Benefits » Health Insurance » PPO
The LANS/LANL National Preferred Provider Organization (National PPO) medical insurance plan provides access to a large national provider network but also offers the option of seeking services from out-of-network providers. The National PPO plan design plan helps keep costs in control by paying a more substantial benefit for services that are rendered with in-network doctors and facilities. Out-of-network services are covered at a reduced amount, and subject to Blue Cross Blue Shield of New Mexico’s allowable cost.
For specific details on the plan design, please see the PPO Summary of Benefits (pdf).
2011 LANL Active Employee Semi-monthly Medical Insurance premium rates (pdf)
You may choose your own in-network provider or out-of-network provider using the BCBSNM Provider Finder. The National PPO plan has a $250 individual/$750 family calendar-year deductible for in-network providers and a $500 individual/$1,500 family calendar-year deductible for out-of-network providers. You are responsible for a $20 co-payment for in-network office visits and 40% after your deductible for out-of-network providers. Any additional costs (for example: diagnostic X-rays or lab work) are subject to deductible and co-insurance.
The Benefit Eligibility Level Codes (pdf) for National PP are 1, 2, and 3. There are no restrictions on zip code. You may enroll your eligible dependents into this plan, but should review the eligibility criteria, as defined in the LANS Summary Plan Description (pdf), before doing so.
New Mexico does not recognize "common law" marriages; therefore, only a legal spouse or eligible domestic partner may be enrolled in LANS sponsored health and welfare plans.
You may enroll yourself or an eligible family member in a LANS-sponsored medical plan if you are a newly-hired employee, have a qualified change of status, or during Open Enrollment, which is held at the Lab each November, with coverage effective January 1st of the following year.
If you are newly hired, you have a period of initial eligibility (PIE) during which you may enroll yourself and your eligible family members. Your PIE starts the day you become eligible—usually on your date of hire—and ends approximately 31 days later.
To enroll, submit a completed insurance enrollment form (pdf) to the Lab’s Benefits Office within 31 days of your PIE.
Your coverage options may change during your employment at LANS where new enrollment options may become available to you. When this happens, contact the Lab's Benefits Office immediately by calling 505-667-1806 or e-mail the Benefits Office to determine when your PIE begins. You will have a 31-day PIE from the date your employment status was changed. Please note, not all changes in employment are eligible for benefits, for example changing from a BELI 3 to a BELI 1 does not make you eligible for medical, unless you have previously selected it, as it is not a new plan option. Please review the Summary Plan Description for more details.
Families change and grow due to marriage, birth or adoption of children, and other events. If enrolling in a medical plan because of a family status change (e.g., marriage or birth of a child), you must request enrollment within 31 days from the date of the qualifying event (e.g., date of marriage or date of the child's birth).
To enroll, contact the Lab’s Benefits Office at 505-667-1806 or e-mail the Benefits Office.
If you are not enrolled in a medical plan, you and your eligible family members may enroll during Open Enrollment, which is usually held in November for coverage effective January 1st of the following year.
If you and/or an eligible family member involuntarily lose other employer-sponsored medical insurance coverage, you may enroll in one of LANS’s medical plans. A new PIE starts the day you lose coverage. You must furnish proof that other employer group coverage was lost.
To enroll e-mail the Benefits Office or call 505-667-1806.
If you are going on or returning from a change of station or extended travel and will be moving in or out of a service area, you may be able to change your insurance plan. Contact the Lab’s Benefits Office at 505-667-1806 or e-mail the Benefits Office about this change.
If you missed your PIE, you can still enroll in medical coverage at any time by submitting an enrollment form to Benefits; however, your medical coverage won’t go into effect for 90 calendar days from the day you submit your form.
LANL employees enrolled in a BCBSNM plan can easily access information on claim status. This on-line service is provided by BCBSNM and allows you to:
Insurance card. If you don’t receive your UBCBSNM card within several weeks of enrollment (45+ days) contact BCBSNM directly at 1-877-878-5265.
Contact customer service.To access information pertaining to your healthcare coverage including claims or covered services contact BCBSNM at 1-877-878-5265 or log-in to your Blue Access account.
Dispute with BCBSNM.You should first contact BCBSNM customer service directly at 1-877-878-5265 to resolve the issue. If you are unsuccessful in resolving the issue through this route, you can meet with the BCBSNM on-site advocate.
Questions? Contact the Lab's Benefits Office at 505-667-1806.