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Sendero - Sendero Health Plans IdealCare Essential
Texas, 2017
Plan Type
HMO
Metal Tier
Bronze
Out of Pocket Maximum
$6,500
Deductible
$6,150
Emergency Room Care: $350 Copay after deductible
Cost Sharing Benefits (In Network)
Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.
| Deductible (Individual) | $6,150 |
|---|---|
| Deductible (Family) | $12,300 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $6,500 |
| Out of Pocket Maximum (Family) | $13,000 |
Doctor Visits
| Primary Care Visit | Data Not Available |
|---|---|
| Specialist Visit | $50 Copay after deductible |
| Inpatient Facility | $750 Copay per stay |
| Inpatient Physician | No charge |
| Emergency Room Services | $350 Copay after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | 75% Coinsurance after deductible |
|---|---|
| Laboratory Outpatient and Professional Services | 100% Coinsurance after deductible |
| X-Ray and Diagnostic Imaging | 100% Coinsurance after deductible |
Health Management Programs
| Asthma | Available |
|---|---|
| Depression | Available |
| Diabetes | Available |
| Heart Disease | Not available |
| High Blood Pressure / High Cholesterol | Not available |
| Lower Back Pain | Not available |
| Pain Management | Not available |
| Pregnancy | Not available |
| Weight Loss | Not available |
Other
| Mental / Behavioral Health Inpatient | $750 Copay per stay |
|---|---|
| Mental / Behavioral Health Outpatient | Data Not Available |
| Rehabilitative Speech Therapy | $50 Copay after deductible |
| Rehabilitative Occupational & Physical Therapy | $50 Copay after deductible |
| Outpatient Facility | 50% Coinsurance after deductible |
| Outpatient Surgery | 50% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | Data Not Available |
|---|---|
| Preferred Brand Rx | Data Not Available |
| Non Preferred Brand Rx | $60 Copay after deductible |
| Specialty Drugs | 30% Coinsurance after deductible |
Other Plans in Texas
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Sendero Health Plans IdealCare Complete | Deductible $6,100 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Sendero Health Plans IdealCare Total | Deductible $0 | Coinsurance Not applicable | Out of Pocket $6,600 |