Rocky Mountain Health Plans
Rocky Mountain Health Plans, a subsidiary of UnitedHealthcare, is a non-profit organization that has been providing Coloradans with quality health plans since their founding in 1974. Today, Rocky Mountain Health Plans (RMHP) covers more than 211,000 people statewide.
The company is based in Grand Junction, and has regional offices in Pueblo, Denver, Colorado Springs, and Durango.
Rocky Mountain Health Plans Financial Strength & Liquidity
Every insurance policy is only as good as the company’s financial capacity to stay in business and pay claims. That’s why financial ratings are an important factor in choosing an insurance company.
RMHP enjoys an A+ rating from Weiss Ratings, which is the highest grade in their rating system, and earns them a place on their prestigious Recommended List, and places Rocky Mountain Health Plans in the top 3.8% of all health insurance carriers.
Understanding the ACA Metallic Plan Tiers in Colorado
Colorado residents have a wide range of Affordable Care Act-qualified plan choices, including health maintenance organizations (HMOs), preferred provider organizations (PPOs), and high-deductible health plans, which allow policyholders to make tax-advantaged contributions to health savings accounts (HSAs).
Rocky Mountain Health Plans offers many health plans via the Connect For Health Colorado marketplace. This means that these plans are eligible for premium tax credits under the Affordable Care Act for lower and middle-income families and individuals.
Like other providers of ACA-qualified plans, RMHP offers their HMO and PPO plans in three “metallic” tier levels: Bronze, Silver, and Gold.
Bronze plans cover 60% of your medical costs once you meet your annual deductible. You are responsible for 40%, up to your plan’s maximum out-of-pocket limit.
These plans have lower monthly premiums than other options. But you retain more risk, and pay more in the event you need medical care.
Silver plans, which are eligible for ACA premium subsidies, cover 70% of your medical costs after you meet your annual deductible. You are responsible for the remaining 30%, up to the annual out-of-pocket limit.
Gold plans offer a high level of coverage and broadest range of protections. They also have higher monthly premiums than the lower tiers. These plans cover 80% of your medical costs after you meet your deductible. You are responsible for the remaining 20%, up to the annual out-of-pocket limit.
Platinum plans have the highest benefit levels and the lowest out-of-pocket exposure to medical costs. They also have higher premiums than the other plan tiers. Platinum plans cover 90% of your medical costs after you meet your deductible. You are responsible for the remaining 10%, up to the annual out-of-pocket limit.
What’s the Out of Pocket Limit?
As of 2023, the ACA annual maximum out of pocket limit for all plan tiers is $9,100. Once you spend the out-of-pocket limit amount out of pocket on qualified health care expenses, your plan covers 100% of costs for the plan 2023
Rocky Mountain Health Plans Available in Colorado
This is RMHP’s most budget-friendly plan, with the lowest monthly premiums. It’s a good solution if you want your plan to focus on catastrophic coverage, and you are willing to pay more out of pocket for routine or minor illnesses and injuries.
Depending on your income and the size of your household, the Essential plan may be as low as $0, after accounting for the Obamacare subsidy. This plan is only available at the Bronze tier. So you would be responsible for up to 40% of medical costs after your deductible, up to the annual out-of-pocket limit.
With the Essential plan, you receive free visits with your primary care doctor once you meet your deductible. (With higher-tier RMHP plans, you enjoy this benefit right away).
Virtual First plans focus on cost reduction by maximizing virtual medical services like Telehealth. It’s ideal for frequent travelers and digital nomads, because you can access virtual care 24/7 from anywhere in the world you have Internet access.
This plan leverages the innovative Galileo mobile app. This plan is available at the Bronze and Silver tiers.
The Value plan features affordable, low-copay primary care visits, along with robust access to money-saving virtual care and telemedicine using the Galileo app.
The RMHC’s Value plan is a great fit if you want to see your doctor fairly often, and you need some more protections and benefits compared to the Essential plan.
Colorado residents can get a RMHP Value plan in Bronze, Silver, and Gold metal levels. You can also get a high deductible version that qualifies for HSA contributions.
The Advantage plan is RMHP’s premier plan, with the highest levels of coverage. It’s best for people who expect to spend more than their deductible, who consume a lot of healthcare, and who are able to pay a higher premium each month to receive more benefits.
Unlike the other RMHP plans, Advantage plans are available with adult vision and dental benefits embedded with the plan. With the other plans, you would have to purchase vision and dental insurance or discount plans separately.
High Deductible Rocky Mountain Health Plans and HSAs
Rocky Mountain Health Plans offers a number of high-deductible health plans (HDHPs). These plans allow otherwise qualified people to save potentially thousands of dollars by making pre-tax contributions to a health savings account (HSA).
These accounts provide a triple tax benefit:
Contributions are pre-tax.
Assets in HSAs grow tax-deferred as long as they’re held within the account
Withdrawals from HSAs to pay for qualified healthcare expenses are tax-free.
Rocky Mountain Health Plans Prescription Drug Coverage
Most Rocky Mountain Health Plans include prescription drug coverage at six different tier levels, depending on the drug.
Tier 1 drugs are generic preventive drugs and are available at zero cost to plan members.
Tier 6 drugs are high-cost specialty drugs, and have the highest copays, though total cost-sharing, including deductibles, copays, and coinsurance is limited to the annual out of pocket limit mentioned above.
Some higher-tier drugs may require prior authorization from RMHP. There may also be quantity limits.
If you’re currently taking prescription medications, it’s a good idea to check whether your medication is listed on the plan formulary, and what your possible copay or other out-of-pocket costs may be.
Your ColoHealth Personal Benefits Manager can help you with that, as well as help you check whether your care providers or pharmacies are included in the plan’s network.
You can contact us for assistance here. It’s free!
Primary Care Access
Most Rocky Mountain Health Plans (other than Essentials) provide unlimited access to your matched primary care provider with a zero-dollar copay, even before you meet your deductible. RMHP’s Essential plan provides this benefit, but only after you meet your deductible for the year.
Unlimited Virtual Urgent Care Benefits
Most Rocky Mountain Health Plans (other than Essential) provide unlimited access to virtual urgent care via the Galileo app, even before you meet your deductible. The Essential plan provides this benefit after you meet your deductible for the year.
This urgent care benefit is available 24/7.
Digital Fitness Classes
RMHP members enjoy access to a premium library with thousands of digital fitness classes – both live and on-demand – included with their health plans.
Rocky Mountain Health Plans Frequently Asked Questions
Yes. RMCP offers a very competitive set of plan options for Colorado employers of all sizes.
RMCP group health plans include a full set of preventive care services at no cost to the employee or covered family member.
These benefits include:
- Physicals, and
- Routine exams
- Pap smears
- Colon cancer screenings
- Prostate cancer screenings
Seasonal flu shots are offered at zero cost to members. Groups over 25 may receive support for an on-site seasonal flu vaccination program.
To arrange a free group health plan design analysis, consultation, and quote, contact a ColoHealth Personal Benefits Manager.
It’s a good idea to have a plan census available, including any family members you want covered, if possible – along with ages and smoking status.
When Can I Sign Up with Rocky Mountain Health Plans?
Most people should sign up for a Rocky Mountain Health Plan during the Colorado Open Enrollment Period, which runs from November 1st through January 15th. During this period, you get a guaranteed right to enroll in the plan of your choice, regardless of your medical history. You cannot be turned down because of your medical condition.
However, if your income is below 150% of the poverty line for your household size, you may be eligible for guaranteed year-round enrollment.
You may also be eligible for a limited 60-day special enrollment period if you have a qualifying life event. Examples include:
- Losing your prior health care coverage
- Getting married or divorced
- The birth or adoption of a child
- Change in citizenship status
- Significant change in income that may affect your eligibility for an ACA subsidy.
If you do not qualify to enroll right now, you may want to consider a health sharing plan, which allows year-round enrollment. For more on whether you may qualify for a special enrollment period, or for help enrolling in a Colorado health plan, contact your ColoHealth personal benefits manager.
Can I use a broker or agent? Or do I have to sign up with Rocky Mountain Health Plans on the Connect For Health Colorado Exchange?
It’s a great idea to get professional advice and guidance from a health insurance broker, such as a ColoHealth Personal Benefits Manager. Your PBM can help you analyze all your healthcare options, both on and off the Connect for Health Colorado exchange.
If an exchange plan is best for you, your PBM can help you enroll – all at zero cost to you!
When you use a broker or agent, the insurance carrier pays their commission, not you.
So you can enroll via ColoHealth and get the benefit of expert health insurance advice and ongoing support and education – essentially free!
If you’re eligible for an Affordable Care Act subsidy, your ColoHealth PBM can help you maximize the value of that subsidy, and make sure you’re enrolled in the best plan possible for you and your family.
Does Rocky Mountain Health Plans require me to get a referral before seeing a specialist?
Yes, if your plan is an HMO, or health maintenance organization, except for emergency care. You would get your referral from your primary care physician assigned to you by your plan. However, you can get this referral using your telemedicine benefit at no cost to you (for all plans except Essentials, which provides this benefit after you reach your annual deductible.
If your plan is a PPO, or preferred provider organization, you do not need to get a referral before seeing a specialist. But except for emergency care, you should see a specialist within your plan network to receive full coverage.
Do I need to use in-network providers with Rocky Mountain Health Plans?
For non-emergency care, you need to use authorized, in-network care providers for non-emergency care. Otherwise you’ll receive reduced coverage or no coverage from your RMHP. This is generally the case with all HMOs and PPOs.
However, emergency care is covered at any provider, in or out of your RMHP network.
HEALTH INSURANCE INFORMATION
- Plans approved and authorized under the Affordable Care Act
- Covers Pre-Existing conditions
- Low cost subsidized plans available to those earning
< 400% of the federal poverty level
- Unlimited lifetime benefits
- Available during open enrollment (November 1 – January 15), or if you qualify for a Special Enrollment Period
HEALTH COST-SHARING INFORMATION
- Not health insurance, but a way for like-minded individuals to share medical expenses
- Waiting periods on pre-existing conditions
- May exclude sharing for certain conditions or activities
- Enroll any time
- Much lower monthly cost than unsubsidized health insurance
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