Monument Health HMO A Silver $3500/70%/$35 RX Copay Plan IDV - Plan Details for 2020- HealthPocket

Monument Health HMO A Silver $3500/70%/$35 RX Copay Plan IDV -

$401.02/mo

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Zip Code80219
Applicant3/28/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameMonument Health HMO A Silver $3500/70%/$35 RX Copay Plan IDV -
Plan IDhhs-97879CO0350007
Plan Year2020
Insurance ProviderRocky Mountain Health Plan
Metal LevelSilver
Plan TypeHMO
Deductible$3,500
Out-of-Pocket Maximum$8,150
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$35 Copay
Specialist Visit$70 Copay
Laboratory Outpatient and Professional Services$40 Copay
X-rays and Diagnostic Imaging30.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans30.00% Coinsurance after deductible
Deductible - Family$7000 per group
Out-of-Pocket Maximum - Family$16300 per group

Prescription drug coverage

Generic Drugs$15 Copay
Preferred Brand Drugs$50 Copay
Non-Preferred Brand Drugs$80 Copay
Specialty Drugs$300 Copay

Access to doctors and hospitals

Provider directory URLhttp://www.rmhp.org
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Not Covered
Does this plan cover services outside plan service area?Yes - Urgent/Emergent Only
Does this plan cover services outside the country?Yes - Urgent/Emergent Only

Hospital services

Emergency Room Services$600 Copay with deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Hospital Services (e.g., Hospital Stay)$750 Copay per Day
Inpatient Physician and Surgical ServicesNot Applicable
Emergency Transportation or Ambulance Service$5 Copay with deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Maternity

Prenatal and Postnatal CareNot Applicable
Delivery and all inpatient services for maternity care$750 Copay

Mental Health

Mental/Behavioral Health Outpatient Services$10 Copay
Mental/Behavioral Health Inpatient Services$750 Copay per Day
Substance use disorder outpatient services$10 Copay
Substance use disorder inpatient services$750 Copay per Day

Medical Management Programs

Does this plan offer disease managment programs?Diabetes, Heart Disease, Pregnancy
Does this plan offer a wellness program?Included

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsNot Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental CareIncluded
Child Dental Coverage - Basic Dental CareIncluded
Child Dental Coverage - OrthodontiaNot Covered
Child Dental Coverage - Major Dental CareIncluded

Adult Dental Coverage

Adult Dental Coverage - Routine Dental CareNot Covered
Adult Dental Coverage - Basic Dental CareNot Covered
Adult Dental Coverage - OrthodontiaNot Covered
Adult Dental Coverage - Major Dental CareNot Covered

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Preventive Care/Screening/Immunization
Bariatric Surgery
Infertility Treatment
Private-Duty Nursing
Imaging (CT/PET Scans, MRIs)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Home Health Care Services
Durable Medical Equipment
Hospice Services
Applied Behavior Analysis Based Therapies
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Autism Spectrum Disorders
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Prosthetics: Legs and Arms
Telehealth PCP
Telehealth Specialist
Partial Hospitalization for Mental Health/Substance Abuse
Intensive Outpatient for Mental Health/Substance Abuse
Residential Day Treatment for Mental Health/Substance Abuse
Intensive Outpatient for Substance Use Disorder
Mental/Behavioral Health Prenatal Care
Partial Hospitalization for Mental/Behavioral Health
Partial Hospitalization for Substance Use Disorder
Postpartum Mental/Behavioral Health
Postpartum Substance Use Disorder
Residential Day Treatment for Mental/Behavioral Health
Residential Day Treatment for Substance Use Disorder
Substance Use Disorder Prenatal Care
Telehealth Mental/Behavioral Health
Telehealth Substance Use Disorder
Autism Spectrum Disorders - Assessment and Evaluation Services
Intensive Outpatient for Mental/Behavioral Health
More Limited BenefitsSkilled Nursing Facility
Hearing Aids
Outpatient Rehabilitation Services
Habilitation Services
Dental Check-Up for Children
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Rehabilitative Occupational Therapy
Rehabilitative Physical Therapy
More Excluded BenefitsAcupuncture
Cosmetic Surgery
Long-Term/Custodial Nursing Home Care
Weight Loss Programs
Routine Foot Care
Abortion for Which Public Funding is Prohibited
PremiumPlan NameDeductible
from $329
Cigna Connect Silver 3500-A
$3,500.00Select
from $341
Cigna Connect Flex Silver 3500
$3,500.00Select
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  • Phone Number
    (303) 935-9142
  • Office Locations
    1930 S Federal Blvd
    Denver, CO 80219
1930 S Federal Blvd Denver CO, 80219
  • What Is the Silver Plan?

    ObamaCare’s Silver Plan is a type of Metal Plan on the Health Insurance Marketplace. Silver Plans qualify for both Tax Credits and Cost Sharing subsidies.Silver Plans have lower out-of-pocket costs than Bronze Plans but higher out- of-pocket costs than both Gold and Platinum Plans. All Silver Plans share the same minimum health benefits, but the way they charge out-of-pocket costs can differ significantly.

  • How are Silver Plans different than other Obamacare health plans?

    The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Silver Plan pays 70% of covered medical costs for a typical enrollee. Silver Plans are also the only metal plans which offer cost-sharing reduction (CSR) versions to consumers that require financial assistance for out-of-pocket costs.

  • How much does a Silver Plan cost?

    The monthly premium for a Silver Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and the region in which you live. You can use HealthPocket’s comparison tool to compare Silver Plan premiums in your area.

  • When Can I Enroll in a Silver Plan?

    The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).