Provider and Prescription Information


Before making any decisions about purchasing an insurance plan…

It’s important to make sure that your plan covers your preferred doctors and providers.  Navigating through the insurance world can be challenging.  Below you can find instructions on how to look up providers and prescription information for the main companies available in the Colorado group health insurance market: Anthem, Humana, UnitedHealthcare, and Kaiser Permanente.  If you have any further questions or need assistance, feel free to contact us at any time.

Please note these search tools only apply to group plan offerings, and the results of any search is not definitive. Doctor and facility contracts may change at any time throughout the calendar year.

Anthem health insurance Colorado

How to make sure your doctor is in network:

  1. Go to Anthem
  2. Under Search as a Guest click on ‘Search by Selecting a Plan or Network’
  3. Then select “Medical” in the “Type of Care” dropdown
  4. Answer the State
  5. Select the network name in the plan you are enrolled in or deciding to enroll in:
    1. Anthem PPO Network
    2. Pathway/ Pathway X Network
    3. Mountain enhanced/ Mountain Enhanced X Network. (Do not use any of the plan/ network lists that have metallic levels indicated.)
    4. Enter your doctor’s name, if applicable, at the next screen and type in your location, then click ‘Search’
      • For a PCP search for Pathway network or Mountain Enhanced networks, check off the “Able to serve as Primary Care Physician )PCP) box before clicking “Search”.
      • You will find the 6-digit PCP ID listed under the doctors’ name.

How to make sure your drugs are covered:

  1. Go to Anthem Pharmacy Information
    • For most Anthem PPO network plans, you want to scroll down to the Preferred Drug Lists and choose the Preferred Drug List 4-Tier (Searchable) for 2017 or National Plus for 2018 (when available).
    • For all the Anthem Pathway HMO network plans and some Anthem PPO plans, scroll down to the Select Drug Lists (2017) and choose the Colorado Select Drug List (Searchable) for 2017. For the 2018 Drug list, scroll to the Select Drug Lists (2018) and choose the Colorado Select Drug List (Searchable) for 2018. For either Drug List year, be sure to choose the link for Colorado under the section that applies to Small Group plans.

Note: Your cost for a drug usually depends on what tier the drug is on. These lists group drugs into tiers, so find your drug, note the tier it’s in. Typically, the higher the tier, the greater your cost. Choose the list for Colorado.

How to search for dental and vision networks:

  1. Go to Anthem
  2. Under Search as a Guest click on ‘Search by Selecting a Plan or Network”
  3. Then select ‘Dental’ or ‘Vision’ in the ‘Type of Care’ dropdown
  4. Answer the State
  5. Select the network name in the plan you are enrolled in or deciding to enroll in:
    • Dental Complete for dental coverage (if the plan you are enrolling in has a different network and you need assistance, please contact MLJ)
    • Blue View Vision for vision coverage (if the plan you are enrolling in has a different network and you need assistance, please contact MLJ)

How to make sure your doctor is in network:

  1. Go to https://www.humana.com/insurance-through-employer-support/benefits/
  2. Scroll down the page to where it lists “Resources” on the left-hand side
  3. Select “Find a doctor”
  4. Select the “Just Looking” tab and choose “Insurance through your employer,” enter your ZIP code, and select your network
  5. Choose what you want to search for (name, specialty, etc.)
  6. Enter your doctor’s name or the specialty, etc. and click ‘Search’

How to make sure your drugs are covered:

  1. Go to https://www.humana.com/pharmacy/insurance-through-employer/tools/druglist/formularies
  2. Choose the plan year (when applicable)
  3. Choose “Small Business” as Coverage Type
  4. Select your state
  5. Select any of the National POS or HMOX plans that list “RX4EHB” as the end of their name
  6. Click on the English PDF link in the right column to open the formulary PDF

Note: Your cost for a drug usually depends on what tier the drug is on. These lists group drugs into tiers, so find your drug, note the tier it’s in. Typically, the higher the tier, the greater your cost. Choose the list for Colorado.

Kaiser health insurance Colorado

To review the qualified physicians in your area:

  1. Go to Kaiser Permanente and click ‘Doctors & Locations’
  2. Choose a Region or enter your ZIP Code
  3. Search by entering Doctor’s nam
  4. Under ‘Heath & Wellness’ tab, click ‘Drugs & Natural Medicines’
  5. Click ‘Covered Drugs’ under Formulary
  6. Click ‘Find out what drugs are covered in your area’
  7. Select’Colorado Marketplace Formulary’

How to make sure your drugs are covered:

  1. Go to Kaiser Permanente and click ‘Doctors & Locations’
  2. Under ‘Heath & Wellness’ tab, click ‘Drugs & Natural Medicines’
  3. Click ‘Covered Drugs’ under Formulary
  4. Click ‘Find out what drugs are covered in your area’
  5. Select’Colorado Marketplace Formulary’

How to search for dental networks:

  1. Go to Delta Dental Dentist Search
  2. Network Selection should be “Delta Dental PPO” only
  3. Put in a zip code
  4. Under Additional Search Criteria, you can add a specific Last Name or Practice Name.

This Search box works for UnitedHealthcare plans and All Savers plans.

How to make sure your doctor is in network:

  1. Go to UnitedHealthcare
  2. On the right side of the page you can select a hyperlink “Find Physician, Laboratory or Facility
  3. Select the “Medical Directory”
  4. Select the “All United HealthCare Plans” Box
  5. Select the network name in the plan you are enrolled in or deciding to enroll in:
    • Choice Plus
      • Choose “People”
      • Choose “Primary Care Physician” or “Specialty Care” for any other doctor you are searching for
      • You can refine your search by Zip code and limiting the mileage
    • Charter HMO/ Charter Balanced HMO/ Charter Plus HMO or Navigate HMO/ Navigate Balanced HMO/ Navigate Plus HMO
      • Choose 2018 as the calendar year you will be accessing the benefits
      • To find a Primary Care Physician for your application, choose “People” and then click on “Primary Care”
      • Click on “Primary Care Physician” and refine your search by your Zip Code
      • Click on the doctor’s name you wish to select as your PCP
      • Click on “Enrollment Information” to find the doctor’s PCP ID listed under the “Medical Groups & IDs”

How to make sure your drugs are covered:

  1. Go to UnitedHealthcare
  2. On the right side of the page you can select a hyperlink “Pharmacy Information
  3. You will want to click the hyperlink that says: 2017 Tier 4 Prescription Drug List effective January 1, 2017 or 2018 Tier 4 Traditional Prescrption Drug List effective January 1. 2018. 

Note: Your cost for a drug usually depends on what tier the drug is on. These lists group drugs into tiers, so find your drug, note the tier it’s in. Typically, the higher the tier, the greater your cost. 

How to search for dental networks:

  • Go to UnitedHealthcare
  • On the right side of the page, you can select the hyperlink “Find a Dentist
  • Answer the State
  • Select the Dental Options PPO Network
  • Choose “Location” and type in your Zip Code and any other information you wish to search by, then click “Search”
  • If you wish to search by your dentist or dentist’s office name instead, choose those search options in stead of “Location” and fill in whatever information is designated as required (red asterisks next to it)

How to search for vision networks:

  1. Go to UnitedHealthcare
  2. On the right side of the page, you can select the hyperlink “Vision Provider
  3. Type in your Zip code or address and click “Search”

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