DHHA Employer Plan enrolled employees living out-of-state or with out-of-state spouse or dependents
For the 2024 plan year, you must notify Health Plan Services (HPS) at 303-602-2100 if anyone on your plan (spouse or dependent) lives out-of-area/out-of-state (considered to be out-of-network).
Only the subscriber (DHHA Employer Plan enrolled employee) is authorized to notify DHMP of out-of-area/out-of-state spouse or dependents.
If a spouse or dependent moves during the plan year, such as a child going out-of-area for college, you must notify HPS. What defines ‘out-of-area/out-of-state’ will be determined by your employer, Denver Health and Hospital Authority.
Additional Information
Prior Authorizations
ANY and ALL services out-of-network will require prior authorization in order for the claim to be processed. The health care provider will need to submit a Request for Prior Authorization to DHMP in advance of the visit. If there is no prior authorization in place, the claim will be denied and the member could be charged. Prior authorization is required for out-of-network services including, but not limited to:
- Primary care provider (PCP) visits
- Annual preventive care visits
- OB/GYN visits
- Outpatient behavioral health visits
Exception: prior authorization is NOT required for urgent or emergency care – which are covered anywhere in the U.S
Changes for 2025:
This process will not be required as of 1/1/2025 due to changes in the DHHA employer plan offerings. For the 2025 plan year, only the Denver Health Extended Plan (POS) will have out-of-state coverage beyond urgent or emergency care. Employees and their spouse or dependents enrolled in the Denver Heath Plan (HMO) will not have routine out-of-state medical care prior authorized and covered.
Additional Information
For more information about coverage for dependents residing outside of the service area and your plan’s provider network, please refer to your member handbook.