Medical
Denver Health offers two medical plan options through the Denver Health Medical Plan.
Before you enroll in medical coverage, take some time to fully understand how each plan works.
ASK YOURSELF THESE QUESTIONS:
Do you live in the Denver area and plan to use the Denver Health network and services?
Consider the Denver Health Plan (HMO). You will pay less from your paycheck each pay period for coverage, and have lower costs at the time of service, when visiting providers and facilities in the Denver Health network.
Do you or your covered dependents live outside of the Denver area?
Consider the Denver Health Extended Plan (POS). While you will pay more from your paycheck each pay period for coverage, you will have access to a wider selection of providers and facilities outside of the Denver Health network and area.
Can you set aside money from your paycheck to help pay for out-of-pocket expenses?
Consider funding a flexible spending account (FSA). Both plans allow you to fund a health care FSA to pay for eligible expenses with tax-free dollars.
MEDICAL COSTS
Listed below are the biweekly costs (24 pay periods) for medical insurance. The amount you pay for coverage is deducted from your paycheck on a pre-tax basis, which means you don’t pay taxes on the amount you pay for coverage.
Full-time benefits eligible: 0.75 to 1.0 FTE
Part-time benefits eligible: 0.50 to 0.74 FTE
Denver Health provides you with two medical plan options with different networks from the Denver Health Medical Plan (DHMP):
- Denver Health Plan (HMO): This plan provides access exclusively to Denver Health facilities and providers. You
may access the First Health network for outpatient behavioral health services only. Providers and facilities outside of
Denver Health require prior authorization for services to be covered. - Denver Health Extended Plan (POS): Prior network authorization is not required when using an extended network
provider; however, your cost at time of service will be lower should you choose to seek services from Denver Health
facilities and providers.- Denver Health network: No deductible to meet, access to all Denver Health facilities and providers.
- Extended network: Access to broader network of providers with a deductible. Network includes AdventHealth, Children’s Hospital, University of Colorado, Intermountain Health, and First Health facilities and providers (excluding HealthOne/HCA).
Locate a Denver Health network provider at goperspecta.com/VPD/dhmp/public/ProviderSearch/SelectProduct, select DHHA from the drop down menu, then choose your medical plan.
The table below summarizes the benefits of each medical plan. The coinsurance amounts listed reflect the amount you
pay. Please refer to the official plan documents for additional information on coverage and exclusions.
(1) Includes deductible, copays and coinsurance. (2) One free exam per year. (3) Denver Health Plan (HMO) requires use of DHHA pharmacy on this tier. (4) Specialty medications (tier 3 and 4) are not eligible for mail order.
Note: Prior authorization is required for all services completed outside of a Denver Health facility on the Denver Health Plan (HMO). Please refer to the prior authorization list or call 303-602-2100 (toll free: 800-700-8140; TTY/TTD users: 711) Monday-Friday, 8 a.m. to 5 p.m. MST with questions.
ARE YOU COVERING YOUR SPOUSE, PARTNER AND/OR DEPENDENT CHILDREN?
In an embedded deductible plan, cost sharing for a member will begin when that member reaches their individual deductible or when a combination of members reaches the family deductible. This means that a member will start to pay copays and/or coinsurance for the remainder of the plan year, or until the individual out-of-pocket maximum is met.
Once the individual reaches their out-of-pocket maximum, then the plan will pay 100% of covered services for that member for the remainder of the plan year.
Note: An individual who meets their individual deductible will initiate cost sharing with the plan prior to other members on the plan.
PREVENTIVE CARE
In-network preventive care is 100% free for medical plan members.
You won’t have to pay anything out of your pocket when you receive in-network preventive care. Practice preventive care and reap the rewards of a healthier future.
Some services are generally not considered preventive if you get them as part of a visit to diagnose, monitor or treat an illness or injury. Please be aware that you will be responsible for the cost of any non-preventive care services you receive at your preventive care exam based on your plan design. Learn more about preventive care at denverhealthmedicalplan.org.
VISION CARE
If you enroll in a Denver Health Medical Plan, you will have access to enhanced vision benefits:
- $30 copay per visit for routine eye exams at either Denver Health Eye Clinic or Eyecare Specialties of Colorado (limited to one routine eye exam every 24 months).
- Up to $350 reimbursement for prescription eyewear once every 24 months.
- The date(s) of service for requested reimbursement cannot be within 24 months of your last requested reimbursement date(s) of service.
- $200 toward Lasik surgery once per lifetime.
VIRTUAL MENTAL HEALTH CARE
Many providers offer access to virtual mental health care. Whether you’re on the go, at home or at the office, care comes to you in the form of virtual mental health care.
Receive mental health support and counseling.
Hand-selected, U.S.-trained, board-certified licensed therapists and psychologists can help diagnose, treat and even prescribe medication when needed for depression and anxiety, substance abuse and panic disorders, PTSD, grief and loss and more.
Talk with a licensed therapist or psychologist by phone or video, 24/7.
Use virtual mental health care to prioritize your health by getting the care you need when you need it. Visit denverhealthmedicalplan.org, email dhmpmemberservices@dhha.org or call
303-602-2100.
DISPATCHHEALTH
DispatchHealth provides on-demand health care in the convenience of your home. They can treat many of the same illnesses and injuries that are treated at an urgent care center.
Services are only available in certain geographic areas. However, new locations are added all the time. Visit dispatchhealth.com or call 888-908-0553 to see if DispatchHealth is available in your area.
KNOW WHERE TO GO FOR CARE
Where you go for medical services can make a big difference in how much you pay and how long you wait to see a health care provider. Use the chart below to help you choose where to go for care.
