Rocky Mountain Health Plans

Colorado Doctors Plan Bronze 6500 $3 Walgreens

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Major Dental Care

Links

Plan Overview

Medical Deductible	Individual: $6,500 Family: $13,000 Per Person: $6,500
Prescription Drug Deductible	Individual: $0 Family: $0 Per Person: $0
Combined Medical and Drug Out of Pocket Maximum	Individual: $8,700 Family: $17,400 Per Person: $8,700

Office Visit

Primary Doctor	CoPay: $25.00 CoInsurance: Not Applicable Covered: Covered
Specialist	CoPay: Not Applicable CoInsurance: 40.00% Coinsurance after deductible Covered: Covered

Prescription Drug Information

Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: 40.00% Coinsurance after deductible Covered: Covered Benefit Explanation: 6-Tier drug plan - Please refer to SBC for plan benefits.
Non Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: 40.00% Coinsurance after deductible Covered: Covered Benefit Explanation: 6-Tier drug plan - Please refer to SBC for plan benefits.
Generic Drugs	CoPay: $35.00 CoInsurance: Not Applicable Covered: Covered Benefit Explanation: 6-Tier drug plan - Please refer to SBC for plan benefits.
Specialty Drugs	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered Benefit Explanation: 6-Tier drug plan - Please refer to SBC for plan benefits.

Inpatient Coverage

Hospital Services	CoPay: Not Applicable CoInsurance: 40.00% Coinsurance after deductible Covered: Covered
Inpatient Services	CoPay: Not Applicable CoInsurance: 40.00% Coinsurance after deductible Covered: Covered

Emergency and Urgent Care

Emergency Room	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered
Urgent Care Facility	CoPay: $75.00 CoInsurance: Not Applicable Covered: Covered Benefit Explanation: Behavioral/Mental Health/Substance Use Disorders - no charge

Maternity

Labor and Delivery Hospital Stay	CoPay: Not Applicable CoInsurance: 40.00% Coinsurance after deductible Covered: Covered
Pre and Postnatal Office Visit	CoPay: Not Applicable CoInsurance: 40.00% Coinsurance after deductible Covered: Covered Benefit Explanation: Prenatal preventive care is no charge in-network.

Vision

Routine Eye Exams For Children

CoPay: No Charge
CoInsurance: No Charge
Covered: Covered
Limit Quantity: 1
Limit Unit : Visit(s) per Year

Major Dental Care

Routine Dental Checkups for Children	CoPay: No Charge CoInsurance: No Charge Covered: Covered Limit Quantity: 1 Limit Unit : Visit(s) per 6 Months
Routine Dental Checkups for Adults	Covered: Not Covered
Basic Dental Care - Adult	Covered: Not Covered
Basic Dental Care - Child	CoPay: No Charge CoInsurance: No Charge Covered: Covered Limit Quantity: 1 Limit Unit : Item(s) per Year
Major Dental Care - Adult	Covered: Not Covered
Major Dental Care - Child	CoPay: No Charge CoInsurance: No Charge Covered: Covered Limit Quantity: 1 Limit Unit : Item(s) per Year

Related Articles

You may be interested in these relevant articles from across the HealthMarkets.com network.

Summer Safety: 8 Kid-Friendly Tips for Warmer Weather

Got a summer safety plan for your kids? When warm weather arrives, chances are…Read More

Read More

Supplemental Vision Insurance: 10 Clear Benefits You May Need to See

Thinking you might need supplemental vision insurance to help keep your eyes healthy? See…Read More

Read More

What Every Medicaid Member Needs to Know About Redetermination

In September 2021, a research report from the Urban Institute made a startling prediction:…Read More

Read More