Rocky Mountain Health Plans

RMHP Colorado Doctors Plan Bronze Copay Focus ($0 Virtual Urgent Care, No Referrals)

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Links

Summary Of Benefits

Plan Overview

Prescription Drug Deductible	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical
Medical Out-of-Pocket Maximum	Individual: $9,200 Family: $18,400 Per Person: $9,200
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Office Visit

Primary Doctor	Standard: Copay: $40.00 \| Coinsurance: Not Applicable
Specialist	Standard: Copay: $130.00 \| Coinsurance: Not Applicable

Prescription Drug Information

Preferred Brand Drugs	Standard: Copay: Not Applicable \| Coinsurance: 40.00% Coinsurance after deductible
Non Preferred Brand Drugs	Standard: Copay: Not Applicable \| Coinsurance: 45.00% Coinsurance after deductible
Generic Drugs	Standard: Copay: $30.00 \| Coinsurance: Not Applicable
Specialty Drugs	Standard: Copay: Not Applicable \| Coinsurance: 50.00% Coinsurance after deductible

Inpatient Coverage

Hospital Services	Standard: Copay: $3000.00 Copay per Day \| Coinsurance: Not Applicable
Inpatient Services	Standard: Copay: Not Applicable \| Coinsurance: Not Applicable

Emergency and Urgent Care

Emergency Room

Standard: Copay: $1,750.00 | Coinsurance: Not Applicable