Rocky Mountain Health Plans (RMHP) - Child Health Plan Plus (CHP+)

Through the Child Health Plan Plus (CHP+) program, Rocky Mountain Health Plans (RMHP) provides low-cost health insurance benefits to children and pregnant Members 19 and older who do not qualify for Health First Colorado but do not earn enough to pay for private health insurance.

RMHP is the CHP+ physical and behavioral health Managed Care plan for Members who live in one of the following counties: Archuleta, Delta, Dolores, Eagle, Garfield, Grand, Gunnison, Hinsdale, Jackson, Lake, La Plata, Mesa, Moffat, Montezuma, Montrose, Ouray, Pitkin, Rio Blanco, Routt, San Juan, San Miguel, and Summit. Rocky Mountain Health Plans is the UnitedHealthcare Community Plan for Colorado.

RMHP helps to coordinate you or your child’s physical and behavioral health care, to include assessments and referrals, access your benefits, make sure you get the help you need - when you need it, work toward health and wellness goals to live healthier lives. RMHP works together with your or your child’s primary care provider, behavioral health provider, care teams, and other local partners to help you or your child get the care needed.

This plan is available in the following counties:

Archuleta , Delta , Dolores , Eagle , Garfield , Grand , Gunnison , Hinsdale , Jackson , La Plata , Lake , Mesa , Moffat , Montezuma , Montrose , Ouray , Pitkin , Rio Blanco , Routt , San Juan , San Miguel , and Summit .

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How you qualify.

• Colorado children age 18 and under and pregnant women.
• Individuals with a household income less than about $30,000 a year, or a family of four that makes less than about $63,000. If your household earns more, you may still qualify.
• Lawfully residing children and pregnant women.
• Children and pregnant women who do not have other health insurance or qualify for Health First Colorado (Colorado's Medicaid Program).

This RMHP CHP+ plan is available in the following counties:

Archuleta, Delta, Dolores, Eagle, Garfield, Grand, Gunnison, Hindsdale, Jackson, La Plata, Lake, Mesa, Moffat, Montezuma, Montrose, Pitkin, Ouray, Rio Blanco, Routt, San Juan, San Miguel, and Summit

To see if you qualify, you can:

• Apply Online: It's the fastest way to find out if you qualify! Apply online by visiting CO.gov/PEAK.
• Apply by Phone: Call CHP+ Customer Service at 1-800-359-1991 / State Relay: 711
• Apply In Person: Apply at your County Department of Human or Social Services Office or an application assistance site. Find a location near you at CO.gov/HCPF/CHPPlus.
• Apply by Mail: Fill out a paper application. You can mail it in or drop it off at your local County Human or Social Services Office or an application assistance site.

For more information:

• Go online to CO.gov/HCPF/CHPPlus.
• Call CHP+ Customer Service at 1-800-359-1991. CHP+ Customer Service is available Monday through Friday, 8 am to 4:30 pm (se habla español).
• Contact or visit your County Department of Human or Social Services. Find their information at CO.gov/HCPF/Counties

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Benefits & features

Preventive and Routine Care

Covered in full when provided by a primary care provider that participates with RMHP. Includes immunizations (shots), checkups, and routine exams. Children need many preventive care services. If you are not sure if your child needs preventive care services, ask your child’s primary care provider if any care is needed.

Medical Office visits are covered for Primary Care Provider (PCP) visits and specialty visits with in-network providers.

Behavioral Health/Mental Health Care Services

You do not need a referral (approval in advance) from your Primary Care Provider (PCP) to get mental or behavioral health services from a specialist, hospital, or other provider that is in RMHP’s network. Your mental health service provider may need to get approval in advance from RMHP for some services.

Example of services include but are not limited to:

• Outpatient Treatment
• Inpatient Services
• Mental Health Emergency Services
• Substance Use Disorder Services
• Medication Management
• Day Treatment
• Residential Treatment Services
• Specialized Mental Health home-based services

File a complaint about access to behavioral health care

Your health plan is subject to the Mental Health Parity Addiction Equity Act of 2008. This means that your covered behavioral health benefits cannot be more difficult to access than physical health benefits. A denial, restriction, or withholding of behavioral health services could be a potential violation of the parity act. File a complaint with the Behavioral Health Ombudsman Office of Colorado if you have a parity concern.

Behavioral Health Ombudsman Office of Colorado

A representative of the Ombudsman Office will call or reply to you directly. You can also ask your behavioral health provider or guardian/legal representative to file a complaint for you.

How to ask for an appeal for a child who is denied residential treatment

If you are a parent or guardian of a child under the age of 18 and your child was denied residential mental health treatment by, Rocky Mountain Health Plans, you have the right to request an additional review of this decision under the Child Mental Health Treatment Act (CMHTA). This review is performed by the Colorado Behavioral Health Administration. The Behavioral Health Administration will have an independent professional perform a free review or assessment of your child and provide a second opinion on your appeal. You must request this review within five (5) calendar days after we make our decision about your appeal. You may request this third-party review even if you do not request a State Review for your appeal. If you want to ask the Colorado Behavioral Health Administration to review the decision we made about your appeal, write, call, or fax:

Colorado Behavioral Health Administration

3824 W. Princeton Circle

Denver, CO 80236

Phone: 303-866-7400; State relay 711

Behavioral Health Crisis Services

We can help you find out how and where to get these services in your area. If you’re struggling or someone you love is hurting and you need to get help right away, contact Colorado Crisis Services. Coloradans can get free, confidential, and immediate help 24 hours a day, 7 days a week, 365 days a year from Colorado Crisis Services. Contact Colorado Crisis Services by calling 844-493-TALK (8255) or text TALK to 38255. You can also get online support at ColoradoCrisisServices.org.

Telehealth

CirrusMD provides the fastest connection to a board-certified doctor - answers to your healthcare questions are a text message away. Securely text, send photos, or video chat with a provider in the app right from your smartphone or computer. CirrusMD is available 24/7 for our Regional Organization (RAE), PRIME, CHP+ and DSNP Members at no cost.

What Can CirrusMD Help With?

• General Health Questions: Do you have questions about medication side effects, lab orders/results, recommended health screens, or follow up questions after recent in-person care?
• Questions About Where to Receive Care: Before you schedule an in-person appointment or go to the ER, chat with a doctor instantly on CirrusMD.
• Urgent Care: coughs, fevers, sore throat, stomach pain, rashes, allergic reactions, animal/insect bites, and pediatric care such as common viral infections
• Mental Health: anxiety, depression, stress, insomnia
• Chronic Care and Prevention: Is your asthma under good control? Questions about weight loss, smoking cessation, managing diabetes, hypertension, or acne?
• Women’s Health: birth control, irregular bleeding, urinary tract infections, wellness

Pregnancy Care

You can go to any doctor in our provider directory for covered services. This includes women’s services. It also includes care when you are pregnant. Some of these doctors are specialists like obstetricians, gynecologists, and certified nurse midwives. As soon as you know you are pregnant you need to begin your prenatal care. This care is very important in the first 8–12 weeks of you being pregnant and then continuing until you have your baby. Please call Member Services if you need help finding a prenatal provider. We can help support you during your pregnancy. We can talk to you to see if you are at risk of having your baby early. Our Care Coordinators can also help you with special issues such as: twins, breast-feeding, premature labor, diabetes, bed rest, and stop-smoking programs.

WellHop and Simplifed are programs to provide support for expectant moms during their pregnancy and beyond. Click on these links for more information: WellHop & SimpliFed.

Refer to Member handbook for more information and exclusions.

Care Coordination

Care coordination is a way that RMHP helps members coordinate services for serious illnesses or injuries or helps to provide individualized support for complex or special needs. Care Coordinators at RMHP work with your doctors to make sure they talk to each other about your care. Sometimes your doctor or hospital may tell RMHP that an RMHP member needs a Care Coordinator. Care Coordinators also check to see if other services may work for you. This helps to make sure you are getting care that is medically necessary. You can also call and ask us for help.

Here is how to reach us:

Call Member Services at 1-877-668-5947 and ask to speak to a Care Coordinator

• If you need language assistance you can call us.
• If you are Deaf, hard of hearing, or have a speech disability, dial 711 for Relay Colorado or use our Live chat on uhccp.com/CO or member secure website at myuhc.com/communityplan
• Care Coordination staff are available Monday through Friday, 8:00 a.m. to 5:00 p.m.
• After hours you can leave a message and we will call you back the next business day.

Eye Care

The following are covered vision services:

• This plan covers age-appropriate vision screening and routine eye exam.
• One routine eye exam is covered per calendar year.
• Routine vision services do not require pre-authorization.
• This plan provides a $150 credit per member per calendar year towards the purchase of lenses, frames, and/or contacts. Lenses, frames, and/or contacts can be purchased from an in-network or out-of-network provider.
• This plan covers specialty vision services to an in-network provider.
• A specialty vision service is when you see a vision provider for something other than a routine exam. Your specialty vision provider may need to submit a pre-authorization request to RMHP.
  

Dental Care

Through DentaQuest; Learn more about Adult Dental Benefits and DentaQuest (https://hcpf.colorado.gov/dental-benefits) Contact DentaQuest to find out more: 1-855-225-1729, TTY: 711 DentaQuest.com/Colorado

Dental Services through DentaQuest include: Services include cleanings, fillings, root canals, crowns, and partial dentures. There are no co-pays applicable. Limit: Annual adult (21 years old and up) benefit of up to $1,500 per state fiscal year which runs from July 1 – June 30. Emergency and dentures benefits are not subject to this limit. There is no limit for children’s services (21 years old and under). There are no exclusions. Sometimes a prior authorization is needed, check https://www.healthfirstcolorado.com/glossary/prior-authorization-request-need-one/ to determine if a prior authorization is needed.

Member Services

Have questions? Visit myUHC.com, email us at rmhp_member_services@uhc.com, or call Member Services at 1-877-668-5947, TTY 711, 8 am – 5 pm, MST, Monday – Friday.

You understand that any email you send to us outside of the MyUHC portal may have your protected health information in it. That email will be sent unencrypted. When an email is sent unencrypted there might be a risk that someone else could read it. The contents of the unencrypted email could be disclosed.

Asthma and COPD Support

Respiratory therapies are covered as ancillary services in an inpatient facility as well as in an outpatient setting. See Member Handbook for more details.

Choice of Doctor

If you want to change your PCP, go to the secure member website (myuhc.com/communityplan) and follow the steps for picking a new PCP. You can change your PCP at any time. Information in the provider directory includes the names, titles, addresses and telephone numbers of providers that are in RMHP’s network. This means you can see these providers without contacting RMHP first.

If you need a provider directory or need help finding a PCP in your area, call Member Services. RMHP’s online provider directory can be found at uhccp.com/CO or by logging into your secure member website at myuhc.com/communityplan. This directory gives you information about contracted providers in your area who speak languages other than English, and which providers accept new patients.

If you are changing doctors because you moved, call CHP+ Eligibility and Enrollment Broker, 1-888-367-6557 to let them know your address has changed. You can also update your address in your PEAK account. Call Member Services if you need help changing your PCP..

Diabetes Support

With a diagnosis of diabetes, we offer support with: inpatient nutrition counseling, outpatient nutrition and self-management training and follow-up visits for members diagnosed as diabetic.

Emergency Transport/Ambulance Services

Coverage for a life or limb-threatening emergency if transported in a licensed ambulance. See Member Handbook for more detail and exclusions.

Equipment and Medical Supplies

Durable Medical Equipment-Maximum of $2,000 per calendar year. See Member Handbook for further details for this benefit.

Home Health Care/Home Infusion Therapy

Who can provide home health care/home infusion therapy?

Benefits are provided for services performed by a home health agency that can arrange and provide nursing services, home health aide services and other therapeutic services. Home infusion therapy is when a nurse comes to your home to give you a medication intravenously (through an IV) or with a shot. Please see Member Handbook for additional covered services.

Hospitalization

Medically Necessary Covered Services for patients that are generally and typically provided by acute care general Hospitals. Hospital Services shall also include services rendered in the emergency room and/or the outpatient department of any Hospital. Except for a Medical Emergency or Written Referral, Hospital Services are Covered Services only when completed by Participating Providers. Please see Member Handbook for other details.

Individuals with Special Health Care Needs

If you are new to RMHP and you have special health care needs and are seeing a doctor that is not on our list, you can:

• Keep seeing your previous primary care doctor for 60 calendar days. You can keep getting the same ongoing care you got before you joined RMHP.
• Keep seeing your other doctors for 75 calendar days. You can keep getting the same care you got before you joined RMHP.
• Keep seeing your previous primary care doctor if you are in your fourth through ninth month of pregnancy. You can keep seeing your previous primary care doctor until you finish the care you need following the birth of your child.

Having special health care needs can be frightening and difficult, but RMHP is here to help you. We want you to follow your doctor’s treatment plan and learn about your special needs. Our nurses and Care Coordinators will work with you one-on-one.

Kidney Disease Care

Kidney Dialysis is covered with $0 copay.

Lab & X-rays

Benefits are provided for diagnostic services received in a provider’s office when they are required to diagnose or monitor a symptom, disease or condition. Benefits for diagnostic services done in a provider’s office include, but are not limited to, the following:

• X-ray and other radiology services,
• Laboratory and pathology services, and
• Ultrasound services for non-pregnancy related conditions.

For pregnancy-related ultrasounds, see the Maternity and newborn child-care section of the Member Handbook.

Language Help

If you need help with the information in any RMHP document, including written/ oral translation; or in a different format like large print or as an audio file, we can help you at no cost. You can get help by calling Rocky Mountain Health Plans (RMHP) at 877-668-5947 or State Relay 711 for callers with speech or hearing disabilities.

Si necesita ayuda con la información en cualquier documento de RMHP incluida la traducción oral/escrita, un formato diferente (como letra grande), o un archivo de audio, podemos ayudarlo sin costo. Puede obtener ayuda llamando Rocky Mountain Health Plans (RMHP) al 877-668-5947 o State Retransmisión 711 para personas con discapacidad auditiva o del habla.

Lead Screening in Children

Covered as part of wellness checkups with your Primary Care Provider.

Medicines

The most up-to-date list of prescription medications covered under this plan is on RMHP’s website at uhccp.com/CO. A paper copy is available at no cost by calling Member Services. The name of the document that lists covered prescription medications for this plan is RMHP PRIME and CHP+ formulary. The RMHP PRIME and CHP+ formulary also provides information about coverage guidelines, quantity limits, which medications that require pre-authorization, and what to do if you are prescribed a medication that is not on the list.

This plan covers up to a 90-day supply of a prescription maintenance medications from an in-network pharmacy. Some medications are limited to 30-day supplies at one time. Mail order fills up to a 90-day supply. Prescription contraceptives, including oral contraceptives (the Pill), contraceptive patches, and vaginal ring contraceptives, can be covered for up to a 12 month (1 year) supply after filling 3 months of the same contraceptive. Please see Member Handbook for more information.

Quit using Tobacco or Vaping Products

Free QuitLine tobacco cessation counselor — Call 800-QUIT-NOW (800-784-8669) or visit www.coquitline.org

Shots and Vaccines

Covered as part of regularly scheduled childhood and adult preventive services.

Therapy Services

Coverage for outpatient physical rehabilitation (physical, occupational, and/or speech therapy) includes up to 30 visits per calendar year per diagnosis.

For children ages 0-3, additional therapies as described above, are unlimited for those members who qualify for Early Intervention Services.

Member resources

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Member resources

Rocky Mountain Health Plans CHP+

We want to make it as easy as possible for you to get the most from your health plan. As our member, we provide member communication and materials to inform and educate you on your plan’s benefits and the resources available.

You can download from the options below or call Member Services at 1-877-668-5947 to request a copy (in large print, other format, or other language) be mailed to you within 5 business days, at no cost.

Welcome Letter

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Clinical Practice Guidelines

These Clinical Practice Guidelines (“Guidelines”) are not meant to replace the clinical judgment of a Member’s physician or other professional health care provider (collectively, “Providers”). As such, these Guidelines do not establish a standard of care or practice or replace appropriate clinical decision-making. These Guidelines must always be used in the context of a health care Provider's clinical judgment in the care of a particular patient.

For that reason, Guidelines may be viewed as an educational tool to provide information and assist Members and Providers in choosing appropriate health care for specific clinical conditions and diagnoses. Deviations from the Guidelines may be necessary and appropriate in certain individual circumstances.

Publication of these guidelines is not a promise or guarantee of coverage. Individuals should review their coverage documents or contact RMHP Member Services at 1-877-668-5947 to determine what health care services are covered benefits and if other conditions or limits of coverage apply.

For more information around clinical guidelines, please visit: Clinical Practice Guidelines for RMHP

Colorado SSUM Guidelines - Under 21 Years Old

Social needs

The Family Healthline is a statewide telephone information and referral service (English and Spanish) that provides callers with the eligibility criteria and resources for Colorado health care programs that provide services to pregnant women, children and individuals. Resources include indigent medical care, vision, dental, mental health care programs and nutrition programs. Information is also available about services for emergency shelters, domestic violence counseling, victim assistance programs, legal aid, housing assistance, abstinence education, family planning and other services as needed. Call 1-800-688-7777 for more information.

How to Contact Us

Visit myUHC.com, email us at rmhp_member_services@uhc.com, or call Member Services at 1-877-668-5947, TTY 711, 8 am – 5 pm, MST, Monday–Friday.

Para Asistencia en espanol, llame al 877-668-5947. Espanol representates de Servicio al Cliente estan disponibles. Tenemos este libro en espanol.

Tell us if you need interpreter services or help in other languages or format. There is no cost for these services.

Advance directives

An advance directive is a type of written instruction about the health care to be followed if you become unable to make decisions about medical treatment. You prepare your Advance Directive when you are able to make these decisions. Then, if there is a time when you are unable to make health treatment decisions, the directive will be followed. These instructions do not take away your right to decide what you want, if you are able to do so at the time a decision is needed.

Member handbook

Member Handbook

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Find a provider

How to Enroll

Health First Colorado specialists can answer questions

Office Hours: Monday - Friday from 8 am - 4:30 pm MST

How to Disenroll

It is your choice to have RMHP CHP+. During the first 90-days of your enrollment or at your annual renewal, you have the option to change MCO's if you live in a county where more than one MCO is offering a CHP+ plan.

You can disenroll from Colorado's Child Health Plan Plus (CHP+) program at any time for any reason. You will need to contact the county or organization that processed your CHP+ application and tell them that you want to disenroll. If you get other insurance, become covered by Health First Colorado, or move out of Colorado, you are no longer eligible for CHP+.

MyRMHP Member Portal

If you have registered for MyRMHP Member Portal, you can access your 2022 information here: www.rmhp.org/member-login

Member newsletters

2024

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RMHP organizational documents

It's important for us to ensure our Members, partners, and stakeholders have the information needed to learn about our Regional Accountable Entity initiative. Please, please find the relevant reports and resources.

• Governance Plan
• Annual Quality Report
• Annual Quality Improvement Plan
• Population Management Strategic Plan
• Annual Network Management Strategic Plan (Includes Practice Support Plan and Administrative Payment Report)
• Quarterly Network Report
• Regional Program Improvement Advisory Council Materials/Minutes
• Member Advisory Council Materials/Minutes

CirrusMD for RMHP

CirrusMD provides the fastest connection to a board-certified doctor - answers to your healthcare questions are a text message away. Securely text, send photos, or video chat with a provider in the app right from your smartphone or computer. CirrusMD is available 24/7 for our Regional Organization (RAE), PRIME, CHP+ and DSNP Members at no cost.

What Can CirrusMD Help With?

• General Health Questions: Do you have questions about medication side effects, lab orders/results, recommended health screens, or follow up questions after recent in-person care?
• Questions About Where to Receive Care: Before you schedule an in-person appointment or go to the ER, chat with a doctor instantly on CirrusMD.
• Urgent Care: coughs, fevers, sore throat, stomach pain, rashes, allergic reactions, animal/insect bites, and pediatric care such as common viral infections
• Mental Health: anxiety, depression, stress, insomnia
• Chronic Care and Prevention: Is your asthma under good control? Questions about weight loss, smoking cessation, managing diabetes, hypertension, or acne?
• Women’s Health: birth control, irregular bleeding, urinary tract infections, wellness

myUHC member portal

myUHC.com/CommunityPlan/CO is the secure member website for RMHP CHP+. See your covered benefits, search for providers, view your member handbook and much more.

Notice of privacy practices

RMHP is committed to protecting the confidentiality of your medical information to the fullest extent of the law. In addition to the laws that govern your privacy, RMHP has its own privacy policies and procedures to help protect your information. If you would like a copy of RMHP’s privacy policies and notices, visit Notice of Privacy Practices, refer to Notice of Privacy Practices in the Member handbook, or call Member Services.

Member Rights and Responsibilities

As a Member, you have the right

• To get information about RMHP and its services, doctors, and health care providers and to get information about your rights and responsibilities
• To be treated with respect and with recognition of your dignity and right of privacy
• To accept or refuse medical treatment to the extent provided by Colorado state law and to participate in making decisions about your health care
• To have open discussions with health care providers about appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage, and presented in a manner appropriate to your condition and ability to understand
• To make appeals, and to bring complaints to RMHP or the Department of Health Care Policy and Financing
• To be furnished with health care services in accordance with federal health care regulations for access and availability, care coordination and quality
• To expect all communications regarding your care to be kept confidential as required by law
• To freely exercise your rights without being treated differently
• To be free from the use of physical restraint or being isolated. These methods may not be used to make you cooperate, to punish you, for the ease of the caregiver, or as a way of getting back at you.
• To get family planning services from any enrolled provider that serves CHP+ members in or out of RMHP’s network, with no referral
• To request and receive your medical records and to have them changed according to federal law
• To get a second opinion with no referral
• To be free from discrimination based on race, color, national origin, age, disability, sex, sexual orientation, or gender identity
• To make recommendations regarding RMHP’s rights and responsibilities policy
• To use any hospital or other setting for emergency care

As a Member you have the responsibility

• To choose a Primary Care Physician (PCP) for each member of your family and to let that PCP know of any Advance Directive regarding your medical care
• To let your PCP direct your care with specialists and other health care providers, except in cases of medical emergencies, urgent care when outside the service area, obstetrical or gynecological care, and eye care
• To learn about your RMHP health care benefits, procedures, and limitations and to be cooperative and considerate with health care providers and staff
• To notify Member Services of membership or address changes, marriage, birth of a child, or adoption of a child
• To take responsibility for copayments and costs for certain health care services and any services that are not covered by CHP+
• To provide the health care provider with all information needed for you to receive appropriate care and to follow the care and instructions agreed upon with your provider
• To follow the plans and instructions for care that you and your provider agreed on
• To tell your providers about any Advance Directives about your health care if you choose to do this
• To follow any protocols of a responsible third-party payor (such as other insurance) prior to receiving any non-emergency services
• To provide RMHP with written notice after filing a claim or action against a third party responsible for your illness or injury
• To understand your health problems and participate in making treatment goals
• To tell RMHP about any other insurance you may have, including Medicare
• To file a complaint or grievance, please follow the rules as described in the Appeal and grievance section of the Member handbook

Filing a Grievance or Appeal

You have many rights as an RMHP Colorado CHP+ member. You have the right to complain about RMHP. You have the right to complain about your care. You, your provider or a Designated Client Representative may complain about anything you are unhappy about or have a problem with. To get more information about appeals and grievances refer to your Member Handbook or call Member Services.

Translation resources

If you need help with the information in this document, including written/oral translation; or in a different format like large print or as an audio file, we can help you at no cost. You can get help by calling Rocky Mountain Health Plans (RMHP) at 877-668-5947 or State Relay 711 for callers with speech or hearing disabilities.

Member forms

Pharmacy Reimbursement Form

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Release of information Form

This form is used to give another person permission to receive or give information about you and your health.

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Revocation of Release Form

This form takes away permission for someone to receive or give information about you and your health.

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Access to care standards

RMHP wants to help our Members get care from providers close to where you live.

For CHP+ we strive to make sure there are at least two behavioral health providers within your zip code or within these distances:

• In urban areas, within a maximum time of 30 minutes or a maximum distance of 30 miles
• In rural areas, within a maximum time of 60 minutes or a maximum distance of 60 miles
• In frontier areas, within a maximum time of 90 minutes or a maximum distance of 90 miles

For CHP+ we strive to make sure there are at least two physical health providers within your zip code or within these distances:

• In urban areas, within a maximum time of 30 minutes or a maximum distance of 30 miles
• In rural areas, within a maximum time of 45 minutes or a maximum distance of 45 miles
• In frontier areas, within a maximum time of 60 minutes or a maximum distance of 60 miles

For CHP+ we strive to make sure there are at least two specialty care providers within your zip code or within these distances:

• In urban areas, within a maximum time of 30 minutes or a maximum distance of 30 miles
• In rural areas, within a maximum time of 45 minutes or a maximum distance of 45 miles
• In frontier areas, within a maximum time of 100 minutes or a maximum distance of 100 miles

CHP+ providers should follow the following appointment timeliness standards:

• Behavioral Health
  • Urgent Care – within 24 hours of initial identification of need
  • Outpatient follow-up – within 7 days after discharge from a hospital
  • Non-urgent, symptomatic care visit – within 7 days after the request
  • Well Care Visit – within 1 month after the request, or in accordance with the Bright Futures Schedule.
  • Emergency behavioral health care
    • By phone within 15 mins after initial contact,
    • In person within 1 hour of contact in urban and suburban areas
    • In person within 2 hours of contact in rural and frontier areas
    • Emergency – 24 hours a day, 7 days a week
    • Urgent Care – within 24 hours of initial identification of need
    • Outpatient follow-up – within 7 days after discharge from a hospital
    • Non-urgent, symptomatic care visit – within 7 days after the request
    • Well Care Visit – within 1 month after the request, or in accordance with the Bright Futures Schedule.
    • Members should not be placed on a waiting list for any initial routine service requests

    Learn More

    Rocky Mountain Health Plans - Child Health Plan Plus (CHP+)

    • Frequently Asked Questions
    • Links to Health Information

    Enrollment information

    Ready to get started?

    Child Health Plan Plus (CHP+) specialists can answer questions
    

    Call us: 1-800-221-3943 / TTY: 711

    Office Hours: Monday - Friday from 8 am - 5 pm MST

    You have chosen to enroll in

    This plan is not currently available in the ZIP code entered.

    Enrollment information

    Ready to get started?

    Child Health Plan Plus (CHP+) specialists can answer questions
    

    Call us: 1-800-221-3943 / TTY: 711

    Office Hours: Monday - Friday from 8 am - 5 pm MST

    You have chosen to enroll in

    This plan is not currently available in the ZIP code entered.

    Member information

    Already a member? You have access to myUHC.com where you can view your benefits, Print ID cards, and more.

    Member Handbook

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    Other format needs?

    We offer our materials in large print, audio files and Braille. Call us today to let us know if you need information in a different format.
    

    Member information

    Already a member? You have access to myUHC.com where you can view your benefits, Print ID cards, and more.

    Member Handbook

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    Individual & Family ACA Marketplace Plans Disclaimer (scroll within this box to view)

    The benefits described may not be offered in all plans or in all states. Some plans may require copayments, deductibles and/or coinsurance for these benefits. This policy has exclusions, limitations, reductions of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, review your plan documents, call or write your insurance agent or the company, whichever is applicable. Plan specifics and benefits vary by coverage area and by plan category. Please review plan details to learn more.

    UnitedHealthcare Individual & Family plans medical plan coverage offered by: UnitedHealthcare of Arizona, Inc.; Rocky Mountain Health Maintenance Organization Incorporated in CO; UnitedHealthcare of Florida, Inc.; UnitedHealthcare of Georgia, Inc; UnitedHealthcare of Illinois, Inc.; UnitedHealthcare Insurance Company in AL, KS, LA, MO, NJ, and TN; Optimum Choice, Inc. in MD and VA; UnitedHealthcare Community Plan, Inc. in MI; UnitedHealthcare of Mississippi, Inc.; UnitedHealthcare of New Mexico, Inc.; UnitedHealthcare of North Carolina, Inc.; UnitedHealthcare of Ohio, Inc.; UnitedHealthcare of Oklahoma, Inc.; UnitedHealthcare of South Carolina, Inc.; UnitedHealthcare of Texas, Inc.; UnitedHealthcare of Oregon, Inc. in WA; and UnitedHealthcare of Wisconsin, Inc. Administrative services provided by United HealthCare Services, Inc. or its affiliates.

    This policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company, whichever is applicable. By responding to this offer, you agree that a representative may contact you.

    1 Unless otherwise required, benefits are available only when services are delivered through a Designated Virtual Network Provider. Virtual visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times, or in all locations, or for all members. Check your benefit plan to determine if these services are available. Data rates may apply. Certain prescriptions may not be available and other restrictions may apply.

    2 Tier 2 prescriptions for $5 or less not available on all medications. 3-month fills apply to select maintenance medications only. Applicable formulary requirements such as prior authorization and quantity limits may apply to your pharmacy benefits. Walgreens discount valid until 12/31/24. Discount valid only for in-store purchases of eligible Walgreens brand health and wellness products by current members eligible for the UnitedHealthcare discount program. Discount cannot be used online. For a full list of Walgreens brand health and wellness products and exclusions, please visit www.walgreens.com/smartsavings.

    Last Updated: 08.21.2024 at 10:19 PM CDT

    Disclaimer information (scroll within this box to view)

    Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

    UnitedHealthcare Dual Complete plans

    Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

    Premium disclaimer

    Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy).

    Benefit disclaimer

    Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.

    Nurse Hotline disclaimer

    This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your provider's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time. Nurse Hotline not for use in emergencies, for informational purposes only.

    UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan)

    UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees.

    UnitedHealthcare Connected® (Medicare-Medicaid plan)

    UnitedHealthcare Connected® (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

    UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan)
    

    UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees.

    UnitedHealthcare Connected® general benefit disclaimer

    This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the member handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® member handbook.

    UnitedHealthcare Senior Care Options (HMO SNP) plan

    UnitedHealthcare Senior Care Options (SCO) is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare and does not have any other comprehensive health Insurance, except Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our Senior Care Options (SCO) program.

    Star ratings disclaimer

    Every year, Medicare evaluates plans based on a 5-Star rating system. The 5-Star rating applies to plan year 2024.

    Important provider information

    The choice is yours

    We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs.

    The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

    Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

    Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

    American Disabilities Act notice

    In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

    Referrals

    Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

    Paper directory requests

    Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

    Inaccurate information

    To report incorrect information, email provider_directory_invalid_issues@uhc.com. This email box is for members to report potential inaccuracies for demographic (address, phone, etc.) information in the online or paper directories. Reporting issues via this mail box will result in an outreach to the provider’s office to verify all directory demographic data, which can take approximately 30 days. Individuals can also report potential inaccuracies via phone. UnitedHealthcare Members should call the number on the back of their ID card, and non-UnitedHealthcare members can call 1-888-638-6613 / TTY 711, or use your preferred relay service.

    Declaration of disaster or emergency

    If you’re affected by a disaster or emergency declaration by the President or a governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

    • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non-contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
    • Where applicable, requirements for gatekeeper referrals are waived in full;
    • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
    • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

    If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.