Frequently Asked Questions by Members

Frequently Asked Questions by Members

Sometimes health insurance can be confusing, so we're here to help by answering some of the questions we get asked most frequently. RMHP offers a variety of plans, so the answers below may differ depending on the RMHP plan through which you receive your benefits. For additional information, review your plan materials or contact Customer Service.

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The subscriber receives a Coverage Schedule that shows how much you pay for the covered healthcare services listed in the Schedule of Benefits in the Health Plan Guide. It also shows benefits that are limited to a number of treatments, days, visits, or a specific dollar amount. This information for most commonly used services is also accessible in access|RMHP, our secure website for Members. Registration is required.
After enrolling in an RMHP plan, the subscriber will receive a Health Plan Guide that includes a Summary of Benefits. If you need a replacement Health Plan Guide, you may contact Customer Service.
A Member Billing Statement (MBS) lists the healthcare services you have received and any deductibles or copayments due to RMHP. You will receive an MBS only when you have received services for which RMHP has already paid the provider in full and for which you must pay your copayment directly to RMHP.
You will receive an Explanation of Benefits (EOB) each time you receive services from a provider who is responsible for collecting your copayment. You will also receive one if you have medical coverage with another health plan. If you have questions about your copayments, coinsurance, or deductibles, the amounts can be found in the Coverage Schedule section of your Health Plan Guide.
There are time limits for making changes to your coverage, such as adding your spouse or other dependents to your plan. See your Health Plan Guide for time limits. If you have a group plan, you can obtain a change form from your employer. Individual plan subscribers can contact our friendly Customer Service team.
The requirements and service area vary depending on your RMHP plan.
Referrals are not required; however, certain healthcare procedures and services must be preauthorized by RMHP before you receive them, or you may not get the maximum level of coverage your plan allows. When you see a participating provider, your doctor gets the necessary prior authorization for you. For services provided by a non-participating provider, it is your responsibility to start the prior authorization process. Failure to have services preauthorized when required will result in a significant reduction in benefits as described in your Health Plan Guide.

To ensure your prior authorization request is completed in a timely manner, please allow:

Medicaid:
10 days

Medicare:
14 days

CHP+:
15 days

Commercial:
15 days

Services requiring prior authorization
Durable Medical Equipment (DME)
Notification of admission to a facility
If you disagree with a decision made by RMHP and wish to appeal the decision, the Dispute Resolution Procedures described in the Health Plan Guide must be used. These procedures vary depending on your RMHP plan.
Coordination of Benefits (COB) happens when a person has healthcare coverage under more than one health plan. Refer to your Health Plan Guide for COB provisions, and be sure to notify RMHP if you or a covered family Member has medical coverage with another health plan.

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