We take your health personally

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We take your health personally

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HighPoint Denver Network ...4

Convenient Locations ... 6

How to Find a Provider ...9

Special Programs ...10

STRONG body STRONG mind Wellness ... 11

Definitions ...12

Choose the Plan that’s Right for You ...13

Comparing Plans ... 14

High Deductible Health Plan (HDHP) ... 15

Deductible HMO (DHMO) ... 21

DHMP

Member Services

We’re Here for You

303–602–2100

8am to 5pm

Monday - Friday

Get quick answers about DHMP benefits and the health network, or the latest information about how to receive services.

You can also request handbooks and provider directories in electronic and printed formats.

Call us to change any personal information for your plan, like phone or mailing address.

DHMP

Care Support

Team

303–602–2080

8am to 5pm

Monday - Friday

Having a “medical home” has been proven to have a positive effect on health and well-being.

Care Support Services can assist you in navigating within your “medical home.” Care Support Services staff may also be able to assist you with scheduling your primary and specialty care appointments.

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A unique network offered only by Denver Health Medical Plan

HighPoint

DenverPlus

A unique network

offered only by

Denver Health Medical Plan

• UCHealth System

University of Colorado Hospital Poudre Valley Hospital

Medical Center of the Rockies Memorial Hospital

Memorial Hospital North • Children’s Hospital Colorado • CU Health Partners

• Denver Health network • First Health national network • Colorado Health Medical Group

2

nd

Tier

HighPoint Denver Plus consists of:

1

st

Tier

All providers in tier one in addition to:

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• Defines and delivers pediatric health care excellence, taking care of kids and only kids for more than 100 years.

• Improves the health of children through nationally and internationally recognized patient care, education, research and advocacy programs. • Offers a family-centered, collaborative approach

that combines the nation’s top 100%-pediatric-trained doctors, nurses and researchers to pioneer new approaches to pediatric medicine. • Provides a leading pediatric network with a

full spectrum of pediatric specialties, including urgent, emergency and specialty care locations throughout Metro Denver.

• The only Level I Pediatric Trauma Center in Colorado.

• Consistently acknowledged as one of the nation’s outstanding pediatric hospitals by U.S. News & World Report and ranked 5th on its Best Children’s Hospitals 2015-16 Honor Roll.

• Winner of the 2015 American Hospital Association McKesson Quest for Quality Prize, recognized for achievement in the Institute of Medicine’s six quality aims.

• Recognized for excellence in nursing from the American Nurses Credentialing Centers and has been designated a Magnet® hospital since 2005. • Provides parents with helpful, free resources

like myChart – secure, online access to your Children’s Colorado health records; ParentSmart Health Line – caring pediatric nurses available 24/7 to answer your questions; and ChildrensMD Symptom Checker Mobile App.

Announcing

HighPoint Denver

Plus

Denver Health Medical Plan now offers the HighPoint Denver Plus network to better fulfill the needs of our members. This network is the result of a strategic partnership between Denver Health and Hospital Authority, UCHealth and Children’s Hospital Colorado.

The HighPoint Denver network replaces “Denver Health only” as 1st tier of service. The HighPoint Denver network will be the first tier of all 2016 plans offered by DHMP. This allows members to have a broader choice of providers in the most affordable tier of service. Members can now choose to

access providers at Denver Health, UCHealth and Children’s Hospital Colorado. This broad network gives members access to more than 650 primary care physicians and almost 3,000 specialists. And there is no requirement by the Plan for a referral to specialty providers.

A plus in the second tier — Cofinity

The Plus in HighPoint Denver Plus is the addition of even more choice through the Cofinity network. Members can choose to seek health care within either tier one or tier two. With the additional choice of the Cofinity network, members gain access to more than 2,300 additional primary care providers and more than 11,000 specialists in Colorado.

In addition, for eligible dependents residing outside of Colorado, we offer the First Health national network. Call for more information.

HighPoint Denver Plus gives members the choice and flexibility to better control health care costs and to choose when and where to access care.

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• Is the largest health care provider in the City and County of Denver; a culturally competent organization known for serving many languages and cultures.

• Offers a centrally located campus in downtown Denver. Denver Health also has eight primary care centers located throughout Denver (a ninth Family Health Center will open in 2016 in Southwest Denver). In addition, Denver Health has 17 School-Based Health Centers inside of Denver Public Schools. Parking is free at all sites.

• Operates on a patient-centered model that is respectful and responsive to each individual’s needs, values, and preferences. Patients are active participants in all health care decisions. • Has one of the lowest C-section rates in Colorado.

Denver Health’s approach respects the natural birth process and supports moms in that effort. Denver Health performs C-sections only when medically necessary.

• Provides same or next-day appointment availability for urgent primary care services at Denver Health through several convenient locations in Denver.

• Has the only Adult Level I and Pediatric Level II trauma centers in the region. During traumas, families stay together and heal together. • Undergoing a state-of-the-art, comprehensive

construction expansion that will include new facilities and updates to current facilities. • Free 24/7 NurseLine for patients in need of

medical advice.

• Denver Health offers a Concierge Line for commercial members. Call this number if you need help making an appointment with a Denver Health provider: 720-956-2227

• Consists of University of Colorado Hospital, Poudre Valley Hospital, Medical Center of the Rockies, Memorial Hospital and Memorial Hospital North. • Offers medical specialists who are

nationally-recognized experts.

• Provides access to the University of Colorado Cancer Center, the only NCI-Designated Comprehensive Cancer Center in Colorado. • Allows patients to view their medical records, test

results and prescriptions as well as communicate with their medical team through My Health Connection.

• Cares for some of the region’s most complex medical conditions and is uniquely able to provide heart transplants, lung transplants, neuro and spine surgeries, advanced cancer treatments and more.

• Is home to one of only two American Burn Center-verified Burn Centers.

• Has one of the region’s most experienced emergency departments and trauma teams. • University of Colorado Hospital is ranked the #1

hospital in Colorado by U.S. News & World Report. • U.S. News Best Hospitals report ranks 11 specialties

at University of Colorado Hospital among the best in the United States.

• Over 170 of University of Colorado School of Medicine physicians areranked as 5280 Top Doctors.

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Convenient Locations

Longmont Boulder Erie Broomfield Thornton DIA Aurora Arvada Westminster Denver Lakewood Littleton

Lone Tree Parker

Centennial 70 225 25 470 36

N

W

E

Providers

Children’s Hospital Denver Health CU Health Partners UCHealth 285 85 E-470 25 70 76

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Children’s Hospital

Colorado

Aurora

Anschutz Medical Campus*+ 13123 E. 16th Ave.

Aurora, CO 80045

Broomfield North Campus *+ 469 W. Highway 7 Broomfield, CO 80023 Broomfield + 8401 Arista Pl. Broomfield, CO 80021 Centennial +

9094 E. Mineral Ave., Suite 110 Centennial, CO 80112 Denver Uptown *+ 1830 Franklin St. Denver, CO 80218

Highlands Ranch South Campus *+ 1811 Plaza Dr.

Highlands Ranch, CO 80129 Littleton +

151 W. County Line Rd. Littleton, CO 80129

Parker at Parker Adventist Hospital * 9395 Crown Crest Blvd.

Parker, CO 80138 Parker +

9399 Crown Crest Blvd., Suite 300 Parker, CO 80138

Parker +

19284 Cottonwood Dr. Parker, CO 80138 Wheat Ridge *+

3455 Lutheran Pkwy., Suite 230 Wheat Ridge, CO 80033 * Urgent or Emergency Care + Outpatient Specialty Care

Denver Health

Webb Center for Primary Care 301 W. 6th Ave.

Denver, CO 80204

Bernard Gipson Eastside Family Health Center 501 28th St.

Denver, CO 80205 La Casa/Quigg Newton Family Health Center 4545 Navajo St. Denver, CO 80211

Lowry Family Health Center 1001 Yosemite St.

Denver, CO 80230

Montbello Family Health Center 12600 E. Albrook Dr.

Denver, CO 80239

Park Hill Family Health Center 4995 E. 33rd Ave.

Denver, CO 80207 Sam Sandos Westside Family Health Center 1100 Federal Blvd. Denver, CO 80204 Westwood 4320 W. Alaska Pl. Denver, CO 80219

Southwest Family Health Center and Urgent Care Center

(Opening 2016) 1339 S. Federal Blvd. Denver, CO 80219

UCHealth

University Hospital 12402 E. 17th Ave. Aurora, CO 80045 Eye Center 8042 E 16th Ave. Aurora, CO 80045 CU Sports Medicine 311 Mapleton Ave. Boulder, CO 80304 Eye Center - Anschutz 385 Broadway

Boulder , CO 80305 Family Medicine Boulder 350 Broadway Boulder, CO 80305 Lowry Clinic 8111 E. Lowry Blvd. Denver, CO 80230 Colorado Center 2000 S. Colorado Blvd. Denver, CO 80222

A.F. Williams - Stapleton 3055 Roslyn St.

Denver, CO 80238 Eye Center - LoDo 1435 Wazee St. Denver, CO 80202

Lone Tree Health Center 9548 Park Meadows Dr. Lone Tree, CO 80124

Eye Center - Park Meadows 8080 Park Meadows Dr. Lone Tree, CO 80124

Lone Tree Breast Center 9544 Park Meadows Dr. Lone Tree, CO 80124 Lone Tree Surgery Center 9218 Kimmer Dr

Lone Tree, CO 80124

Denver Health offers a Concierge Line for commercial members. Call this number if you need help making an appointment with a Denver Health provider:

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CHMG Longmont Clinic 1925 W. Mountain View Ave. Longmont, CO 80501 CHMG Heart Center CV Surgery

2030 Mountain View Ave. Longmont, CO 80501 Family Medicine 7403 Church Ranch Blvd . Westminster, CO 80021 UCHealth ED Arvada 9505 Ralston Rd. Arvada, CO 80002 UCHealth ED Broomfield 875 W 136th Ave. Broomfield, CO 80023 UCHealth ED Commerce City 15100 E. 104th Ave. Commerce City, CO 80022 UCHealth ED Thornton 1 12020 Colorado Blvd. Thornton, CO 80241 UCHealth ED Thornton 2 13631 Colorado Blvd. Thornton, CO 80602 UCHealth ED Littleton 13351 W. Bowles Ave. Littleton, CO 80127 UCHealth ED Aurora SE 25551 E. Smoky Hill Rd. Aurora, CO 80016

UCHealth ED Green Valley Ranch 18610 Green Valley Ranch Blvd. Denver, CO 80249

CU Health Partners

CU Sports Medicine 2243 Colorado Ave. Boulder , CO 80302

The Little Clinic

Locations

12167 Sheridan Blvd. Broomfield, CO 80020 2355 W 136th Ave. Broomfield, CO 80023 100 Founders Pkwy Castle Rock, CO 80104 19711 E Smoky Hill Rd. Centennial, CO 80015 3100 S Sheridan Blvd. Denver, CO 80227 2810 Quebec St. Denver, CO 80207 6000 S Holly St. Greenwood Village, CO 80111 9557 S University Blvd. Highlands Ranch, CO 80126 480 N Highway 287 Lafayette, CO 80026 7984 W Alameda Ave. Lakewood, CO 80226 11747 W Ken Caryl Ave. Littleton, CO 80127 12959 S Parker Rd Parker, CO 80134 13700 Colorado Blvd. Thornton, CO 80602 3400 Youngfield St. Wheat Ridge, CO 80033

Preventive care

at any of our HighPoint

providers is covered at

no charge in both

the HDHP and

the DHMO plans:

Annual check ups Prenatal visits Well child care Well woman exams Immunizations

Deductible/coinsurance

do not apply to

preventive care

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Finding a Provider

in the HighPoint Denver network

Click Here

For a Cofinity (2nd tier) provider For a HighPoint Denver

(first tier) provider

Choose the network you

would like to search:

Go to

www.DenverHealthMedicalPlan.org

and click on

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Healthy Heroes for Kids

A club created by DHMP, Healthy Heroes for Kids is a fun way for you to encourage healthy habits in your kids.

Children receive special promotions such as quarterly kids newsletters, activity sheets and HealthTip postcards in the mail.

The program is split into three groups so that everyone receives age-appropriate materials. The three groups are: Explorers for children 3-5, Rangers for children 6-9, and X-Kidz for pre-teens 10-12.

Care Support Team

Having a “medical home” has been proven to have a positive effect on health and well-being. That’s why Care Support Services is here, to assist you in navigating within your “medical home.” Care Support Services staff can also assist you with appointments, both primary and specialty care, as well as many other member needs.

Member Services 303-602-2100

Member Services staff and health care navigators are available from 8 AM to 5 PM, Monday through Friday.

You can speak to our specially trained representatives to get:

• Answers about your health network and benefits

• Information about how to obtain services

• Access to a wide variety of

information, such as handbooks and provider directories in both electronic and printed formats

Health Coaches

Trained professionals who partner with you to identify goals and action plans that are invaluable in helping you achieve your wellness goals. Complementary Health and Wellness classes plus classes for chronic disease management are also available to you.

Health and Wellness also offers healthy cooking recipe books, disease management information and invitions to telephonic

seminars.

Once again, we’ve teamed with Weight Watchers to bring you effective weight management offerings at a special price. A 35% subsidy on the cost of your Weight Watchers program is yours if you take advantage of one of four Weight Watchers options:

• At Work Meetings

• Local Meeting vouchers • Online subscription • At Home kit

You pick the option that best suits your lifestyle and needs.

Getting a portion of your Curves membership paid for with DHMP is easy. Simply pay your monthly Curves fee as usual, workout at Curves at least eight times in any given month, and the bank

account you use to pay your dues will be credited $20.

That’s $20 of savings just for keeping in shape. Each month. Every month.

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Good health goes beyond a yearly physical or getting cough medicine for a chest

cold. Staying healthy and feeling alive is a state of mind. It’s the desire to do the best

you can, no matter how big or small the challenge.

Denver Health Medical Plan has developed a comprehensive, interactive wellness program for your body and spirit. Each aspect of Strong body Strong mind is a fun and rewarding experience for you. You can share positive behaviors and uplifting experiences with like-minded plan members and coaches, as well as your own family and close friends. Try it, you’ll like it!

Personal Profile

A custom dashboard is developed just for you, to help you learn about and target your health, nutrition and fitness goals.

Online Health Risk Assessment (HRA)

That’s a few big words for an easy idea. Identify behaviors that may put your health at risk so you can choose a direction for positive change.

Wellness Workshops

The week-by-week “how-to” part of the program is a step-by-step guide. Get action items and tips to put you on the road to eating a healthy diet, increasing physical activity, quitting nicotine, managing stress and preventing diabetes and cardiovascular disease.

Tracking Tools

You don’t have to remember everything every day. Your custom tracking tools can show you how you are managing your weight and offer meal planning options to track your food choices. We can set you up with a progressive strength training and cardio log, even if you are starting from scratch. And, we

walk in a day. Here are some examples: • Health snapshot – is a daily log of your

progress and upcoming events

• Rewards tracker – earn points and get prize rewards for your participation and progress

• Mobile app – who said you can’t take it with you?

• Upload the mobile version on your iPhone®, Droid™, Blackberry®, or Windows® mobile.

Online Social Support

We’ve all been there. Your support system might include blogs, member forums,

even a diet or exercise buddy. You will get encouragement from your peers and have the opportunity to lift another’s spirits when they’re down.

Team Challenges

If you like to be social, there’s no better way to get involved in healthy activities than to team up with other Plan members. Win prizes for achieving a physical activity challenge or celebrate meeting and beating your weight goals.

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Monthly premium

The fixed amount you pay each month for your health insurance plan.

Out-of-pocket costs

What you pay for medical expenses that aren’t paid back by your health insurance plan.Your out-of-pocket costs include deductibles,copays, and coinsurance for health care services. In other words, any costs you personally pay for covered medical or pharmacy services.

Deductibles

The amount you owe for medical services BEFORE your health insurance plan pays.You will pay the full deductible amount toward medical expenses before your health plan pays anything. In an HDHP the deductible will also apply to pharmacy costs. Once you meet the applicable deductible, your plan will start to cover your expenses based on your list of benefits.

Copay

A fixed amount that you pay out-of-pocket for certain covered medical care services.

Coinsurance

A percentage of your out-of-pocket cost when you visit your doctor, have tests or receive treatment. For example, if your doctor’s charge for an office visit is $100 (and you’ve met your TOTAL deductible for the year), a 20% coinsurance payment on $100.00 would be only $20.00! Your health insurance pays the rest of the allowed amount…you would save $80.00!

Out-of-pocket maximum

The MOST you pay out during a policy

Simple

Choices.

Simple

Language.

limit includes the TOTAL of your deductible, coinsurance and copays. This DOES NOT include your monthly premiums. In an HDHP, the individual out-of-pocket maximum does not apply to a family plan.

A “billed” amount

This is what the provider bills for a service you received. These are “full” charges and the discount DHMP negotiated has not been applied yet.

An “allowed” amount

DHMP negotiates a discount with each provider in our network. You have the advantage of this discount (allowed amount) and will never pay more than our negotiated price.

HSA

A Health Savings Account is like a

personal savings account, but the money in it is used to pay for health care expenses. You — not your employer or insurance company — own and control the money in your Health Savings Account. You have the option to deduct a portion of your pre-tax earnings each pay period to go directly into your HSA account to help pay your deductible, coinsurance and other qualified medical expenses.

HDHP

A High Deductible Health Plan, or HDHP has a higher annual deductible than typical health plans. In exchange for that higher deductible, you will pay a lower premium each month for your health insurance. In an HDHP, the individual deductible and out-of-pocket maximum do not apply to a family plan. A family must meet the entire family deductible before the Plan begins to pay

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Choose the Plan

t

hat’s right for you.

At Denver Health Medical Plan, we know that you lead a busy life. We want to

make choosing the right health insurance plan easy and uncomplicated.

Choice 1

High Deductible Health Plan

Lower Monthly

Premium

Higher

Out-of-Pocket

Cost

Save money on monthly premiums.

Have a tax-free HSA to help you with unexpected health care expenses.

Choice 2

Deductible HMO

Higher Monthly

Premium

Lower

Out-of-Pocket

Cost

Pay larger monthly premiums.

Pay less out-of-pocket when you access care.

Not eligible for an HSA.

You

Choose

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xible Sa

vings

Account vs.

Health

Sa

vings Account

1st tier Highpoint Denver 2nd tier Plus (Cofinity) 1st tier Highpoint Denver 2nd tier Plus (Cofinity) When I visit my PCP,

what will I pay? (non-preventative) Deductible and 10% coinsurance Deductible and 20%

coinsurance $25/visit $30/visit

What about when I

visit a specialist? Deductible and 10%

coinsurance

Deductible and 20%

Urgent Care visit Deductible and

10% coinsurance

Deductible and 20%

Emergency

Room visit Deductible and 10%

coinsurance

Deductible and 20%

Inpatient Stay/

Outpatient Surgery Deductible and 10%

coinsurance Deductible and 20% coinsurance Deductible and 20% coinsurance Deductible and 30% coinsurance

HDHP*

*HSA Eligible

DHMO

Comparing

Plans

Quic

k Plan Compar

isons

Use it or lose it each year YES_lost., any amount not used is NO_{account year after year.}, you can grow this

Submit receipts YES_{each time you withdraw funds.}, you must submit receipts NOhome. You will only need them , you keep your receipts at

if audited by the IRS.

Personal Savings Account NOaccount, it is not owned by , this is simply a spending

you.

YES. This is an actual savings account, opened by and belonging to the employee.

Tax-free contributions and

withdrawals YES. YES.

Tax-free earnings NO_{earn interest.}. This account does not YES.

Contribution limit In 2016_$2,500:

In 2016:

$3,350 Individual $6,750 Multi-Tier (Family) Employees over 55 can contribute an additional $1,000.

YES. This is your account.

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HighPoint Denver Cofinity Network Out of Network

Deductible

Individual Family

n $1,350 per calendar year. n $2,700 per calendar year.

Applicable to medical care & prescription drug benefits; family deductible includes employee & one or more enrolled family members, no coverage may be paid for any family member unless the family deductible is met.

Services received in either tier will accumulate towards this amount.

Not applicable.

Out of Pocket Maximum

Individual Family

The out-of-pocket maximum includes the annual deductible, coinsurance and copays. It does not include premiums.

Applicable to medical care & prescription drug benefits; family out-of-pocket maximum includes employee & one or more enrolled family members, maximum is not met for any family member unless the family out-of-pocket maximum is met.

Services received in either tier will accumulate towards this amount.

Not applicable.

Lifetime maximum

n No lifetime maximum. n No lifetime maximum. Not applicable.

Covered Providers

n Denver Health and Hospital Authority, University

of Colorado Hospital and Children’s Hospital Colorado providers and facilities including Colorado Health Medical Group (CHMG). Columbine network for chiropractic. See online provider directory for a complete list of current providers: www.denverhealthmedicalplan.org/ find-doctor

n Cofinity network providers and facilities.

Columbine network for chiropractic. See online provider directory for a complete list of current providers: www. denverhealthmedicalplan.org/find-doctor

Not applicable.

Medical Office Visits

Personal providers (Family Medicine, Internal Medicine and Pediatrics)

n Deductible and 10% coinsurance will apply. n Deductible and 20% coinsurance will

apply. Not covered.

Specialist n Deductible and 10% coinsurance will apply. n Deductible and 20% coinsurance will

apply. Not covered.

HDHP

Denver Health Medical Plan, Inc.

Career Service Authority (CSA) and Denver Employee Retirement Plan (DERP)

2016 Two Tiered HDHP

HighPoint Denver

Plus

Network

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HighPoint Denver Cofinity Network Out of Network

Preventive Services

Children Adults

n No copayment (100% covered).

This applies to all preventive services with an A or B recommendation from the U.S. Preventive Services Task Force (USPSTF).

Annual well visit, well woman exams, prenatal visits; colonoscopy, mammogram. See USPSTF list on our website at

www.denverhealthmedicalplan.org

n No copayment (100% covered).

This applies to all preventive services with an A or B recommendation from the U.S. Preventive Services Task Force (USPSTF). Annual well visit, well woman exams, prenatal visits; colonoscopy, mammogram. See USPSTF list on our website at www.denverhealthmedical plan.org

Not covered.

Maternity

Prenatal Care

Delivery, Inpatient and Well Baby Care

apply. Not covered.

Prescription Drugs

n Deductible will apply.

After deductible is met:

Denver Health Pharmacy (30-day supply)

n Preferred Generics: $10 copay

n Generics & Preferred Brand: $15 copay n Non-preferred Brand: $30 copay n Specialty: $30 copay

Denver Health Pharmacy or Denver Health Pharmacy by Mail

(90-day supply)

n Preferred Generics: $20 copay n Generics & Preferred Brand: $30 copay n Non-preferred Brand: $60 copay n Specialty: N/A

Non-Denver Health Pharmacy (30-day supply)

n Preferred Generics: $20 copay n Generics & Preferred Brand: $40 copay n Non-preferred Brand: $60 copay n Specialty: $60 copay

n Generics & Preferred Brand: $80 copay n Non-preferred Brand: $120 copay n Specialty: N/A

For drugs on our approved list, call Member Services at (303) 602-2100.

n Deductible will apply.

After deductible is met:

n Generics & Preferred Brand: $40 copay n Non-preferred Brand: $60 copay n Specialty: $60 copay

n Generics & Preferred Brand: $80 copay n Non-preferred Brand: $120 copay n Specialty: N/A

Not covered.

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HighPoint Denver Cofinity Network Out of Network

Outpatient/Ambulatory Surgery

apply.* Not covered.

Diagnostics Laboratory and Radiology

Laboratory, X-ray and CT scans

MRI and PET scans

n Deductible and 10% coinsurance will apply.

n Deductible and 20% coinsurance will

apply.

Not covered.

Other Diagnostic and Therapeutic Services Sleep study Radiation therapy Infusion therapy (includes chemotherapy) Injections Renal Dialysis

n Deductible and 10% coinsurance will apply. n Deductible and 10% coinsurance will apply.

n Deductible and 10% coinsurance will apply

(immunizations, allergy shots and any other injection given by a nurse

is a $0).

apply.

apply (immunizations, allergy shots and any other injection given by a nurse is a $0).

apply.

Not covered.

Emergency Care

apply. n Deductible and 10% coinsurance will apply. Urgent Care

apply. n Deductible and 10% coinsurance will apply. Ambulance

apply.

n Deductible

and 10% coinsurance will apply.

Behavioral Health, Mental Health Care and Substance Abuse

Outpatient: n Deductible and 10% coinsurance will apply. n Deductible and 20% coinsurance will

apply. Not covered. Inpatient: n Deductible and 10% coinsurance will apply.* n Deductible and 20% coinsurance will

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HighPoint Denver Cofinity Network Out of Network

Therapies

Rehabilitative: Physical, Occupational, and Speech Therapy

n Deductible and 10% coinsurance will apply. n 20 of each therapy per calendar year.

apply.

n 20 of each therapy per calendar year.

Not covered.

Habilitative: Physical, Occupational, and Speech Therapy

apply.

Not covered.

Pulmonary Rehabilitation

apply.

Not covered.

Cardiac Rehabilitation n Deductible and 10% coinsurance will apply. n 20 of each therapy per calendar year.

apply.

Not covered.

Durable Medical Equipment

n Deductible and 10% coinsurance will apply;

maximum benefit is $2,000 per calendar year. *

apply; maximum benefit is $2,000 per calendar year. *

Not covered.

Hearing Aids

Adults n Medically-necessary hearing aids prescribed

by a DHMP Medical Care Network provider are covered every five years in network. For adults age over 18, there is a $1,500 benefit maximum every 5 years. Charges exceeding the $1,500 hearing aid maximum benefit, are the responsibility of the member. *

n Medically-necessary hearing aids

prescribed by a DHMP Medical Care Network provider are covered every five years in network. For adults age over 18, there is a $1,500 benefit maximum every 5 years. Charges exceeding the $1,500 hearing aid maximum benefit, are the responsibility of the member. *

Not covered.

Children n Children under age 18 are covered at 100%, no

maximum benefit applies. Hearing screens and fittings for hearing aids are covered under office visits and the applicable copayment applies. Hearing aids no longer apply to the annual DME limit.

n Cochlear implants are now covered for children

under age 18. The device is covered at 100%, applicable inpatient/outpatient surgery charges will apply. *

n Children under age 18 are covered at

100%, no maximum benefit applies. Hearing screens and fittings for hearing aids are covered under office visits and the applicable copayment applies. Hearing aids no longer apply to the annual DME limit.

n Cochlear implants are now covered for

children under age 18. The device is covered at 100%, applicable inpatient/ outpatient surgery charges will apply. *

Not covered.

Prosthetics

n Deductible and 10% coinsurance will apply;

no maximum benefit, does not apply to DME maximum. *

apply; no maximum benefit, does not apply to DME maximum. *

Not covered.

Orthotics (Shoe)

Medically necessary orthotics are reimbursed up to $100 per calendar year.

Oxygen/Oxygen Equipment

Oxygen n 100% Covered. * n 100% Covered. * Not covered.

Equipment n Deductible and 10% coinsurance will apply;

no maximum benefit, does not apply to DME

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HighPoint Denver Cofinity Network Out of Network

Organ Transplants

Only covered at authorized facilities. Coverage no less extensive than for other physical illness. Covered transplants include: cornea, kidney, kidney-pancreas, heart, lung, heart-lung, liver and bone marrow for Hodgkin’s, aplastic anemia, leukemia, immunodeficiency disease, neuroblastoma, lymphoma, high risk stage II and III breast cancer and Wiskott-Aldrich Syndrome only. Peripheral stem cell support is a covered benefit for the same conditions listed above for bone marrow transplants. *

apply. Only covered at authorized facilities. Coverage no less extensive than for other physical illness. Covered transplants include: cornea, kidney, kidney-pancreas, heart, lung, heart-lung, liver and bone marrow for Hodgkin’s, aplastic anemia, leukemia, immunodeficiency disease, neuroblastoma, lymphoma, high risk stage II and III breast cancer and Wiskott-Aldrich Syndrome only. Peripheral stem cell support is a covered benefit for the same conditions listed above for bone marrow transplants. *

Not covered.

Home Health Care

n No copay (100% covered) for prescribed

medically necessary skilled home health services. *

Hospice Care

n No copay (100% covered). * n Deductible and 20% coinsurance will

Skilled Nursing Facility

n No copay (100% covered). Maximum benefit is

100 days per calendar year at authorized facility.*

apply.Maximum benefit is 100 days per calendar year at authorized facility. *

Not covered.

Dental Care

Not covered except for fluoride varnish at PCP visit. Not covered.

Vision Care

Not covered. Not covered. Not covered.

Chiropractic

Maximum 20 visits per calendar year. Services must be provided by Columbine Chiropractic in order to be covered.

apply. Maximum 20 visits per calendar year. Services must be provided by Columbine Chiropractic in order to be covered.

Not covered.

Note: Massage therapy is not a plan benefit but DHMP offers a discount program through Columbine Chiropractic. Many chiropractic offices offer massage therapy as well. DHMP will not pay for massage therapy received at a Columbine Chiropractic office. Member must pay through discount program.

Additional Benefits

Weight Watchers discount. DHMP will share the cost of Weight Watchers with members. Join Weight Watchers through DHMP and the plan will pay 35% of your cost!

Curves Wellness program. DHMP will pay $20 toward the monthly fee for every month that members who join Curves work out at least 8 times per month.

eLearning module for parents-to-be. Online childbirth classes, free of charge to members.

STRONG body STRONG mind incentive plan.

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HighPoint Denver Cofinity Network Out of Network

Deductible

Individual Family

n $500 per calendar year. n $1,500 per calendar year.

All individual deductible amounts will count toward the family deductible; an individual will not have to pay more than the individual deductible amount

n $750 per calendar year. n $1,750 per calendar year.

All individual deductible amounts will count toward the family deductible; an individual will not have to pay more than the individual deductible amount

Not applicable.

Out of Pocket Maximum

Individual Family

The out-of-pocket maximum includes the annual deductible, coinsurance and copays. It does not include premiums. All individual out-of-pocket amounts will count toward the family out-of-pocket maximum; an individual will not have to pay more than the individual out-of-pocket maximum.

Not applicable.

Lifetime Maximum

n No lifetime maximum. n No lifetime maximum. Not applicable.

Covered Providers

n Denver Health and Hospital Authority,

University of Colorado Hospital and Children’s Hospital Colorado providers and facilities including Colorado Health Medical Group (CHMG). Columbine network for chiropractic. See online provider directory for a complete list of current providers: www. denverhealthmedicalplan.org/find-doctor

n Cofinity network providers and

facilities. Columbine network for chiropractic. See online provider directory for a complete list of current providers: www. denverhealthmedicalplan.org/find-doctor

Not applicable.

Medical Office Visits

Primary Care providers (Family Medicine, Internal Medicine and Pediatrics)

n $25 Copay per visit.

n In addition to the visit Copayment,

the applicable Copayment and any Deductible/Coinsurance applies for additional services.

n In addition to the visit Copayment,

the applicable Copayment and any Deductible/Coinsurance applies for additional services.

Not covered.

Specialist n $50 copay per visit. n $50 copay per visit. Not covered.

DHMO

Denver Health Medical Plan, Inc.

Career Service Authority (CSA) and Denver Employee Retirement Plan (DERP)

2016 Two Tiered DHMO

HighPoint Denver

Plus

Network

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HighPoint Denver Cofinity Network Out of Network

Preventive Services

Children Adults

n No copayment (100% covered)

Annual well visit, well woman exams, prenatal visits; colonoscopy,mammogram. See USPSTF list on our website at www.denverhealthmedicalplan.org

n No copayment (100% covered)

Annual well visit, well woman exams, prenatal visits; colonoscopy,mammogram. See USPSTF list on our website at www.denverhealthmedicalplan.org

Not covered.

Maternity

Prenatal Care

Delivery, Inpatient and Well Baby Care

n 20% after Per Occurrence Deductible

of $150 and Annual Deductible have been met.

Not covered.

Prescription Drugs

Denver Health Pharmacy (30-day supply)

n Preferred Generics: $12 copay. n Generics & Preferred Brand: $40 copay. n Non-preferred Brand: $50 copay. n Specialty: $50 copay.

Denver Health Pharmacy or Denver Health Pharmacy by Mail (90-day supply).

n Preferred Generics: $24 copay. n Preferred Brand: $80 copay. n Non-preferred Brand: $100 copay. n Specialty: N/A

Non-Denver Health Pharmacy (30-day supply).

n Preferred Generics: $20 copay. n Generics & Preferred Brand: $50 copay. n Non-preferred Brand: $80 copay. n Specialty: $80 copay

n Preferred Generics: $40 copay. n Generics & Preferred Brand:

$100 copay.

n Non-preferred Brand: $160 copay. n Specialty: N/A

n Preferred Generics: $20 copay. n Generics & Preferred Brand: $50 copay. n Non-preferred Brand: $80 copay. n Specialty: $80 copay.

n Preferred Generics: $40 copay. n Generics & Preferred Brand:

$100 copay.

n Non-preferred Brand: $160 copay. n Specialty: N/A

Not covered.

Inpatient Hospital

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HighPoint Denver Cofinity Network Out of Network

Outpatient/Ambulatory Surgery

n 20% after Per Occurrence Deductible of $150 and Annual Deductible have been met.

Not covered.

Diagnostics Laboratory and Radiology

Laboratory, X-ray and CT

MRI and PET scans

apply.

n $150 copay per visit.

apply.

Not covered.

Other Diagnostic and Therapeutic Services Sleep study Radiation therapy Infusion therapy (includes chemotherapy) Injections Renal Dialysis

apply.

apply.(immunizations, allergy shots and any other injection given by a nurse is a $0)

apply.

apply. (immunizations, allergy shots and any other injection given by a nurse is a $0)

apply.

Not covered.

Emergency Care

n $300 copay (deductible and coinsurance do not apply)

Urgent Care

n $75 copay (deductible and coinsurance do not apply)

Ambulance

apply.

n Deductible and 20%

coinsurance will apply.

Behavioral Health, Mental Health Care and Substance Abuse

Outpatient: n $50 copay per visit. n $50 copay per visit. Not covered.

Inpatient: n 20% after Per Occurrence Deductible

of $150 and Annual Deductible have been met. *

of $150 and Annual Deductible have been met. * Not covered. Therapies Rehabilitative: Physical, Occupational, and Speech Therapy

Not covered.

Habilitative: Physical, Occupational, and Speech Therapy

Not covered.

Pulmonary Rehabilitation

Not covered. Cardiac Rehabilitation n $25 copay per visit.

Not covered.

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HighPoint Denver Cofinity Network Out of Network

Durable Medical Equipment

apply; maximum benefit is $2,500 per calendar year.*

Not covered.

Hearing Aids

Adults n Medically-necessary hearing aids

n Medically-necessary hearing aids

Not covered.

Children n Children under age 18 are covered at

n Children under age 18 are covered at

Not covered.

Prosthetics

Not covered.

Orthotics (Shoe)

Medically necessary orthotics are reimbursed up to $100 per calendar year

Oxygen/Oxygen Equipment

Oxygen n 100% Covered. * n 100% Covered. * Not covered.

Equipment n Deductible and 20% coinsurance will

Not covered.

Organ Transplants

apply. Only covered at authorized facilities. Coverage no less extensive than for other physical illness. Covered transplants include: cornea, kidney, kidney-pancreas, heart, lung, heart-lung, liver and bone marrow for Hodgkin’s, aplastic anemia, leukemia, immunodeficiency disease, neuroblastoma, lymphoma, high risk stage II and III breast cancer

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HighPoint Denver Cofinity Network Out of Network

Home Health Care

n 20% after Deductible has been met. Benefits are limited to 60 visits per calendar year. *

n 30% after Deductible has been met. Benefits are limited to 60 visits per calendar year. *

Not covered.

Hospice Care

n 20% after Deductible has been met. * n 30% after Deductible has been met. * Not covered.

Skilled Nursing Facility

Not covered.

Dental Care

Not covered except for fluoride varnish at PCP visit. Not covered.

Vision Care

Benefits are limited to 1 exam every 24 months.

Not covered.

Chiropractic

n $50 copay per visit. Maximum 20 visits

per calendar year. Services must be provided by Columbine Chiropractic in order to be covered.

n $50 copay per visit. Maximum 20 visits

per calendar year. Services must be provided by Columbine Chiropractic in order to be covered.

Not covered.

Note: Massage therapy is not a plan benefit but DHMP offers a discount program through Columbine Chiropractic. Many chiropractic offices offer massage therapy as well. DHMP will not pay for massage therapy received at a Columbine Chiropractic office. Member must pay through discount program.

Additional Benefits

Weight Watchers Discount. DHMP will share the cost of Weight Watchers with members. Join Weight Watchers through DHMP and the plan will pay 35% of your cost!

Curves Wellness program. DH MP will pay $20 toward the monthly fee for every month that members who join Curves work out at least 8 times per month.

eLearning module for parents-to-be. Online childbirth classes, free of charge to members.

STRONG body STRONG mind incentive plan.

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Notes:

___________________

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A unique network offered only by Denver Health Medical Plan

HighPointDenverPlus

For more information call Member Services at

303-602-2100 or visit our website at