DHHA Employer Plan enrolled employees living out of state or with out-of-state spouse or dependents

All DHHA Employer Plan members are covered at any urgent care or emergency room anywhere in the U.S. 

Only the Denver Health Extended Plan (POS) has out-of-state coverage beyond urgent or emergency care. Employees and their spouse or dependents enrolled in the Denver Heath Plan (HMO) are not eligible to have routine out-of-state medical care prior authorized and covered.

Prior Authorizations

ANY and ALL out-of-network services 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

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.