Sendero - IdealCare HSA by Sendero Health Plans

Texas, 2018

  • Plan Type

    HMO

  • Metal Tier

    Bronze

  • Out of Pocket Maximum

    $6,650

  • Deductible

    $5,000

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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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) $5,000
Deductible (Family) $10,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,650
Out of Pocket Maximum (Family) $13,300

Doctor Visits

Primary Care Visit $25 Copay after deductible
Specialist Visit $50 Copay after deductible
Inpatient Facility $500 Copay per stay after deductible
Inpatient Physician No charge
Emergency Room Services $500 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $300 Copay after deductible
Laboratory Outpatient and Professional Services $40 Copay after deductible
X-Ray and Diagnostic Imaging $40 Copay 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 $500 Copay per stay after deductible
Mental / Behavioral Health Outpatient $25 Copay after deductible
Rehabilitative Speech Therapy $50 Copay after deductible
Rehabilitative Occupational & Physical Therapy $50 Copay after deductible
Outpatient Facility 25% Coinsurance after deductible
Outpatient Surgery 25% Coinsurance after deductible

Prescription Drugs

Generic Rx $5 Copay after deductible
Preferred Brand Rx $40 Copay after deductible
Non Preferred Brand Rx $80 Copay after deductible
Specialty Drugs 30% Coinsurance after deductible

Other Plans in Texas

Plan IdealCare Complete by Sendero Health Plans Deductible $3,850 Coinsurance Not applicable Out of Pocket $7,350
Plan IdealCare Essential by Sendero Health Plans Deductible $6,500 Coinsurance Not applicable Out of Pocket $7,350
Plan IdealCare Total by Sendero Health Plans Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,000
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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) $5,000
Deductible (Family) $10,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,650
Out of Pocket Maximum (Family) $13,300

Doctor Visits

Primary Care Visit $25 Copay after deductible
Specialist Visit $50 Copay after deductible
Inpatient Facility $500 Copay per stay after deductible
Inpatient Physician No charge
Emergency Room Services $500 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $300 Copay after deductible
Laboratory Outpatient and Professional Services $40 Copay after deductible
X-Ray and Diagnostic Imaging $40 Copay 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 $500 Copay per stay after deductible
Mental / Behavioral Health Outpatient $25 Copay after deductible
Rehabilitative Speech Therapy $50 Copay after deductible
Rehabilitative Occupational & Physical Therapy $50 Copay after deductible
Outpatient Facility 25% Coinsurance after deductible
Outpatient Surgery 25% Coinsurance after deductible

Prescription Drugs

Generic Rx $5 Copay after deductible
Preferred Brand Rx $40 Copay after deductible
Non Preferred Brand Rx $80 Copay after deductible
Specialty Drugs 30% Coinsurance after deductible

Other Plans in Texas

Plan IdealCare Complete by Sendero Health Plans Deductible $3,850 Coinsurance Not applicable Out of Pocket $7,350
Plan IdealCare Essential by Sendero Health Plans Deductible $6,500 Coinsurance Not applicable Out of Pocket $7,350
Plan IdealCare Total by Sendero Health Plans Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,000