5-Star Member Satisfaction Rating We understand how important it is to trust your health care plan and know you are getting the best care and coverage possible. RMHP received a 5-Star Member Satisfaction Rating in 2012. RMHP's Medicare 5-Star Member Satisfaction Rating in 2012 shows you we place your needs above all else, and we are here to help you fully understand your Medicare plan.
The Medicare Member Satisfaction rating comes from the 2011 Consumer Assessment of Health Plans Survey results as featured in Medicare & You 2012. This is the star rating for Ratings of Health Plan Responsiveness and Care for 2012 Plan Ratings. Star ratings are assessed each year and may change from one year to the next. You can find more information on RMHP plan ratings at www.medicare.gov.
For the 2012 plan year, Rocky Mountain Health Plans received a Medicare 4.5-Star Overall Plan Rating. Plan performance summary star ratings are assessed each year and may change from one year to the next. You can view RMHP’s overall Medicare Plan Rating scorecard here.
About Medicare Part D Coverage
Rocky Mountain Health Plans (RMHP) offers coverage for Medicare beneficiaries looking for Medicare Part D prescription drug benefits from a strong and stable company you can trust.
We have served Colorado residents since 1977 under a contract with the Centers for Medicare & Medicaid Service (CMS), the provider of Original Medicare benefits. RMHP is a Medicare approved Part D sponsor. Choosing to receive your Medicare Part D benefits through RMHP is an excellent Medicare choice. Because RMHP is a not-for-profit organization, we are able to concentrate on serving our Members and offering other advantages such as:
- Extensive formulary
- Large list of participating pharmacies throughout the State
- Colorado-based Customer Service located in Grand Junction
Formulary
Click here for the Premier Formulary to see the comprehensive list of prescription drugs covered.
Click here to see a list of Medicare Part D drugs that require prior authorization.
Click here to see the copy of the Preauthorization Form physicians use to preauthorize your prescription drugs.
The formulary will also explain the copayment or tier level applicable to the drugs you take (for example: Tier 1, Tier 2, Tier 3, etc.), and any quantity limitations that may apply to your drugs.
RMHP is required to provide 60-days notice regarding removal or change in the tier level applicable to the drugs on the formulary. Click here to see RMHP’s Formulary Change Notice.
If your current prescription drugs are not on the formulary or are limited on the formulary, click here to learn more about Rocky Mountain Health Plan's prescription drug Transition Process.
In some cases, RMHP requires you to first try certain drugs to treat your medical condition before another drug will be covered for that condition. Click here to see Drugs Requiring Step Therapy.
Participating Pharmacies
Click here to see the RMHP Medicare Provider Directory, which includes the list of contracting pharmacies that you must use for the RMHP Medicare Part D drug benefits.
This document will give you more information about:
- The number of pharmacies in the network
- The pharmacy addresses and phone numbers
- The types of pharmacies that you may utilize to access your prescription drugs through RMHP Medicare Part D plans
RMHP has contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area.
You can get a 30-day supply of your drugs at all contracting retail pharmacies. The provider directory will also give you more information on which retail pharmacies you can use to get a 90-day supply of your prescription. (Residents of a long-term care facility are able to get a 31-day supply of their medication from the long-term care facility’s pharmacy).
Generally, you must use a contracting pharmacy to receive covered Medicare Part D drugs. However, covered Medicare Part D drugs are available at out-of-network pharmacies in special circumstances including illness while traveling outside of the plan's service area where there is no network pharmacy. You are limited to a 30-day supply when you receive a prescription from an out-of-network pharmacy and restrictions may apply. In addition to paying the copayments/coinsurances, you will be required to pay the difference between what we would pay for a prescription filled at an in-network retail pharmacy and what the out-of-network pharmacy charged for your prescriptions.
For additional, network pharmacy information, call Customer Service at 888-282-1420. You can call 8:00 a.m. to 8:00 p.m., Mountain Time, 7 days a week.
• TTY 711
• Para asistencia en español llame al 888-282-1420.
You can also write to:
Rocky Mountain Health Plans
Customer Service
PO Box 10600
Grand Junction, CO 81502
Mail Order Pharmacy
You can use a contracting mail order pharmacy to have a 90-day supply of your prescriptions mailed directly to your home. If you are interested in using the mail order pharmacy,
click here to receive more information.
Extra Help
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductible, and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don't even know it. For more information about this Extra Help or to see if you qualify, contact 1-800-MEDICARE (1-800-633-4227) (TTY/TDD users should call 877-486-2048) 24 hours/day, 7 days/week. You can also call your State Medicaid Office or the Social Security Administration at 1-800-772-1213 or on the toll free TTY/TDD number, 1-800-325-0778, between 7 a.m. and 7 p.m. Monday through Friday. Click here to
fill out an application to see if you qualify for Extra Help. By clicking on this link, you will be leaving the RMHP website.
If you have qualified for additional assistance for your Medicare Prescription Drug Plan costs, the amount of your premium and cost at the pharmacy will be less. Once you have enrolled in a RMHP Medicare Part D Plan, Medicare will tell us how much assistance you are receiving, and we will send you information on the amount you will pay.
If you believe you qualify for extra help with your Medicare prescription drug costs, you may provide evidence to RMHP so that your costs will be reduced.
Click here to find out more information on Medicare's policy about submitting "best available evidence" (BAE). By clicking on this link, you will be leaving the RMHP website.
Click here to see the Premium Summary Table for those receiving extra help:
Medication Therapy Management
RMHP offers Medication Therapy Management programs to our Members. Medication Therapy Management programs (MTM) are available to all Medicare Part D Members who meet the limited criteria and are designed to assist Members in optimizing their medication therapies. This program combines the services of RMHP clinical pharmacists and Colorado registered pharmacists with medication data from Rocky Mountain Health Plans and is provided at NO CHARGE to our Members. MTM services are voluntary and the program is not considered a benefit of your plan. Contact RMHP Customer Service for additional information.
Complaints, Coverage Determinations and Appeals
Click here to see the Medicare Prescription Drug Coverage Determination Request Form.
Click here to see the copy of the Formulary Exception Request Form used by physicians to send supporting statements for exception requests:
Call Rocky Mountain Health Plans Customer Service at 888-282-1420 for information on how to file or check on the status of an appeal.
You can call 8:00 a.m. to 8:00 p.m., Mountain Time, 7 days a week.
• TTY: 711
• Para asistencia en español llame al 888-282-1420.
If you wish to authorize another individual to make requests, obtain information or present information to us on your behalf, you must complete the
Appointment of Representation Form and send it to RMHP, PO Box 10600, Grand Junction, CO 81502.
To obtain an aggregate number of the Plan’s grievances, appeals, and exceptions please call Rocky Mountain Health Plans Customer Service.
Information is current as of 12/16/11. Please call to confirm you have the most up to date information about our Medicare Plans. Full list of Medicare Disclaimers.
Medicare-approved Cost plan. H0602_1037025 MC150WEB Approved 12162011
