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Employers & Organizations
Benefit Plans
Overview
Employer-Offered Large-Group Plans
Employer Portal Login
Small Group Plan Documents
Large Group Plan Documents
Forms & Other Resources for Members
New Members
Tax Forms & Information
Pharmacy/Formulary
Seeking Healthcare Services
Preventive Health Guidelines for Men, Women, Children
Case Management Services
Disease Management Services
Out-of-State Coverage
Protecting Your Privacy
Quality Program for Members
Member Rights and Responsibilities
Out-of-State Coverage
for PPO Plan Members
Our PPO plans allow members the flexibility to choose their level of benefits when seeking care. If you are a PPO plan member, please keep these things in mind:
Members will receive the highest benefit level—and pay the least amount out of their own pockets—when they see providers who are in the True Health New Mexico provider network. (See our
Online Provider Directory page
to search for in-network providers.)
If a member chooses to see an out-of-network provider, then out-of-network benefits will apply. True Health New Mexico will pay the out-of-network provider up to the usual, customary, and reasonable (URC) charge for the service. The out-of-network provider may bill the member for the remaining balance because the out-of-network provider is not a True Health New Mexico contracted provider. The member will be responsible for the remaining amount up to billed charges if billed by the provider. This is called “balance billing.”
Please refer to the Summary of Benefits and Coverage (SBC) for your particular plan to learn what your out-of-network PPO benefits are. You can find your SBC on our
Small Group Plan Documents page
or our
Large Group Plan Documents page
, depending on what type of group coverage you have.