.
2022 Monthly Premiums
| Monthly | |
| Employee | $29.14 |
| Employee + 1 Dependent | $56.30 |
| Employee + Family | $94.66 |
Enroll by completing and signing the Enrollment and Authorization Form (click here) and return with your payment for the appropriate amount to BenefitSource by dropping it off at our office, regular mail, or email.
To find an Elite Plan Participating Provider, go to the Search for Provider link and specify Elite Plan when defining plan type.
Federal Members
Option 3: PPO Dental Plan
This plan is a traditional dental indemnity plan with freedom of choice to see any licensed dentist. When using our PPO Dental Plan providers, you have lower out of pocket costs and no balance billing for dental services.
Plan features: No waiting period for preventive and basic dental services – 6 month waiting period for major services – No deductible for class I services – $50 deductible per person, $150 per family for class II and class III services – Overall plan maximum of $1,200 per person – A broad dental provider network with almost 90% of all dental offices accepting insurance throughout New Mexico, participate.
Class I: Diagnostic/Preventive
Covered at 100% In-Network
Covered at 80% Out-of-Network
No waiting periods
Oral exams, Cleanings, Fluoride treatment, Space
maintainers, Sealants, Palliative emergency treatment, dental x-rays
Class II: Basic Services
Covered at 80% In-Network
Covered at 60% Out-of-Network
No waiting periods
Silver fillings, Restorations (fillings), Anterior composite white fillings
Class III: Major Services
Covered at 50% In-Network
Covered at 40% Out-of-Network
6 month waiting period from date of enrollment.
Crowns, Bridges, Dentures, Inlays, Other prosthetic services, Oral surgery, Extractions, Anesthesia (in conjunction with oral surgery), Endodontic services, Periodontal services
Class IV: Orthodontic
Covered at 50% In-Network
Covered at 50% Out-of-Network
24 month waiting period from date of enrollment.
Up to age 19 only, lifetime maximum of $1,000
This is only a brief description of the dental plan. Please refer to the policy for complete details including limitations and exclusions.
2022 Monthly Premiums
| Monthly | |
| Employee | $29.28 |
| Employee + 1 Dependent | $56.42 |
| Employee + Family | $99.18 |
Enroll by completing and signing the Enrollment and Authorization Form (click here) and return with your payment for the appropriate amount to BenefitSource by dropping it off at our office, regular mail, or email.
To find a PPO Plan Participating Provider, go to the Search for Provider link and specify PPO Plan when defining plan type.
The Elite and PPO dental plans are provided through BenefitSource, which is the local administrator and underwritten by Companion Life Insurance Company, an A.M. Best Rated A+ (Superior) rated company Jan 25, 2019. The rating represents an independent opinion from the leading provider of insurer ratings of a company’s financial strength and ability to meet its obligations to policyholders.
Federal Members
Vision Materials Option
Buying eye glasses or contact lenses can be very costly. This vision materials benefit option provides excellent coverage for this added expense.
Vision Plan Allowance and Frequency
| Materials Allowance | $15 Materials Payment at the time of service |
|
Frame Allowance |
$130 frame allowance Member responsible for amount exceeding $130 |
|
Lenses |
Single Vision, Flat Top 25/28 Bifocal, Flat Top 7×25: 7×28 Trifocal or Lenticular. Progressive multifocal member pays difference of retail price of progressive and trifocal.
Lens enhancements, tints, anti-reflective, scratch coats customary charge |
|
Contact Lenses |
Contact lens allowance of $130 instead of eye glasses may be applied toward materials and fitting |
Enrolled members are able to use this vision materials plan once every 12 months
Vision Materials Plan Low Monthly Rate
| Employee | $ 7.98 |
| Employee + 1 Dependent | $12.64 |
| Employee + Child | $14.56 |
| Employee + Family | $24.62 |
Vision Providers
The vision materials benefit is available from participating Vision Care Direct (VCD) providers. Click here to search for the most current list of participating VCD Providers. When using non-participating vision providers, there is still coverage for frames up to $35 and for lenses at a modified schedule.
How do I join?
Enroll by completing and signing the Enrollment and Authorization Form (click here) and return with your payment for the appropriate amount to BenefitSource by dropping it off at our office, regular mail, or email.
MEDICARE ADVANTAGE
Sandia Dental Plan
Also, as a member of Presbyterian Medicare Advantage you are automatically enrolled in our Sandia Dental Plan at no additional monthly cost.
With the Sandia Dental Plan, you will enjoy on the spot savings from 20% to 60% on more than 250 dental procedures like exams, cleanings, fillings, root canals, and crowns. This plan is a referral dental plan that is an alternative to expensive dental insurance.
Plan discounts are designed to encourage proper dental care by promoting early detection and regular dental health maintenance. This is done by providing deeper discounted fees for routine and basic dental services. There are substantial savings for more extensive dental services such as restorations, crowns, oral surgery, root canals, periodontics, and prosthodontics (dentures).
MEDICARE ADVANTAGE
Elite Dental Plan
Something else to smile about!
The Elite Dental Plan is exclusively available to Presbyterian Medicare Advantage Members.
What is the Elite Dental Plan?
It is a PPO Dental Plan that provides freedom of choice to see any licensed dentist. When members who obtain dental care from one of our PPO Dental Providers, there are lower out of pocket costs for the dental visit. Members pay the listed in-network PPO Fee directly to the dental office at the time of service. When obtaining dental services from non-network providers, the plan pays the amount listed on the PPO Fee Schedule, but the dental office may balance bill you for any differences in fees.
Advantages of the Elite Dental Plan
- Freedom to see any licensed Provider
- Low monthly premium of $35.35 per person, or $424.20 annually per person, for those enrolling in October of each year.
- No deductible for in-network dentists for preventive and diagnostic care
- Low, $50 annual deductible applies to in-network dental care for all other dental procedures.
- $75 annual deductible for out-of-network dental care
- Out-of-pocket costs limited to guaranteed pre-set fee schedule for in-network services
- 6 month waiting period for major (class III) services: fixed prosthodontics, endodontics, periodontics, removable prosthodontics, and oral surgery.
- $1,000 annual maximum per person
- A very broad dental provider network, almost 90% of all dental offices accepting insurance throughout New Mexico, participate. We credential additional providers and add them on a weekly basis. For the most updated list of providers, go to the Search for Provider link and specify Elite Dental Plan when defining plan type.
For a comprehensive list of the Elite Plan Fee Schedule and an Application, click here.
The Elite Dental Plan is provided through BenefitSource, which is the local administrator and underwritten by Companion Life Insurance Company, an A.M. Best Rated A+ (Superior) rated company Jan 25, 2019. The rating represents an independent opinion from the leading provider of insurer ratings of a company’s financial strength and ability to meet its obligations to policyholders.
MEDICARE ADVANTAGE
Our Provider Network
We have a very broad dental provider network, almost 90% of all dental offices accepting insurance throughout New Mexico, participate. Additional providers are credential and added on a weekly basis. For the most updated list of providers, go to the Search for Provider link and specify Sandia Plan when defining your plan type.
For a complete list of dental procedures and the fees you will pay directly to the dental office for specified procedures click here for the Sandia Dental Plan Fee Schedule.
Individual & Family
The Standard Plan and Premium Plan Features
PPO Dental Plan, which means that members have lower out-of-pocket costs when obtaining dental care within the network. Members are also covered when obtaining dental care from non-participating providers.
Freedom to see any licensed dentist. Out-of-pocket costs are lower when receiving in-network care. Members are still covered when using non-participating providers, but at a greater out-of-pocket cost.
A very broad dental provider network, almost 90% of all dental offices accepting insurance throughout New Mexico, participate. We credential additional providers and add them on a weekly basis. For the most updated list of providers, go to the Search for Provider link and specify PPO Plan when defining plan type.
Individual & Family
Standard Class Dental Plan is included!
- Included at no additional cost. All Presbyterian Individual Plan members automatically have access to preventive dental coverage at no cost.
- Preventive care. Coverage for dental bitewing x-rays, one comprehensive or periodic oral examination and one child or adult cleaning each calendar year.
- No charge for in-network services. Obtain routine cleaning and x-rays from an in-network provider and services are not subject coinsurance or deductibles.
Summary of Benefits
Standard Plan
| Standard Class Dental Plan
Included at no additional cost |
You Pay
In- Network |
You Pay
Out-of-Network |
| Preventive
(each service 1 per calendar year per enrolled member) • Comprehensive or Periodic Oral Examination • Child or Adult prophylaxis cleaning • Bitewing X-Rays (4 films) |
0% |
20% (MAC)*
|
Premium Plan
| Premium Dental Plan | You Pay
In-Network |
You Pay
Out-Of-Network |
| Class I: (Preventive Care)
• Oral Examinations • 2nd Cleaning • Fluoride Treatment • Space Maintainers • Sealants • Palliative Emergency Treatment • Dental X-ray |
0% |
20% (MAC)* |
| Class II: (Basic)
• Oral Surgery • Extractions • Restorations (Fillings) • Anesthesia (in conjunction with oral surgery |
20% (MAC)* |
50% (MAC)* |
| Class III: (Major)**
• Crowns • Bridges • Dentures • Inlays • Partial Dentures Other Prosthetic Services • Endodontic Services • Periodontal Services |
50% (MAC)* |
75% (MAC)* |
|
• Maximum Allowable Charge (MAC)* – This PPO Plan will pay the applicable percentage of the contracted rate as determined by the PPO agreement between BenefitSource and the Preferred Provider. • Class III: (Major)** services are subject to a six-month waiting period from the effective date of coverage. Members must be covered under the plan for six consecutive months in order to be eligible for Class III (Major) services. • Maximum Benefit per calendar year for all Class I, II and III expenses…………………………………………………..…$1,000 per person • Deductible applicable to Class II and III covered expenses…………………………………………………………………………………….$50 per person Deductible is based on calendar year with a maximum of three (3) deductibles per family ($150)
|
||
Additional cost. As a member of Presbyterian Individual and Family Plans, the BenefitSource Premium Plan is available for an additional premium. If elected, Premium Plan replaces the Standard Plan.
2020 Monthly Premium
| Single | $18.15 |
| Two Enrolled | $35.05 |
| Three or More Enrolled | $59.17 |
This is only a brief description of the dental plan. Please refer to the policy for complete details including limitations and exclusions.
To learn more about the plan benefits and to obtain an application to enroll on the Premium Plan, please click here (this is a link to the PDF of the PHP brochure which is required). Complete the Payment Authorization Form to enroll on the Premium Plan and return it to Presbyterian Health Plan. There is no action required for the Standard Plan as it is provided automatically to all Individual and Family Plan Members.
These dental plans are provided through BenefitSource, which is the local administrator and underwritten by Companion Life Insurance Company, an A.M. Best Rated A+ (Superior) rated company Jan 25, 2019. The rating represents an independent opinion from the leading provider of insurer ratings of a company’s financial strength and ability to meet its obligations to policyholders.
Want information about another plan?
BenefitSource has been helping you and your family stay healthy since 1995.
Headquartered in Albuquerque, BenefitSource offers benefits and value added programs to groups throughout New Mexico and surrounding states.
BenefitSource has established many strategic partnerships with insurance companies and health care organizations throughout the country to bring competitive insurance and membership based products to New Mexico.
Many of these products are available for individuals, families and groups of all sizes. These products enable individuals and families to save on their out of pocket expenses and employer groups can enhance their employee benefit package and attract top notch employees.
Want to know more? Contact Us
For questions contact us:
customerservice@benefitsource.org
If you Prefer to speak to a BenefitSource representative, please call us Monday through Friday, between 8am to 5pm Mountain Time:
HOURS
Monday-Friday: 8:00 am – 5:00 pm