PPO Plan Comparisons for Small Employer Groups

PPO Plan Comparisons for Small Employer Groups

To view coverage and deductible information for each Colorado Small Group PPO health plan offered by Rocky Mountain Health Plans, please review our PPO Plan Comparison Grid below, or download our Small Employer Group plan brochures.

  
2017 Rocky Mountain Summit Small Group Brochure     2017 Rocky Mountain Monument Health Small Group Brochure
Rocky Mountain Summit Provider Directory                       Rocky Mountain Monument Health Provider Directory
View 2016 Small Group PPO Plan Documents

2017 Rocky Mountain Summit PPO Plans

Summit PPO Gold 0/70

In-Network:
No Deductible

Out-of-Network:
$1,000/$2,000

In-Network:
30% after deductible


Out-of-Network:
50% after deductible

In-Network:
30% coinsurance


Out-of-Network:
50% coinsurance

In-Network:
$6,500/$13,000


Out-of-Network:
$13,000/$26,000

In-Network:
Tier 1: $20
Tier 2: $40
Tier 3: $65
Tier 4: $175
Tier 5: $375 


Out-of-Network: Not Covered

SBC
Benefit Summary
EOC
Drug Price Check

Summit PPO Gold 500/80 - $35

In-Network:
$500/$1,000


Out-of-Network:
$1,000/$2,000

In-Network:
$35/$50 no deductible


Out-of-Network: 
50% after deductible

In-Network:
20% coinsurance


Out-of-Network:
50% coinsurance

In-Network:
$4,000/$8,000


Out-of-Network:
$8,000/$16,000

In-Network:
Tier 1: $15
Tier 2: $40
Tier 3: $70
Tier 4: $175
Tier 5: $275 (no deductible)


Out-of-Network: Not covered

SBC
Benefit Summary 
EOC
Drug Price Check

Summit PPO Gold 1000/Copay - $30

In-Network:
$1,000/$2,000


Out-of-Network:
$2,000/$4,000

In-Network:
$30/$55 no deductible


Out-of-Network:
50% after deductible

In-Network:
100% covered after deductible


Out-of-Network:
50% coinsurance

In-Network:
$6,500/$13,000


Out-of-Network:
$13,000/$26,000

In-Network:
Tier 1: $15
Tier 2: $55
Tier 3: $100
Tier 4: $200
Tier 5: $350 (no deductible)


Out-of-Network: Not covered

SBC
Benefit Summary
EOC
Drug Price Check

Summit PPO Gold HSA 2000/100

In-Network:
$2,000/$4,000


Out-of-Network:
$4,000/$8,000

In-Network:
100% covered after deductible


Out-of-Network:
50% after deductible

In-Network:
100% covered after deductible


Out-of-Network:
50% coinsurance

In-Network:
$2,000/$4,000


Out-of-Network:
$8,000/$16,000

In-Network: After Medical Deductible
Tier 1: 0%
Tier 2: 0%
Tier 3: 0%
Tier 4: 0%
Tier 5: 0%


Out-of-Network: Not covered

SBC
Benefit Summary
EOC

Summit PPO Silver 1750/70 - $40

In-Network:
$1,750/$3,500


Out-of-Network:
$3,500/$7,000

In-Network:
$40/$55 no deductible


Out-of-Network:
50% after deductible

In-Network:
30% coinsurance


Out-of-Network:
50% coinsurance

In-Network:
$6,800/$13,600


Out-of-Network:
$13,600/$27,000

In-Network:
Tier 1: $15
Tier 2: $45
Tier 3: $75
Tier 4: $275
Tier 5: $375 (no deductible)


Out-of-Network: Not covered

SBC
Benefit Summary
EOC
Drug Price Check

Summit PPO Silver 2700/70 - $45

In-Network:
$2,700/$5,400


Out-of-Network:
$5,400/$10,800

In-Network:
$45/$65 no deductible


Out-of-Network:
50% after deductible

In-Network:
30% coinsurance


Out-of-Network:
50% coinsurance

In-Network:
$7,000/$14,000


Out-of-Network:
$14,000/$28,000

In-Network:
Tier 1: $15
Tier 2: $40
Tier 3: $55
Tier 4: 30%
Tier 5: 40% (no deductible)


Out-of-Network: Not covered

SBC
Benefit Summary
EOC
Drug Price Check

Summit PPO Silver 3200/80 - $40

In-Network:
$3,200/$6,400


Out-of-Network:
$6,400/$12,800

In-Network:
$40/$55 no deductible


Out-of-Network:
50% after deductible

In-Network:
20% coinsurance


Out-of-Network:
50% coinsurance

In-Network:
$7,000/$14,000


Out-of-Network:
$14,000/$28,000

In-Network:
Tier 1: $15
Tier 2: $40
Tier 3: $70
Tier 4: 30%
Tier 5: 40% (no deductible)


Out-of-Network: Not covered

SBC
Benefit Summary
EOC
Drug Price Check

Summit PPO Silver HSA 3750/100

In-Network:
$3,750/$7,500


Out-of-Network:
$7,500/$15,000

In-Network:
100% covered after deductible


Out-of-Network:
50% after deductible

In-Network:
100% covered after deductible


Out-of-Network:
50% coinsurance

In-Network:
$3,750/$7,500


Out-of-Network:
$15,000/$30,000

In-Network: After Medical Deductible:
Tier 1: 0%
Tier 2: 0%
Tier 3: 0%
Tier 4: 0%
Tier 5: 0%


Out-of-Network: Not covered

SBC

Benefit Summary

EOC

Summit PPO Silver 4000/Copay - $30

In-Network:
$4,000/$8,000


Out-of-Network:
$8,000/$16,000

In-Network:
$30/$55 no deductible


Out-of-Network:
50% after deductible

In-Network:
100% covered after deductible


Out-of-Network:
50% coinsurance

In-Network:
$7,000/$14,000


Out-of-Network:
$14,000/$28,000

In-Network:
Tier 1: $15
Tier 2: $55
Tier 3: $150
Tier 4: $250
Tier 5: $400 (no deductible)


Out-of-Network: Not covered

SBC
Benefit Summary
EOC
Drug Price Check

Summit PPO Bronze HSA 5500/50

In-Network:
$5,500/$11,000


Out-of-Network:
$11,000/$22,000

In-Network:
50% after deductible


Out-of-Network:
50% after deductible

In-Network:
50% coinsurance


Out-of-Network:
50% coinsurance

In-Network:
$6,550/$13,100


Out-of-Network:
$13,100/$26,200

After Medical Deductible:
Tier 1: $20
Tier 2: $60
Tier 3: 30%
Tier 4: 40%
Tier 5: 50%


Out-of-Network: Not covered

SBC
Benefit Summary
EOC
Drug Price Check

Summit PPO Bronze 5800/65

In-Network:
$5,800/$11,600


Out-of-Network:
$11,600/$23,200

In-Network:
PCP: First 2 visits: $50 no deductible, then 35% coinsurance after deductible.  
Specialist: 35% coinsurance


Out-of-Network:
50% after deductible

In-Network:
35% coinsurance


Out-of-Network:
50% coinsurance

In-Network:
$7,100/$14,200


Out-of-Network:
$14,200/$28,400

In-Network:
Tier 1: $25
Tier 2: $70
Tier 3: $200
Tier 4: $450
Tier 5: $540 (no deductible)


Out-of-Network: Not covered

SBC
Benefit Summary
EOC
Drug Price Check

Summit PPO Bronze HSA 6550/100

In-Network:
$6,550/$13,100


Out-of-Network:
$13,100/$26,200

In-Network:
100% covered after deductible


Out-of-Network:
50% after deductible

In-Network:
100% covered after deductible


Out-of-Network:
50% coinsurance

In-Network:
$6,550/$13,100


Out-of-Network:
$15,000/$30,000

After Medical Deductible:
Tier 1: 0%
Tier 2: 0%
Tier 3: 0%
Tier 4: 0%
Tier 5: 0%


Out-of-Network: Not covered

SBC
Benefit Summary
EOC

2017 Monument Health PPO Group Plans

Monument Health PPO Gold 1000/2000

In-Network:
Tier 1: $1,000/$2,000 
Tier 2: $2,000/$4,000

Out-of-Network:
$4,000/$8,000

In-Network:
Tier 1: $15/$50 no deductible
Tier 2: $40/$50 no deductible


Out-of-Network:
50% after deductible

In-Network:
Tier 1: 20% coinsurance

Tier 2: 40% coinsurance

Out-of-Network:
50% coinsurance

In-Network: 
Tier 1: $3,500/$7,000
Tier 2: $6,000/$12,000

Out-of-Network:
$12,000/$24,000

In-Network:
Tier 1: $15
Tier 2: $40
Tier 3: $65
Tier 4: $175
Tier 5: $350 (no deductible)

Out-of-Network: Not covered

SBC
Benefit Summary
EOC
Drug Price Check

Monument Health PPO Silver 3000/4500

In-Network: 
Tier 1: $3,000/$6,000
Tier 2: $4,500/$9,000


Out-of-Network:
$8,000/$16,000

In-Network:
Tier 1: $20/$60 no deductible
Tier 2: $45/$60 no deductible


Out-of-Network:
50% after deductible

In-Network:
Tier 1: 30% coinsurance
Tier 2: 50% coinsurance


Out-of-Network:
50% coinsurance

In-Network:
Tier 1: $6,400/$12,800
Tier 2: $6,850/$13,700


Out-of-Network:
$15,000/$30,000

In-Network:
Tier 1: $15
Tier 2: $40
Tier 3: $75
Tier 4: $200
Tier 5: $400 (no deductible)


Out-of-Network: Not covered

SBC
Benefit Summary
EOC
Drug Price Check

Monument Health PPO Bronze 5650/6500

In-Network:
Tier 1: $5,650/$11,300
Tier 2: $6,500/$13,000

Out-of-Network:
$12,000/$24,000

In-Network:
Tier 1: PCP: $45 no deductible
Specialist: $95 no deductible

Tier 2: PCP: $70 no deductible
Specialist: 50% after deductible


Out-of-Network:
50% after deductible

In-Network:
Tier 1: 40% coinsurance
Tier 2: 50% coinsurance


Out-of-Network:
50% coinsurance

In-Network:
Tier 1: $6,850/$13,700
Tier 2: $7,100/$14,200


Out-of-Network:
$18,000/$36,000

In-Network:
Tier 1: $28
Tier 2: $75
Tier 3: $400
Tier 4: $540
Tier 5: $540 (no deductible)


Out-of-Network: Not covered

SBC
Benefit Summary
EOC
Drug Price Check

Monument Health PPO Silver HSA 4000/5500

In-Network:
Tier 1: $4,000/$8,000
Tier 2: $5,500/$11,000


Out-of-Network:
$9,000/$18,000

In-Network:
Tier 1: PCP: 100% covered after deductible
Specialist: 100% covered after deductible

Tier 2: PCP: 100% covered after deductible
Specialist: 100% covered after deductible


Out-of-Network:
50% after deductible

In-Network:
Tier 1: 100% covered after deductible
Tier 2: 100% covered after deductible


Out-of-Network:
50% coinsurance

In-Network:
Tier 1: $4,000/$8,000
Tier 2: $5,500/$11,000


Out-of-Network:
$12,000/$24,000

In-Network:
After Tier 1 Deductible: 
Tier 1: 0%
Tier 2: 0%
Tier 3: 0%
Tier 4: 0%
Tier 5: 0%


Out-of-Network: Not covered

SBC
Benefit Summary
EOC
Drug Price Check

Monument Health PPO Bronze HSA 6500/7100

In-Network:
Tier 1: $6,500/$13,000
Tier 2: $7,100/$14,200

Out-of-Network:
$10,000/$20,000

In-Network:
Tier 1: PCP: 100% covered after deductible
Specialist: 100% covered after deductible

Tier 2: PCP: 100% covered after deductible
Specialist: 100% covered after deductible


Out-of-Network:
50% after deductible

In-Network:
Tier 1: 100% covered after deductible
Tier 2: 100% covered after deductible


Out-of-Network:
50% coinsurance

In-Network:
Tier 1: $6,500/$13,000
Tier 2: $7,100/$14,200


Out-of-Network:
$15,000/$30,000

In-Network:
After Tier 1 Deductible: 
Tier 1: 0%
Tier 2: 0%
Tier 3: 0%
Tier 4: 0%
Tier 5: 0%


Out-of-Network: Not covered

SBC
Benefit Summary
EOC
Drug Price Check
1Specialty Drugs may not be available at all pharmacies.  Call Customer Service to confirm drug availability.

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