RMHP Monument Health Silver Value-C ($0 Virtual UC, $2 Tier 2 Rx, $0 Insulin, No Referrals, Rx Copay)
Rocky Mountain Health Maintenance Organization, Inc. · 2027 plan year
Silver
- Ind. deductible
- $100
- Family deductible
- $200
- Ind. OOP max
- $2,400
- Family OOP max
- $4,800
Other cost-sharing reduction variants for this plan:
More Rocky Mountain Health Maintenance Organization, Inc. plans in CO
RMHP Monument Health Gold Value ($0 Virtual UC, $5 Tier 2 Rx, $0 Insulin, No Referrals, Rx Copay)RMHP Monument Health Silver Advantage ($0 Virtual UC, $7 Tier 2 Rx, $0 Insulin, No Referrals, Rx Copay)RMHP Monument Health Bronze Value ($0 Virtual UC, HSA, $0 Insulin, No Referrals, Rx Copay)RMHP Monument Health Bronze Value HSA ($0 Virtual UC, $0 Insulin, No Referrals)
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 | $3.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $15.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 15.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 15.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 15.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | $20.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $2.00 |
| Medical Service Drugs | 15.00% Coinsurance after deductible |
| Non-Preferred Brand Drugs | $40.00 |
| Non-Preferred Generic Drugs | $30.00 |
| Preferred Brand Drugs | $30.00 |
| Preventive Drugs | No charge |
| Specialty Drugs | $60.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Intensive Outpatient for Mental/Behavioral Health | 15.00% Coinsurance after deductible |
| Intensive Outpatient for Substance Use Disorder | 15.00% Coinsurance after deductible |
| Mental Health Wellness Visit | No charge |
| Mental/Behavioral Health Inpatient Services | 15.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | 15.00% Coinsurance after deductible |
| Mental/Behavioral Health Prenatal Care | $10.00 |
| Office Visit - Mental/Behavioral Health | $10.00 |
| Office Visit - Substance Use Disorder | $10.00 |
| Partial Hospitalization for Mental/Behavioral Health | 15.00% Coinsurance after deductible |
| Partial Hospitalization for Substance Use Disorder | 15.00% Coinsurance after deductible |
| Postpartum Mental/Behavioral Health | $10.00 |
| Postpartum Substance Use Disorder | $10.00 |
| Residential Day Treatment for Mental/Behavioral Health | 15.00% Coinsurance after deductible |
| Residential Day Treatment for Substance Use Disorder | 15.00% Coinsurance after deductible |
| Substance Use Disorder Prenatal Care | $10.00 |
| Telehealth Mental/Behavioral Health | $10.00 |
| Telehealth Substance Use Disorder | $10.00 |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | No charge |
| Acupuncture | $3.00 |
| Allergy Testing | 15.00% Coinsurance after deductible |
| Applied Behavior Analysis Based Therapies | 15.00% Coinsurance after deductible |
| Autism Spectrum Disorders - Assessment and Evaluation Services | $15.00 |
| Bariatric Surgery | 15.00% Coinsurance after deductible |
| Basic Dental Care - Child | No charge |
| Chemotherapy | 15.00% Coinsurance after deductible |
| Chiropractic Care | $3.00 |
| Delivery and All Inpatient Services for Maternity Care | 15.00% Coinsurance after deductible |
| Dental Check-Up for Children | No charge |
| Diabetes Education | $15.00 |
| Diabetic Supplies | 15.00% Coinsurance after deductible |
| Dialysis | 15.00% Coinsurance after deductible |
| Durable Medical Equipment | 15.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 15.00% Coinsurance after deductible |
| Eye Glasses for Children | 15.00% Coinsurance after deductible |
| Gender Affirming Care | 15.00% Coinsurance after deductible |
| Habilitation Services | $15.00 |
| Hearing Aids | 15.00% Coinsurance after deductible |
| Home Health Care Services | 15.00% Coinsurance after deductible |
| Hospice Services | 15.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | 15.00% Coinsurance after deductible |
| Infertility Treatment | 15.00% Coinsurance after deductible |
| Infusion Therapy | 15.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 15.00% Coinsurance after deductible |
| Inpatient Rehabilitation | 15.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | $10.00 |
| Major Dental Care - Child | No charge |
| Nutritional Counseling | 15.00% Coinsurance after deductible |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $3.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 15.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | $15.00 |
| Prenatal and Postnatal Care | No charge |
| Private-Duty Nursing | 15.00% Coinsurance after deductible |
| Prosthetic Devices | 15.00% Coinsurance after deductible |
| Prosthetics: Legs and Arms | 20.00% |
| Prosthetics: Recreational | 15.00% Coinsurance after deductible |
| Radiation | 15.00% Coinsurance after deductible |
| Reconstructive Surgery | 15.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $15.00 |
| Rehabilitative Occupational Therapy | $15.00 |
| Rehabilitative Physical Therapy | $15.00 |
| Rehabilitative Speech Therapy | $15.00 |
| Routine Eye Exam for Children | No charge |
| Skilled Nursing Facility | 15.00% Coinsurance after deductible |
| Standalone Laboratory | $10.00 |
| Substance Abuse Disorder Inpatient Services | 15.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | 15.00% Coinsurance after deductible |
| Telehealth PCP | $3.00 |
| Telehealth Specialist | $15.00 |
| Transplant | 15.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | 15.00% Coinsurance after deductible |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 15.00% Coinsurance after deductible |
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