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Sendero - IdealCare Total by Sendero Health Plans
Texas, 2018
Plan Type
HMO
Metal Tier
Gold
Out of Pocket Maximum
$5,000
Deductible
$1,000
Emergency Room Care: 20% Coinsurance 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) | $1,000 |
|---|---|
| Deductible (Family) | $2,000 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $5,000 |
| Out of Pocket Maximum (Family) | $10,000 |
Doctor Visits
| Primary Care Visit | Data Not Available |
|---|---|
| Specialist Visit | Data Not Available |
| Inpatient Facility | 20% Coinsurance after deductible |
| Inpatient Physician | No charge |
| Emergency Room Services | 20% Coinsurance after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | Data Not Available |
|---|---|
| Laboratory Outpatient and Professional Services | Data Not Available |
| X-Ray and Diagnostic Imaging | Data Not Available |
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 | 20% Coinsurance after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | Data Not Available |
| Rehabilitative Speech Therapy | Data Not Available |
| Rehabilitative Occupational & Physical Therapy | Data Not Available |
| Outpatient Facility | $150 Copay after deductible |
| Outpatient Surgery | $150 Copay after deductible |
Prescription Drugs
| Generic Rx | Data Not Available |
|---|---|
| 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 | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| 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 HSA by Sendero Health Plans | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $6,650 |