To view coverage and deductible information for each Colorado Small Group HSA option offered by Rocky Mountain Health Plans, review our HSA Option Comparison Grid below.
2019 Rocky Mountain Canyon HMO HSA Plans
Rocky Mountain Canyon HMO Bronze HSA 6500/100
Deductible Individual / Family
$6,500/$13,000
Office Visits
0% coinsurance after deductible
Inpatient Hospital Stay (after deductible)
0% coinsurance after deductible
Out of Pocket Maximum
$6,500/$13,000
Prescription Drug Coverage
After Medical Deductible:
Tier 1: 0%
Tier 2: 0%
Tier 3: 0%
Tier 4: 0%
Tier 5: 0%
Rocky Mountain Canyon HMO Silver HSA 4500/100
Deductible Individual / Family
$4,500/$9,000
Office Visits
0% coinsurance after deductible
Inpatient Hospital Stay (after deductible)
0% coinsurance after deductible
Out of Pocket Maximum
$4,500/$9,000
Prescription Drug Coverage
After Medical Deductible:
Tier 1: 0%
Tier 2: 0%
Tier 3: 0%
Tier 4: 0%
Tier 5: 0%
2019 Rocky Mountain Range - HMO HSA Group 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 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 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%
2019 Rocky Mountain Summit HMO HSA Plans
Summit 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%
Summit 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%
Summit 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%
2018 Monument Health - PPO HSA Group Plans
Monument Health PPO Bronze HSA 6500/6550
Deductible Individual / Family
In-Network:
Tier 1: $6,500/$13,000
Tier 2: $6,550/$13,100
Out-of-Network:
$10,000/$20,000
Office Visits
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
Inpatient Hospital Stay (after deductible)
In-Network:
Tier 1: 0% coinsurance after deductible
Tier 2: 0% coinsurance after deductible
Out-of-Network:
50% coinsurance after deductible
Out of Pocket Maximum
In-Network:
Tier 1: $6,500/$13,000
Tier 2: $6.550/$13,100
Out-of-Network:
$15,000/$30,000
Prescription Drug Coverage
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 Silver HSA 4500/6500
Deductible Individual / Family
In-Network:
Tier 1: $4,500/$9,000
Tier 2: $6,500/$13,000
Out-of-Network:
$9,000/$18,000
Office Visits
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
Inpatient Hospital Stay (after deductible)
In-Network:
Tier 1: 0% coinsurance after deductible
Tier 2: 0% coinsurance after deductible
Out-of-Network:
50% coinsurance after deductible
Out of Pocket Maximum
In-Network:
Tier 1: $4,500/$9,000
Tier 2: $6,500/$13,000
Out-of-Network:
$12,000/$24,000
Prescription Drug Coverage
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
2018 Rocky Mountain Summit PPO HSA Plans
Summit PPO Bronze HSA 6550/100
Deductible Individual / Family
In-Network: $6,550/$13,100
Out-of-Network: $13,100/$26,200
Office Visits
In-Network: 100% covered after deductible
Out-of-Network: 50% after deductible
Inpatient Hospital Stay (after deductible)
In-Network: 100% covered after deductible
Out-of-Network: 50% coinsurance
Out of Pocket Maximum
In-Network: $6,550/$13,100
Out-of-Network: $15,000/$30,000
Prescription Drug Coverage
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 HSA 4000/100
Deductible Individual / Family
In-Network: $4,000/$8,000
Out-of-Network: $8,000/$16,000
Office Visits
In-Network: 100% covered after deductible
Out-of-Network: 50% after deductible
Inpatient Hospital Stay (after deductible)
In-Network: 100% covered after deductible
Out-of-Network: 50% coinsurance
Out of Pocket Maximum
In-Network: $4,000/$8,000
Out-of-Network: $16,000/$32,000
Prescription Drug Coverage
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 HSA 2800/100
Deductible Individual / Family
In-Network: $2,800/$5,600
Out-of-Network: $5,600/$11,200
Office Visits
In-Network: 100% covered after deductible
Out-of-Network: 50% after deductible
Inpatient Hospital Stay (after deductible)
In-Network: 100% covered after deductible
Out-of-Network: 50% coinsurance
Out of Pocket Maximum
In-Network: $2,800/$5,600
Out-of-Network: $5,600/$22,400
Prescription Drug Coverage
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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