[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-269285-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-269285-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","quality-overview-rocky-mountain-health-plans-plan-year-2019-2020","Quality Overview - Rocky Mountain Health Plans - Plan Year 2019-2020","","Quality Overview for Rocky Mountain Health Plans (RMHP) for the Connect for Health Colorado marketplace, covering clinical quality measurement, enrollee experience, and plan administration for the 2019–2020 plan year. The document explains how ratings are produced using Centers for Medicare & Medicaid Services data from 2018, and summarizes key indicators such as confirmed complaints, consumer complaint index, and medical loss ratio requirements under the Affordable Care Act. 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It will give you information about clinical quality measurement (medical care), enrollee experience (member satisfaction) and plan administration (efficiency, affordability and management) so you can compare health plans while you shop for insurance coverage.  \nThis information comes from the federal Centers for Medicare & Medicaid Services (part of the U.S. Department of Health and Human Services) using data provided by health plans in 2018. You can learn more about these ratings on the federal website. [www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/ACA-MQI/Quality-Rating-System/About-the-QRS.html](www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/ACA-MQI/Quality-Rating-System/About-the-QRS.html)  \nCompany Statistics  \nFounded In: 1974  \n\n| Website: | [www.RMHP.org](www.RMHP.org) |\n| --- | --- |\n| Coverage Area: | Offered to Individuals and Families in Mesa County |\n\nColorado Membership (2018 Membership):  \nIndividual Members: 1,770  \nCoverage area shows the area where a health insurance plan accepts members.  \nConfirmed Complaints  \nConfirmed Complaints: 0  \nPeople complain to the Colorado Division of Insurance (DOI) about things like claims handling, cancellation of a policy ora premium refund. In a “confirmed complaint,” the DOI decided the insurance company did not follow the state insurance law or regulation, a federal requirement, or the terms and conditions of an insurance policy or certificate they sold. Confirmed complaints come from people in all group sizes, not just individual plans like we sell at Connect for Health Colorado.  \nColorado Market Share  \nPercentage of total market share is based on all medical and dental carriers.  \nConsumer Complaint Index  \n0.08  \n2.0  \nWorse than Average  \n1.0  \nAverage  \n0  \nBetter than Average  \nThe complaint index shows how often people complain about their health insurance company compared to other companies. These numbers are adjusted for the size of the company and how many policy holders it has in Colorado. A company’s total number of complaints divided by its total premium income fora specific insurance product is the complaint index. The average is 1.0. An index greater than 1.0 means more people complained about Rocky Mountain Health Plans than other companies.  \nSource: 2018 Colorado DORA Division of Insurance Online Complaint Report  \nQuality Overview: Rocky Mountain Health Plans  \nPlan Year: 2019–2020 Connect for Health Colorado  \nFor more information, visit: [www.ConnectForHealthCO.com](www.ConnectForHealthCO.com)  \n1  \nMedical Loss Ratio (MLR)  \nMedical Loss Ratio (MLR) Explained  \nThe Affordable Care Act requires insurers to explain how much of your premium dollars are spent on medical services and quality improvement. This is called the Medical Loss Ratio (MLR) . It also requires them to give you a rebate if they don’t meet the minimum of 80% MLR for individual and small group plans. This limits the amount insurers spend on things like profits, executive salaries and other overhead.  \nMedical Loss Ratio  \nIndividual  \nIndividual Patient Care Costs:  \n111%  \n0% 100%  \nIf a MLR is more than 100%, that company spent more money on medical care than it received in premium dollars.  \nQuality Overview: Rocky Mountain Health Plans  \nPlan Year: 2019–2020 Connect for Health Colorado  \nFor more information, visit: [www.ConnectForHealthCO.com](www.ConnectForHealthCO.com)  \n2  \nAccreditation and Quality Ratings  \nAccreditation for the Exchange Product  \nAccreditation is when an impartial organization reviews a company’s operations to make sure the company is following national standards.  \nAccreditation: NCQA Health Plan Accreditation (Marketplace HMO)  \nThe National Committee for Quality Assuranc","cbCaivTbIARSMsxh","https://ap.wps.com/l/cbCaivTbIARSMsxh","pdf",1705960,"English","# Purpose of This Document\n# Company Statistics\n# Colorado Market Share and Consumer Complaint Index\n# Medical Loss Ratio (MLR)\n# Accreditation and Quality Ratings\n## Accreditation for the Exchange Product\n## Quality Ratings System: Global Rating\n## Quality Ratings System: Summary Indicators\n# Additional Detail and Where to Find More Measures","[{\"question\":\"What information does the Quality Overview use to help compare health plans?\",\"answer\":\"It covers clinical quality measurement (medical care), enrollee experience (member satisfaction), and plan administration (efficiency, affordability, and management).\"},{\"question\":\"How are consumer complaints measured in this overview?\",\"answer\":\"Confirmed complaints reflect decisions by the Colorado Division of Insurance that the insurer did not follow state law, federal requirements, or policy terms. The consumer complaint index adjusts complaints by company size and Colorado policy holders, compared against an average of 1.0.\"},{\"question\":\"What is the Medical Loss Ratio (MLR) and how does it affect rebates?\",\"answer\":\"The Affordable Care Act requires insurers to explain how premium dollars are spent on medical services and quality improvement, and to provide a rebate if they do not meet the minimum 80% MLR for individual and small group plans.\"}]","Quality Overview - Rocky Mountain Health Plans - Plan Year 2019-2020 | PDF",1789449981,25]