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.

Presbyterian MemberPerks

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.

Discover MemberPerks

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 Plan

Member Plans

Federal Members

Dental & Vision Options

Medicare Advantage

Member Plans

Individual & Family

Member Plans

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.

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

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.

**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 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)

2020 Monthly Premium

Employee $32.73
Employee + Spouse $73.05
Employee + Child(ren) $67.22
Employee + Family $99.88

Standard Option Benefit Summary

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.

**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 contract year for all Class I, II and III expenses $1,200 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)

2020 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.

2020 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.

Start Your Enrollment Download Application
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.

2020 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.

Start Your Enrollment Download Application
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.

SERVICE TYPE

 

DESCRIPTION
 

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. 

2020 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.

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. 

2020 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.

Start Your Enrollment Download Application
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.

Start Your Enrollment Download Application
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:

(505) 237-1501 or
1 (888) 862-8659 Toll Free

HOURS

Monday-Friday: 8:00 am – 5:00 pm