Rocky Mountain Health Plans SOLO Select PPO

	Deductible (In network)	Out of Pocket Maximum (In network)	Office Visit Copay	Coinsurance (After Deductible)	Accident Benefit Included	Prescription Drug	Optional Prescription Drug
Solo 500 (Maternity Coverage Available)	$500	$3,000	$30	80% covered in-network 60% covered out-of-network	Yes*	$10 copay for generic drugs	$10 generic $40 preferred $60 nonpreferred
Solo 1000	$1000	$3,000	$30	80% covered in-network 60% covered out-of-network	Yes*	$10 copay for generic drugs	$10 generic $40 preferred $60 nonpreferred
Solo 1500	$1500	$3,000	$30	80% covered in-network 60% covered out-of-network	Yes*	$10 copay for generic drugs	$10 generic $40 preferred $60 nonpreferred
Solo 2500	$2500	$3,000	$30	80% covered in-network 60% covered out-of-network	Yes*	$10 copay for generic drugs	$10 generic $40 preferred $60 nonpreferred

Maternity Rider

Maternity is available as an option for the Solo 500 Select plan in Colorado shown above. The maternity rider is only available to females between the ages of 17 and 39. The maternity rider will not be issued to any applicant with a previous history of complications of pregnancy (miscarriage, toxemia, pre-eclampsia, etc). Coverage cannot be issued to any applicant who is pregnant or to any adult member of a pregnant person’s family.

Coverage Details

The maternity rider will cover prenatal care with a 50% coinsurance after the deductible. The coinsurance does not apply toward the annual out-of-pocket maximum. Delivery and in-patient well baby care is covered at 20% coinsurance after the deductible.

HSA Qualified Plans

Rocky Mountain Health Plans offers 2 HSA qualified plans that are very attractive to Coloradoans looking to save money on healthcare expenses. Although you can setup your health savings account with any bank you wish, Rocky Mountain Health Plans works with Wells Fargo. You can see the Rocky Mountain Health Plans/ Wells Fargo page here.

See how the 2 HSA qualified plans offered through Rocky Mountain Health Plans differ below:

Rocky Mountain Health Plans of Colorado SOLO Smart Choice PPO

	Deductible (In network)	Out of Pocket Maximum (In network)	Coinsurance (After Deductible)	Accident Benefit Included	Prescription Drug**	Optional Prescription Drug**
SOLO HDHP 2800/100	$2800 Individual $5600 Family	$2800 Individual $5600 Family Includes Deductible	100% covered in-network 60% covered out-of-network	Optional rider available*	Generic drugs 100% covered after deductible	Generic and brand name drugs 100% covered after deductible
SOLO HDHP 2800/80	$2800 Individual $5600 Family	$5000 Individual $10,000 Family Includes Deductible	80% covered in-network 60% covered out-of-network	Optional rider available*	Generic drugs 80% covered after deductible	Generic and brand name drugs 100% covered after deductible

**Coinsurance paid by the Member for prescription drugs applies to the annual out-of-pocket maximum

You can see more detailed HSA qualified policy information in the Colorado plan description form, and see the details of the optional prescription drug benefit.

 

Rocky Mountain Health Plans of Colorado SOLO Safety Net PPO

	Deductible (In network)	Out of Pocket Maximum (In network)	Coinsurance (After Deductible)	Preventive Screenings	Prescription Drug	Optional Prescription Drug
SOLO 5K	$5,000 Individual $10000 Family	$6,000 Individual $12,000 Family	80% covered in-network 60% covered out-of-network	100% Covered Not Subject to Deductible	$10 copay for generic drugs	$10 generic $40 preferred $60 nonpreferred 20% specialty
SOLO 10K	$10,000 Individual $20000 Family	$10,000 Individual $20,000 Family	80% covered in-network 60% covered out-of-network	100% Covered Not Subject to Deductible	$10 copay for generic drugs	$10 generic $40 preferred $60 nonpreferred 20% specialty

*Accident Supplement

$1 to $500 covered in full for each accident, then deductible and coinsurance apply

Payment

Rates are based on the age and gender of each enrollee and will be based on specific geographic or regional areas. Rates are available for “Tobacco User” and “Non-Tobacco User.” To qualify as a non-tobacco user, applicants must certify that neither he/she nor anyone living in the household has used tobacco products for 12 months prior to the application. Adult family members will be subject to “Tobacco” rates if any family member uses tobacco.

The first month’s premium will be billed to the member upon Underwriting approval. The first month’s premium can be prorated to accommodate any effective date up to 30 days after approval.

Premiums for the SOLO Health Care Plan can be paid on a monthly basis via automatic bank withdrawal or deducted from a nonbusiness personal checking or savings account. You can get premium information by looking at the rate sheet. (It says "effective 8/1/06 - 12/31/2006", but they've extended those rates through the first quarter of 2007!!)

Options Include:

Payment Frequency	Payment Method
Monthly	Automatic bank withdrawal (only option)
Quarterly	check, cash, credit card
SemiAnnually	check, cash, credit card
Annually	check, cash, credit card