To view coverage and deductible information for each Colorado Small Group HMO health plan offered by Rocky Mountain Health Plans, review our HMO Plan Comparison Grid below, or download our Small Employer Group plan brochures.
2018 Rocky Mountain Range Regional HMO Plans
Range HMO Bronze HSA 6550/100
Deductible Individual / Family
$6,550/$13,100
Office Visits
0% coinsurance after deductible
Inpatient Hospital Stay (after deductible)
0% coinsurance after deductible
Out of Pocket Maximum
$6,550/$13,100
Prescription Drug Coverage
After Medical Deductible:
Tier 1: 0%
Tier 2: 0%
Tier 3: 0%
Tier 4: 0%
Tier 5: 0%
Range HMO Bronze 6000/65 - $60
Deductible Individual / Family
$6,000/$12,000
Office Visits
PCP: First 4 visits: $60 no deductible, then 35% coinsurance after deductible
Specialist: 35% coinsurance after deductible
Inpatient Hospital Stay (after deductible)
35% coinsurance after deductible
Out of Pocket Maximum
$7,350/$14,700
Prescription Drug Coverage
Tier 1: $20
Tier 2: $50
Tier 3: $125
Tier 4: $300
Tier 5: $500
(no deductible)
Range HMO Silver 5000/50 - $55
Deductible Individual / Family
$5,000/$10,000Office Visits
PCP: First 5 visits: $55, no deductible, then 50% after deductibleSpecialist: $80, no deductible
Inpatient Hospital Stay (after deductible)
$1,750 per stay,then 50% coinsurance after deductible
Out of Pocket Maximum
$7,350/$14,700Prescription Drug Coverage
Tier 1: $20Tier 2: $55
Tier 3: $100
Tier 4: $300
Tier 5: $500
(no deductible)
Range HMO Silver 4500/75 - $55
Deductible Individual / Family
$4,500/$9,000Office Visits
$55/$80, no deductibleInpatient Hospital Stay (after deductible)
25% coinsurance after deductibleOut of Pocket Maximum
$7,000/$14,000Prescription Drug Coverage
Tier 1: $20, no deductibleAfter $200 Rx deductible:
Tier 2: $50
Tier 3: $80
Tier 4: 25%
Tier 5: 30%
Range HMO Silver HSA 4000/100
Deductible Individual / Family
$4,000/$8,000
Office Visits
0% coinsurance after deductible
Inpatient Hospital Stay (after deductible)
0% coinsurance after deductible
Out of Pocket Maximum
$4,000/$8,000
Prescription Drug Coverage
After Medical Deductible:
Tier 1: 0%
Tier 2: 0%
Tier 3: 0%
Tier 4: 0%
Tier 5: 0%
Range HMO Silver 3000/70 - $55
Deductible Individual / Family
$3,000/$6,000
Office Visits
$55/$80 no deductible
Inpatient Hospital Stay (after deductible)
30% coinsurance after deductible
Out of Pocket Maximum
$7,350/$14,700
Prescription Drug Coverage
Tier 1: $20
Tier 2: $50
Tier 3: $80
Tier 4: $300
Tier 5: $400
(no deductible)
Range HMO Silver 2000/65 - $45
Deductible Individual / Family
$2,000/$4,000
Office Visits
PCP - First 3 visits $45, no deductible, then 35% after deductible
Specialist - $70, no deductible
Inpatient Hospital Stay (after deductible)
$1000 per stay,
then 35% coinsurance after deductible
Out of Pocket Maximum
$7,300/$14,600
Prescription Drug Coverage
Tier 1: $20
Tier 2: $50
Tier 3: $80
Tier 4: $300
Tier 5: $400
(no deductible)
Range HMO Gold HSA 2800/100
Deductible Individual / Family
$2,800/$5,600
Office Visits
0% coinsurance after deductible
Inpatient Hospital Stay (after deductible)
0% coinsurance after deductible
Out of Pocket Maximum
$2,800/$5,600
Prescription Drug Coverage
After Medical Deductible:
Tier 1: 0%
Tier 2: 0%
Tier 3: 0%
Tier 4: 0%
Tier 5: 0%
Range HMO Gold 1000/75 - $40
Deductible Individual / Family
$1,000/$2,000
Office Visits
$40/$60 no deductible
Inpatient Hospital Stay (after deductible)
$500 per stay,
then 25% after deductible
Out of Pocket Maximum
$6,500/$13,000
Prescription Drug Coverage
Tier 1: $20
Tier 2: $40
Tier 3: $65
Tier 4: $175
Tier 5: $275
(no deductible)
Range HMO Gold 500/80 - $40
Deductible Individual / Family
$500/$1,000
Office Visits
$40/$60 no deductible
Inpatient Hospital Stay (after deductible)
20% coinsurance
Out of Pocket Maximum
$5,000/$10,000
Prescription Drug Coverage
Tier 1: $20
Tier 2: $40
Tier 3: $65
Tier 4: $175
Tier 5: $275
(no deductible)
2018 Rocky Mountain Summit HMO Plans
Summit HMO Bronze HSA 6550/100
Deductible Individual / Family
$6,550/$13,100
Office Visits
100% covered after deductible
Inpatient Hospital Stay (after deductible)
100% covered after deductible
Out of Pocket Maximum
$6,550/$13,100
Prescription Drug Coverage
After Medical Deductible:
Tier 1: 0%
Tier 2: 0%
Tier 3: 0%
Tier 4: 0%
Tier 5: 0%
Summit HMO Bronze 6000/65 - $60
Deductible Individual / Family
$6,000/$12,000
Office Visits
PCP: First 4 visits: $60 no deductible, then 35% coinsurance after deductible.
Specialist: 35% coinsurance after deductible
Inpatient Hospital Stay (after deductible)
35% coinsurance after deductible
Out of Pocket Maximum
$7,350/$14,700
Prescription Drug Coverage
Tier 1: $20
Tier 2: $50
Tier 3: $125
Tier 4: $300
Tier 5: $500
(no deductible)
Summit HMO Silver 5000/50 - $55
Deductible Individual / Family
$5,000/$10,000
Office Visits
PCP: First 5 visits $55, no deductible, then 50% after deductible
Specialist: $80, no deductible
Inpatient Hospital Stay (after deductible)
$1750 per stay, then 50% coinsurance after deductible
Out of Pocket Maximum
$7,350/$14,700
Prescription Drug Coverage
Tier 1: $20
Tier 2: $55
Tier 3: $100
Tier 4: $300
Tier 5: $500
(no deductible)
Summit HMO Silver 4500/75 - $55
Deductible Individual / Family
$4,500/$9,000
Office Visits
$55/$80 no deductible
Inpatient Hospital Stay (after deductible)
25% coinsurance after deductible
Out of Pocket Maximum
$7,000/$14,000
Prescription Drug Coverage
Tier 1: $20, no deductible
After $200 Rx deductible
Tier 2: $50
Tier 3: $80
Tier 4: 25%
Tier 5: 30%
Summit HMO Silver HSA 4000/100
Deductible Individual / Family
$4,000/$8,000
Office Visits
100% covered after deductible
Inpatient Hospital Stay (after deductible)
100% covered after deductible
Out of Pocket Maximum
$4,000/$8,000
Prescription Drug Coverage
After Medical Deductible:
Tier 1: 0%
Tier 2: 0%
Tier 3: 0%
Tier 4: 0%
Tier 5: 0%
Summit HMO Silver 3000/70 - $55
Deductible Individual / Family
$3,000/$6,000
Office Visits
$55/$80 no deductible
Inpatient Hospital Stay (after deductible)
30% coinsurance after deductible
Out of Pocket Maximum
$7,350/$14,700
Prescription Drug Coverage
Tier 1: $20
Tier 2: $50
Tier 3: $80
Tier 4: $300
Tier 5: $400
(no deductible)
Summit HMO Silver 2000/65 - $45
Deductible Individual / Family
$2,000/$4,000
Office Visits
PCP: First 3 visits $45, no deductible, then 35% after deductible
Specialist: $70 no deductible
Inpatient Hospital Stay (after deductible)
$1,000 per stay,
then 35% coinsurance after deductible
Out of Pocket Maximum
$7,300/$14,600
Prescription Drug Coverage
Tier 1: $20
Tier 2: $50
Tier 3: $80
Tier 4: $300
Tier 5: $400
(no deductible)
Summit HMO Gold HSA 2800/100
Deductible Individual / Family
$2,800/$5,600
Office Visits
100% covered after deductible
Inpatient Hospital Stay (after deductible)
100% covered after deductible
Out of Pocket Maximum
$2,800/$5,600
Prescription Drug Coverage
After Medical Deductible:
Tier 1: 0%
Tier 2: 0%
Tier 3: 0%
Tier 4: 0%
Tier 5: 0%
Summit HMO Gold 1000/75 - $40
Deductible Individual / Family
$1,000/$2,000
Office Visits
$40/$60 no deductible
Inpatient Hospital Stay (after deductible)
$500 per stay,
then 25% coinsurance after deductible
Out of Pocket Maximum
$6,500/$13,000
Prescription Drug Coverage
Tier 1: $20
Tier 2: $40
Tier 3: $65
Tier 4: $175
Tier 5: $275
(no deductible)
Summit HMO Gold 500/80 - $40
Deductible Individual / Family
$500/$1,000
Office Visits
$40/$60 no deductible
Inpatient Hospital Stay (after deductible)
20% coinsurance after deductible
Out of Pocket Maximum
$5,000/$10,000
Prescription Drug Coverage
Tier 1: $20
Tier 2: $40
Tier 3: $65
Tier 4: $175
Tier 5: $275
(no deductible)
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