RMHP Monument Health Silver Advantage ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, $0 Insulin, Rx Copay) - 97879CO0350002 Health Insurance Plan
Rocky Mountain HMO, Inc. health insurance plan with the Plan ID 97879CO0350002. The plan is called RMHP Monument Health Silver Advantage ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, $0 Insulin, Rx Copay).
Based on the data of Health Plan Issuer, this plan has an actuarial value of 94.24% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 5.76% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 97879CO0350002 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Colorado | ||||||||||||||||||
| Health Insurance Issuer | Rocky Mountain HMO, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 97879CO0350002-06 | ||||||||||||||||||
| Provider Network(s) | ['CON001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Thu, 21 Nov 2024 00:44 GMT). |
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| Available Variants of the Health Plan | Standard On Exchange Plan - 97879CO0350002-01 Open to Indians below 300% FPL - 97879CO0350002-02 Open to Indians above 300% FPL - 97879CO0350002-03 73% AV Silver Plan - 97879CO0350002-04 |
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| Last Plan Update Date | Fri, 31 May 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
RMHP Monument Health Silver Advantage-C ($0 Virtual Urgent Care + $0 PCP Visits, $1 Tier 2 Rx, $0 Insulin, Rx Copay) Health Insurance Plan Variant 97879CO0350002-06 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | 94% AV Level Silver Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| EHB Percent of Total Premium | 100% |
| First Tier Utilization | 65% |
| Formulary ID | COF018 |
| HIOS Product ID | 97879CO035 |
| Import Date | 5/31/2024 |
| Inpatient Copayment Maximum Days | 4 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 94.24% |
| Issuer ID | 97879 |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Silver |
| Multiple In Network Tiers | Yes |
| National Network | No |
| Network ID | CON001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Urgent/Emergent Only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Plan covers eligible expenses provided by a Network Physician or other provider or facility within the Network Area |
| Plan Effective Date | 1/1/2024 |
| Plan ID (Standard Component ID with Variant) | 97879CO0350002-06 |
| Plan Level Exclusions | Some exclusions may apply. See the applicable Evidence of Coverage for details. |
| Plan Marketing Name | RMHP Monument Health Silver Advantage ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, $0 Insulin, Rx Copay) |
| Plan Type | HMO |
| Plan Variant Marketing Name | RMHP Monument Health Silver Advantage-C ($0 Virtual Urgent Care + $0 PCP Visits, $1 Tier 2 Rx, $0 Insulin, Rx Copay) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $300 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $150 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $100 |
| SBC Scenario, Having Diabetes, Deductible | $100 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $400 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $200 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $150 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 35% |
| Service Area ID | COS001 |
| Source Name | SERFF |
| Plan ID | 97879CO0350002 |
| State Code | CO |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family | per person not applicable | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 30.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $150 per person | $300 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $150 |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 50.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family | $300 per person | $600 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual | $300 |
| TEHBDedOutofNetFamily | per person not applicable | per group not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $700 per person | $1400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $700 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family | $700 per person | $1400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $700 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | per person not applicable | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of RMHP Monument Health Silver Advantage ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, $0 Insulin, Rx Copay) Health Insurance Plan, 97879CO0350002
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about RMHP Monument Health Silver Advantage ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, $0 Insulin, Rx Copay), 97879CO0350002 Health Insurance Plan, 97879CO0350002
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Does RMHP Monument Health Silver Advantage ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, $0 Insulin, Rx Copay) Health Insurance Plan, 97879CO0350002 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (97879CO0350002) Health Insurance Plan, Variant (97879CO0350002-06) have Out Of Country Coverage?
Does (97879CO0350002) Health Insurance Plan, Variant (97879CO0350002-06) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Thu, 21 Nov 2024 00:44 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API