PPO Plan Comparisons for Small Employer Groups

PPO Plan Comparisons for Small Employer Groups

Monument Health PPO plans are available in Mesa County.  These tiered benefit plans offer preferred access to the Monument Health Network along with access to our statewide and national network of providers and facilities.  No referrals are needed.

2019 Monument Health Service Area

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.

2019 Rocky Mountain Monument Health Small Group Brochure

2018 Rocky Mountain Monument Health Small Group Brochure

Rocky Mountain Monument Health Provider Directory

2018 Monument Health PPO Group Plans

Monument Health PPO Bronze HSA 6500/6550

In-Network:
Tier 1: $6,500/$13,000
Tier 2: $6,550/$13,100

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

In-Network:
Tier 1: PCP: 0% coinsurance after deductible
Specialist: 0% coinsurance after deductible

Tier 2: PCP: 0% coinsurance after deductible
Specialist: 0% coinsurance after deductible


Out-of-Network:
50% coinsurance after deductible

In-Network:
Tier 1:  0% coinsurance after deductible
Tier 2:  0% coinsurance after deductible


Out-of-Network:
50% coinsurance after deductible

In-Network:
Tier 1: $6,500/$13,000
Tier 2: $6.550/$13,100


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

Monument Health PPO Bronze 6000/6700

In-Network:
Tier 1: $6,000/$12,000
Tier 2: $6,700/$13,400

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

In-Network:
Tier 1: PCP: $55 no deductible
Specialist: $95 no deductible

Tier 2: PCP: $75 no deductible
Specialist: 50% coinsurance after deductible


Out-of-Network:
50% coinsurance after deductible

In-Network:
Tier 1: 40% coinsurance
Tier 2: $500 per stay, then 50% coinsurance after deductible


Out-of-Network:
50% coinsurance after deductible

In-Network:
Tier 1: $7,350/$14,700
Tier 2: $7,350/$14,700


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

In-Network:
Tier 1: $25
Tier 2: $60
Tier 3: $150
Tier 4: $300
Tier 5: $450


Out-of-Network: Not covered

SBC
Benefit Summary
EOC

Monument Health PPO Silver HSA 4500/6500

In-Network:
Tier 1: $4,500/$9,000
Tier 2: $6,500/$13,000


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

In-Network:
Tier 1: PCP: 0% coinsurance after deductible
Specialist: 0% coinsurance after deductible

Tier 2: PCP: 0% coinsurance after deductible
Specialist: 0% coinsurance after deductible


Out-of-Network:
50% coinsurance after deductible

In-Network:
Tier 1: 0% coinsurance after deductible
Tier 2: 0% coinsurance after deductible


Out-of-Network:
50% coinsurance after deductible

In-Network:
Tier 1: $4,500/$9,000
Tier 2: $6,500/$13,000


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

Monument Health PPO Silver 4000/5500

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


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

In-Network:
Tier 1:  PCP - $35
Specialist - $70
Tier 2: PCP - $50
Specialist - $80

No deductible 

Out-of-Network:
50% coinsurance after deductible

In-Network:
Tier 1: 40% coinsurance
Tier 2: $500 per stay, then 50% coinsurance after deductible


Out-of-Network:
50% coinsurance after deductible

In-Network:
Tier 1: $7,000/$14,000

Tier 2: $7,000/$14,000

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

In-Network:
Tier 1: $15
Tier 2: $50
Tier 3: $80
Tier 4: $300
Tier 5: $450


Out-of-Network: Not covered

SBC
Benefit Summary
EOC

Monument Health PPO Silver 3500/5000

In-Network: 
Tier 1: $3,500/$7,000
Tier 2: $5,000/$10,000


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

In-Network:
Tier 1: PCP: 1st 3 visits 100% covered, then $35, no deductible; Specialist: $70, no deductible

Tier 2: PCP: $50, no deductible; Specialist: $80, no deductible


Out-of-Network:
50% coinsurance after deductible

In-Network:
Tier 1: $750 per day, up to 4 days
Tier 2: 50% coinsurance after deductible


Out-of-Network:
50% coinsurance after deductible

In-Network:
Tier 1: $7,350/$14,700
Tier 2: $7,350/$14,700


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

In-Network:
Tier 1: $15
Tier 2: $50
Tier 3: $80
Tier 4: $300
Tier 5: $450


Out-of-Network: Not covered

SBC
Benefit Summary
EOC

Monument Health PPO Gold 1000/2500

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

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

In-Network:
Tier 1: PCP - $15
Specialist - $50 
Tier 2: PCP - $40
Specialist - $70


Out-of-Network:
50% coinsurance after deductible

In-Network:
Tier 1: 20% coinsurance after deductible

Tier 2: 40% coinsurance after deductible

Out-of-Network:
50% coinsurance after deductible

In-Network: 
Tier 1: $5,500/$13,000
Tier 2: $5,500/$13,000

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

In-Network:
Tier 1: $15
Tier 2: $40
Tier 3: $80
Tier 4: $200
Tier 5: $300

Out-of-Network: Not covered

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

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