Select Health Monument Value Gold $1750 Medical Deductible HSA Qualified · 55584CO0030032
SelectHealth offers this marketplace health insurance plan (Plan ID 55584CO0030032) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.
Metal level: GoldPlan type: EPOCSR: Standard Gold On Exchange PlanIssuer: SelectHealth
Telehealth
Data pending
HSA eligible
Yes
Dental
Not listed
Vision
Not listed
Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Colorado). Submit changes before the deadline to avoid a coverage gap.
Enroll by Dec 15 for Jan 1 starts.
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Special Enrollment Periods
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Report the event within 60 days.
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CSR & subsidy reminders
Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.
Enter accurate income to maximize Advanced Premium Tax Credits.
Standard Gold On Exchange Plan plans like this one keep deductibles and copays lower if you qualify.
Thinking about switching?
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Match provider networks so ongoing care isn’t disrupted.
Confirm prescriptions stay on-formulary or budget for tier changes.
Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.
Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).
Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.
Tier
Covered drugs
NON-PREFERRED-GENERIC
2,299
NON-PREFERRED-BRAND
703
SPECIALTY-DRUGS
478
ZERO-COST-SHARE-PREVENTIVE-DRUGS
385
Prior authorization
Drugs
Required
536
Not Required
3,329
Step therapy
Drugs
Required
186
Not Required
3,679
Quantity limits
Drugs
Has Limit
399
No Limit
3,466
Customer highlights
What stands out for members
Issuer: SelectHealth · Plan ID 55584CO0030032 · 2025 filing.
Disease management programs available: Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma.
Variant 55584CO0030032-01 (Standard On Exchange Plan) currently displayed.
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Variant attributes
Select Health Monument Value Gold $1750 Medical Deductible HSA Qualified · Variant 55584CO0030032-01
Plan identifiers & tier
Issuer-provided metadata for this variant.
Business Year
2025
CSR Variation Type
Standard Gold On Exchange Plan
HIOS Product ID
55584CO003
Metal Level
Gold
Plan ID (Standard Component ID with Variant)
55584CO0030032-01
Plan Marketing Name
Select Health Monument Value Gold $1750 Medical Deductible HSA Qualified
Plan Variant Marketing Name
Select Health Monument Value Gold $1750 Medical Deductible HSA Qualified
Issuer & service area
Issuer-provided metadata for this variant.
Issuer ID
55584
Market Coverage
Individual
Multiple In Network Tiers
No
National Network
No
Network ID
CON001
Out of Country Coverage
No
Out of Country Coverage Description
All services obtained outisde the service area, except urgent or emergent conditions apply to nonparticipating benefits
Out of Service Area Coverage
Yes
Out of Service Area Coverage Description
All services obtained outisde the service area, except urgent or emergent conditions apply to nonparticipating benefits
Service Area ID
COS002
State Code
CO
Cost sharing & actuarial values
Issuer-provided metadata for this variant.
AV Calculator Output Number
0.797465295
Medical Drug Deductibles Integrated
Yes
Medical Drug Maximum Out of Pocket Integrated
Yes
SBC Scenario, Having a Baby, Coinsurance
$1,000
SBC Scenario, Having a Baby, Copayment
$0
SBC Scenario, Having a Baby, Deductible
$1,750
SBC Scenario, Having Diabetes, Coinsurance
$60
SBC Scenario, Having Diabetes, Copayment
$0
SBC Scenario, Having Diabetes, Deductible
$1,750
SBC Scenario, Treatment of a Simple Fracture, Coinsurance
$30
SBC Scenario, Treatment of a Simple Fracture, Copayment
$0
SBC Scenario, Treatment of a Simple Fracture, Deductible
$1,750
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, In Network (Tier 1), Default Coinsurance
10.00%
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family
$8050 per person | $16100 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual
$8,050
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
Enrollment & documents
Issuer-provided metadata for this variant.
Formulary ID
COF010
SBC Scenario, Having a Baby, Limit
$60
SBC Scenario, Having Diabetes, Limit
$20
SBC Scenario, Treatment of a Simple Fracture, Limit
$0
Additional attributes
Issuer-provided metadata for this variant.
Child-Only Offering
Allows Adult and Child-Only
Composite Rating Offered
No
Dental Only Plan
No
Design Type
Not Applicable
Disease Management Programs Offered
Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma
EHB Percent of Total Premium
99%
First Tier Utilization
100%
Import Date
1/13/2025
HSA Eligible
Yes
IsItANewPlan
Existing
Notice Required for Pregnancy
No
Is a Referral Required for Specialist?
No
Plan Effective Date
1/1/2025
Plan Expiration Date
12/31/2025
Plan Level Exclusions
Administrative Services/Charges; Certain Allergy Tests; Biofeedback/Neurofeedback; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Travel-Related Expenses; computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.
Plan Type
EPO
QHP/Non QHP
Both
Source Name
SERFF
Plan ID
55584CO0030032
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), Family
$3500 per person | $3500 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual
$1,750
TEHBDedOutofNetFamily
per person not applicable | per group not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Individual
Not Applicable
Unique Plan Design
No
Version Number
1
Wellness Program Offered
Yes
Copay & coinsurance
Pharmacy cost sharing by tier
Drug tier
Pharmacy type
Copay amount
Copay option
Coinsurance rate
Coinsurance option
Mail order
Questions & answers
Frequently asked questions
How do I choose the right ACA plan in Colorado?
Select Health Monument Value Gold $1750 Medical Deductible HSA Qualified (55584CO0030032) is a Gold EPO from SelectHealth in Colorado for the 2025 coverage year.
Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.
Does Select Health Monument Value Gold $1750 Medical Deductible HSA Qualified support telehealth or virtual urgent care?
The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.
Is Select Health Monument Value Gold $1750 Medical Deductible HSA Qualified HSA-eligible and does it include dental or vision coverage?
It is HSA-eligible, so you can pair it with a Health Savings Account to lower taxes.
Dental coverage is not listed for this plan.
Vision coverage is not listed for this plan.
Does Select Health Monument Value Gold $1750 Medical Deductible HSA Qualified support mail-order prescriptions?
Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.
Which disease management programs come with Select Health Monument Value Gold $1750 Medical Deductible HSA Qualified?
The issuer lists disease management resources for: Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma.
Is there out-of-country coverage for Select Health Monument Value Gold $1750 Medical Deductible HSA Qualified?
No, out-of-country services are not covered for this plan. Details: All services obtained outisde the service area, except urgent or emergent conditions apply to nonparticipating benefits
Does Select Health Monument Value Gold $1750 Medical Deductible HSA Qualified cover care outside the service area?
Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: All services obtained outisde the service area, except urgent or emergent conditions apply to nonparticipating benefits
How do I enroll in or manage payments for Select Health Monument Value Gold $1750 Medical Deductible HSA Qualified?
Use HealthPorta to shortlist plans, then finish enrollment through Healthcare.gov or your state-based marketplace.
Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
