RMHP Monument One Bronze Value ($0 Virtual UC, HSA, $0 Insulin, No Referrals, Rx Copay)
Rocky Mountain Health Maintenance Organization, Inc. · 2027 plan year
Expanded BronzeHSA eligible
- Ind. deductible
- $8,000
- Family deductible
- $16,000
- Ind. OOP max
- $12,000
- Family OOP max
- $24,000
Compare with other Expanded Bronze plans in CO
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Rocky Mountain Health Maintenance Organization, Inc. plans in CO
Monthly premiums by age
Rating Area 5 — the lowest-priced of the 2 areas this plan covers. Premiums differ by area.
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $391 | $391 |
| 21 | $511 | $536 |
| 30 | $580 | $638 |
| 40 | $653 | $718 |
| 50 | $912 | $1,049 |
| 60 | $1,386 | $1,594 |
| 64 and over | $1,533 | $1,762 |
Live premium estimate
Benefits & cost sharing
Primary Care
| Benefit | In-network |
|---|---|
| Preventive Care/Screening/Immunization | No charge |
| Primary Care Visit to Treat an Injury or Illness | $25.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $100.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 35.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 40.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 35.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | $30.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $20.00 |
| Medical Service Drugs | 35.00% Coinsurance after deductible |
| Non-Preferred Brand Drugs | $300.00 |
| Non-Preferred Generic Drugs | $150.00 |
| Preferred Brand Drugs | $150.00 |
| Preventive Drugs | No charge |
| Specialty Drugs | $700.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Intensive Outpatient for Mental/Behavioral Health | 35.00% Coinsurance after deductible |
| Intensive Outpatient for Substance Use Disorder | 35.00% Coinsurance after deductible |
| Mental Health Wellness Visit | No charge |
| Mental/Behavioral Health Inpatient Services | 40.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | 35.00% Coinsurance after deductible |
| Mental/Behavioral Health Prenatal Care | $80.00 |
| Office Visit - Mental/Behavioral Health | $80.00 |
| Office Visit - Substance Use Disorder | $80.00 |
| Partial Hospitalization for Mental/Behavioral Health | 35.00% Coinsurance after deductible |
| Partial Hospitalization for Substance Use Disorder | 35.00% Coinsurance after deductible |
| Postpartum Mental/Behavioral Health | $80.00 |
| Postpartum Substance Use Disorder | $80.00 |
| Residential Day Treatment for Mental/Behavioral Health | 35.00% Coinsurance after deductible |
| Residential Day Treatment for Substance Use Disorder | 35.00% Coinsurance after deductible |
| Substance Use Disorder Prenatal Care | $80.00 |
| Telehealth Mental/Behavioral Health | $80.00 |
| Telehealth Substance Use Disorder | $80.00 |
Other
| Benefit | In-network |
|---|---|
| Rehabilitative Occupational Therapy | $100.00 |
| Rehabilitative Physical Therapy | $100.00 |
| Rehabilitative Speech Therapy | $100.00 |
| Hospice Services | 35.00% Coinsurance after deductible |
| Abortion for Which Public Funding is Prohibited | See plan details |
| Acupuncture | $25.00 |
| Allergy Testing | 35.00% Coinsurance after deductible |
| Applied Behavior Analysis Based Therapies | 35.00% Coinsurance after deductible |
| Autism Spectrum Disorders - Assessment and Evaluation Services | $100.00 |
| Bariatric Surgery | 35.00% Coinsurance after deductible |
| Basic Dental Care - Child | See plan details |
| Chemotherapy | 35.00% Coinsurance after deductible |
| Chiropractic Care | $25.00 |
| Delivery and All Inpatient Services for Maternity Care | 40.00% Coinsurance after deductible |
| Dental Check-Up for Children | No charge |
| Diabetes Education | $110.00 |
| Diabetic Supplies | 35.00% Coinsurance after deductible |
| Dialysis | 35.00% Coinsurance after deductible |
| Durable Medical Equipment | 35.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 35.00% Coinsurance after deductible |
| Eye Glasses for Children | 35.00% Coinsurance after deductible |
| Gender Affirming Care | 35.00% Coinsurance after deductible |
| Habilitation Services | $100.00 |
| Hearing Aids | 35.00% Coinsurance after deductible |
| Home Health Care Services | 35.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | 35.00% Coinsurance after deductible |
| Infertility Treatment | 35.00% Coinsurance after deductible |
| Infusion Therapy | 35.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 40.00% Coinsurance after deductible |
| Inpatient Rehabilitation | 40.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | $30.00 |
| Major Dental Care - Child | See plan details |
| Nutritional Counseling | 35.00% Coinsurance after deductible |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $25.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 35.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | $100.00 |
| Prenatal and Postnatal Care | No charge |
| Private-Duty Nursing | 35.00% Coinsurance after deductible |
| Prosthetic Devices | 35.00% Coinsurance after deductible |
| Prosthetics: Legs and Arms | 20.00% |
| Prosthetics: Recreational | 35.00% Coinsurance after deductible |
| Radiation | 35.00% Coinsurance after deductible |
| Reconstructive Surgery | 35.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $100.00 |
| Routine Eye Exam for Children | No charge |
| Skilled Nursing Facility | 40.00% Coinsurance after deductible |
| Standalone Laboratory | $30.00 |
| Substance Abuse Disorder Inpatient Services | 40.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | 35.00% Coinsurance after deductible |
| Telehealth PCP | $25.00 |
| Telehealth Specialist | $100.00 |
| Transplant | 40.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | 35.00% Coinsurance after deductible |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 35.00% Coinsurance after deductible |
Service area
This plan covers 4 geographic areas.
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