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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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