Need Coverage? (800) 453-2981 (Individuals) (970) 683-5630 (Employers) Provider Directory

Getting coverage

You need health insurance. Not only is it smart: It’s the law. The Affordable Care Act requires individuals to have health insurance or pay a tax penalty. In 2016, that penalty was $695 per person ($347.50 per child under 18) or 2.5 percent of your yearly household income, whichever is greater. (There are exceptions.)

Employers generally offer insurance to full-time workers. But if you are not covered by your employer, you will need to buy your own. How?

Choosing a plan

There are three major factors for choosing a health plan: cost, your own health status, and the network of providers included in the plan.

11

How much will it cost?

The most obvious cost is the monthly premium, the monthly amount you pay to maintain health coverage. But a low premium isn’t the best choice for everyone, and it’s certainly not the only cost to consider. There are out-of-pocket cost factors that come into play when you use health services.

Out-of-pocket costs include

  • Copay – the fee you pay each time you visit a provider;
  • Deductible – the amount you pay before your insurance coverage begins to pay.
  • Co-insurance – the fixed percentage of costs that will be covered once you meet your deductible. For instance, your plan may pay 80% of the agreed-upon charges with a provider in your network, while you pay 20%.

It’s important to also look for the out-of-pocket maximum, or the most money your plan requires you to pay over a plan year. After you reach this amount, your plan pays the full cost for covered services up to their allowed charge.

22

How much health care do I expect to use?

  • If you plan to have a baby soon, or you or a family member has a chronic condition that requires regular treatment, you may prefer a plan with fewer out-of-pocket costs.
  • If you are generally healthy, you may want to choose a lower monthly premium and a higher deductible. You’ll still be protected against a medical catastrophe, but you’ll pay more if you do encounter unexpected illness or injury.
33

Who are the providers in the plan network?

Most plans designate a network of providers that are in your “network.” The Monument Health provider network was developed in a different way. We identify a top tier of providers—Tier 1—who agree to

  • Be part of a network that is physician-led. This means the people who set the network guidelines really understand you and your health needs and will put you in the center of care.
  • Share data across the network so fewer unnecessary tests are done or repeated.
  • Coordinate your care.
  • Payment based on how well they provide care–so doctors can spend the time with you that you need to attain optimal health.

All Monument Health network plans feature our high-performing clinical network that gives you local access to appropriate, more affordable, whole-person care. This is our preferred network—our Tier 1 providers.

In addition to Monument Health Tier 1 providers, you can still use providers outside our network. Many local, statewide and even national providers are available to you through the Tier 2 benefit level. And remember, all emergency care is always covered as if it’s in-network, at the Tier 1 benefit level.

MORE RESOURCES

Families USA offers a variety of tools to help you decide on the type of coverage you need.

Fairhealthconsumer.org also offers resources for choosing the best health plan for you.

More than three hundred  providers—physicians, specialists and hospitals—are in the Monument Health network. Providers who agree to meet quality, information sharing and a payment system based on quality are accepted into our Tier 1 network of high-performing providers. Learn more about our network and what makes Monument Health different from a typical health plan.

You can also choose to use providers outside the Tier 1 Monument Health network. Many local providers are available to you through the Tier 2 benefit level. And if you need care when traveling outside Mesa County, emergency care is always covered as if it’s in-network. Out-of-network coverage (Tier 3) is also included when you receive non-emergency care out-of-network.

Want to learn more? See the Monument Health Products or download the 2017 Individual Plan coverage details.

Questions?
Call us. 970.683.5630

Ready to buy?
Call RMHP. 800.453.2981

Search