Colorado Doctors Plan Bronze 6500 $3 Walgreens Plan Details for 2021- HealthPocket

ZIP Code
County
Applicant Info
Applicant
Date of birth
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Gender
male
female
Income
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Zip Code	80219 (edit)
Applicant	8/8/1987 Male (edit)

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Insurance Type	ACA (Obamacare)
Plan Name	Colorado Doctors Plan Bronze 6500 $3 Walgreens
Plan ID	hhs-97879CO0420029
Plan Year	2021
Insurance Provider	Rocky Mountain Health Plan
Metal Level	Expanded Bronze
Plan Type	HMO
Deductible	$6,500
Out-of-Pocket Maximum	$8,700
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	$25 Copay
Specialist Visit	40% Coinsurance after deductible
Laboratory Outpatient and Professional Services	40% Coinsurance after deductible
X-rays and Diagnostic Imaging	40% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans	40% Coinsurance after deductible
Deductible - Family	$13000 per group
Out-of-Pocket Maximum - Family	$17400 per group

Prescription drug coverage
Generic Drugs	$35 Copay
Preferred Brand Drugs	40% Coinsurance after deductible
Non-Preferred Brand Drugs	40% Coinsurance after deductible
Specialty Drugs	50% Coinsurance after deductible

Access to doctors and hospitals
Provider directory URL	http://www.rmhp.org
Does this plan have access to a national provider network?	No
Is a referral required to see a Specialist?	No -
Does this plan cover services outside plan service area?	Yes - Urgent/Emergent Only
Does this plan cover services outside the country?	Yes - Urgent/Emergent Only

Hospital services
Emergency Room Services	50% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	40% Coinsurance after deductible
Inpatient Physician and Surgical Services	40% Coinsurance after deductible
Emergency Transportation or Ambulance Service	40% Coinsurance after deductible

Maternity
Prenatal and Postnatal Care	40% Coinsurance after deductible
Delivery and all inpatient services for maternity care	40% Coinsurance after deductible

Mental Health
Mental/Behavioral Health Outpatient Services	40% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services	40% Coinsurance after deductible
Substance use disorder outpatient services	40% Coinsurance after deductible
Substance use disorder inpatient services	40% Coinsurance after deductible

Medical Management Programs
Does this plan offer disease managment programs?	Diabetes, Heart Disease
Does this plan offer a wellness program?	Covered

Vision Coverage
Routine Eye Exam for Children	Covered
Eye Glasses for Children	Covered
Routine Eye Exam for Adults	Not Covered

Child Dental Coverage
Child Dental Coverage - Routine Dental Care	Covered
Child Dental Coverage - Basic Dental Care	Covered
Child Dental Coverage - Orthodontia	Covered
Child Dental Coverage - Major Dental Care	Covered

Adult Dental Coverage
Adult Dental Coverage - Routine Dental Care	Not Covered
Adult Dental Coverage - Basic Dental Care	Not Covered
Adult Dental Coverage - Orthodontia	Not Covered
Adult Dental Coverage - Major Dental Care	Not Covered

Exclusions and Limitations
More Included Benefits	Other Practitioner Office Visit (Nurse, Physician Assistant) Preventive Care/Screening/Immunization Bariatric Surgery Infertility Treatment Private-Duty Nursing Imaging (CT/PET Scans, MRIs) Outpatient Surgery Physician/Surgical Services Urgent Care Centers or Facilities Inpatient Physician and Surgical Services Durable Medical Equipment Hospice Services Applied Behavior Analysis Based Therapies Accidental Dental Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Nutritional Counseling Prosthetic Devices Radiation Reconstructive Surgery Transplant Treatment for Temporomandibular Joint Disorders Well Baby Visits and Care Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Prosthetics: Legs and Arms Telehealth PCP Telehealth Specialist Intensive Outpatient for Substance Use Disorder Mental/Behavioral Health Prenatal Care Partial Hospitalization for Mental/Behavioral Health Partial Hospitalization for Substance Use Disorder Postpartum Mental/Behavioral Health Postpartum Substance Use Disorder Residential Day Treatment for Mental/Behavioral Health Residential Day Treatment for Substance Use Disorder Substance Use Disorder Prenatal Care Telehealth Mental/Behavioral Health Telehealth Substance Use Disorder Autism Spectrum Disorders - Assessment and Evaluation Services Intensive Outpatient for Mental/Behavioral Health
More Limited Benefits	Skilled Nursing Facility Hearing Aids Home Health Care Services Outpatient Rehabilitation Services Habilitation Services Dental Check-Up for Children Chiropractic Care Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy Rehabilitative Occupational Therapy Rehabilitative Physical Therapy Inpatient Rehabilitation
More Excluded Benefits	Acupuncture Cosmetic Surgery Weight Loss Programs Routine Foot Care Abortion for Which Public Funding is Prohibited Long-Term/Custodial Nursing Home Care

+ See All Coverage Details

Premium	Plan Name	Deductible
from $260	Oscar Bronze Classic ($3 Prescription List + Free 24/7 Virtual	$6,300.00	Select
from $274	Colorado Doctors Plan Bronze 6500	$6,500.00	Select
from $279	KP Select CO Bronze 6500/50	$6,500.00	Select
from $280	Silver 6700 Direct	$6,700.00	Select
from $284	Bronze Classic (Colorado Partners Choice) ($0 Virtual Care + $3 Drugs)	$6,500.00	Select

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Jesse O. Sutherland Jr., M.d.

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Sarah, Kois

Larry Fisher, MD

Phone Number
(303) 935-9142
Office Locations
1930 S Federal Blvd
Denver, CO 80219

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ZIP Code
County
Applicant Info
Applicant
Date of birth
//
Gender
male
female
Income
$

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Colorado Doctors Plan Bronze 6500 $3 Walgreens

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Benefits & Coverage

Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

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Colorado Doctors Plan Bronze 6500 $3 Walgreens

Apply For This Plan

Benefits & Coverage

Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

Similar Plans

Physician Finder

Related Articles

Related Searches

Apply For This Plan

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