New Mexico Health Connections | my connection | Spring 2017

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THE FUTURE OF THE AFFORDABLE CARE ACT
Numbers you
need to know
CUSTOMER SERVICE:
855-769-6642,
Monday through Friday,
8 a.m. to 5 p.m.
•Benefits.
•ID cards.
•Billing questions.
•Claims questions, status
and reconsiderations.
•Member login help.
•General information.
OPTUMRX,
OUR PHARMACY
BENEFIT MANAGER:
855-577-6550
BRIOVARX®, OPTUMRX’S
SPECIALTY PHARMACY:
866-618-6741
Message
from
Martin
Martin Hickey, MD, CEO of New Mexico Health Connections
A s I write this, health insurance coverage is being hotly debated once again by
Congress and the Trump administration. They have pledged to repeal and
replace the Affordable Care Act (ACA).
The dialogue about ACA’s future is noisy and raucous. Some of you may
be worried about your health insurance. We don’t yet know how the marketplace will
change. But I would like to offer you some reassurance as our nation works through this
very important issue.
The ACA did reach its goal of providing health insurance to millions more Americans.
However, parts of the law were not working out as planned. Those parts need to be fixed
so that health insurance becomes and stays affordable for more people.
Recently I met with leaders of both parties in Washington, DC, about the future of
the ACA. Despite the drama playing out, there is a true commitment within our national
leadership to crafting a healthcare law that is fair, affordable and accessible. At present, it
appears that little is likely to change for 2017, or perhaps even longer.
At NMHC, we are doing all we can to be ready for changes to the insurance market-
place so that we can continue to offer you the best possible health insurance choices for
you, your family and your business. NMHC has a secure future and is well-positioned to
handle any challenges. I will continue to be a strong advocate in the national debate for
you, our members, and for our innovative model of coverage.
{ G O O N L I N E }
HEALTH
OF MIND
Finding a
behavioral
health provider
2
MEDICATION
SAFETY
Could you be
putting your
health at risk?
3
What is a Summary
of Benefits and
Coverage?
Every health plan is required to give
its members a Summary of Benefits and
Coverage (SBC). SBCs offer you a brief
overview of your health plan benefits and
your out-of-pocket costs.
Learn more about SBCs, why they are
required and how you can find yours online:
(look under the 2017 “Summaries of Benefits
and Coverage” heading).
2440 Louisiana Blvd. NE, Suite 601
Albuquerque, NM 87110
Standard
U.S. Postage
PAID
Walla Walla, WA
Permit No. 44
Important health plan benefits for women
Know your mastectomy benefits
Your health plan provides benefits for mastectomy-related services. This
includes all stages of reconstruction and surgery to achieve symmetry
between the breasts. It also includes prostheses and treatments for complica-
tions resulting from a mastectomy, including lymphedema. These benefits
are required by the Women’s Health and Cancer Rights Act of 1998. Call
Customer Service at 855-7MY-NMHC (855-769-6642) to learn more.
Delivery requires a minimum hospital stay
New Mexico law requires at least 48 hours of inpatient care after a vagi-
nal birth and at least 96 hours after a Cesarean section. Only the doctor
in charge of the mother’s and baby’s care can decide to reduce the period
of inpatient care for the mother or baby. The doctor must talk with the
mother before making that choice. To learn more, please see the “Mater-
nity Care” benefit description in your Member Handbook (also called an
Evidence of Coverage).