Presbyterian
About the Plan
The Presbyterian medical plan is available to active benefits-eligible employees and provides access to these networks. To find a provider under this plan, visit Presbyterian.
UNM LoboCare Network
Tier 1
UNM Health System
Optum Health (formerly DaVita Medical Group)
First Choice Community Health Providers and Facilities
LoboCare Clinic for same-day or next-day acute care appointments
Presbyterian In-Network
Tier 2
Presbyterian Health Plan providers, hospital/clinic facilities and pharmacies within New Mexico.
Nationally, outside of New Mexico for in-network tier 2 level coverage, members may access the Multi-Plan Network.
Out of Network
Tier 3
Only usual and customary charges are covered
Providers and facilities not contracted with your Third-Party Administrator (TPA). Notify your TPA first to receive the maximum available benefit if you use this option.
FY27 (July 1, 2026 – June 30, 2027) plan year
When and How to Enroll
First, verify your eligibility.
Next, you may take advantage of these three enrollment opportunities:
- When you are newly hired or newly eligible for benefits
- During the annual Open Enrollment period, typically held in April/May
- When you experience a Qualifying Change in Status
Finally, if you are enrolling dependents, be prepared to provide “proof documentation”. Some Examples of Dependent Proof Documents are available here. Deadlines for submission of these documents vary in accordance with the enrollment opportunities listed above.
Note: If you separate from employment, termination of coverage will occur; however, you may elect to continue coverage in accordance with COBRA.
Using Your Presbyterian Medical Benefit
- Use an In-Network provider and find doctors, services, and hospitals on phs.org.
Or;
Use an Out-of-Network provider where only usual and customary charges are covered, and providers and facilities are not contracted with your third-party administrator (TPA). Notify your TPA first to receive the maximum available benefit if you use this option. - Make an appointment with your selected provider.
- Present your medical ID card. Presbyterian ID Cards will be created for each plan participant and mailed to the primary member by Presbyterian.
- Refer to UAP 3410, Sick Leave for time away from work for medical services.
- For information about your prescription drug benefits, see the Prescription Drug Plan page.