Sendero Health Pure Silver / $30 PCP (1 Free PCP Visit) / $20 Gen Rx / $70 Specialist – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $30 copay
Specialist visit: $70 copay
Urgent care visit: $50 copay
Description
Health Care Plan Details
| Network type | HMO |
| Deductible | $1,500 per person $1,500 per person |
| Out-of-pocket max | $8,000 per person $16,000 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $30 copay |
| Specialist visit | $70 copay |
| Preventive care visit | No data available |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $50 copay |
| Emergency room | $800 copay |
| Ambulance | $500 copay after deductible |
| Hospital stay (facility) | $2000 copay per Stay after deductible |
| Hospital stay (physician) | 20% coinsurance after deductible |
| Outpatient procedure (facility) | $650 copay |
| Outpatient procedure (physician) | $650 copay |
| Physical rehabilitation | $70 copay |
Maternitowny and Pregnancy
| Well baby care | No data available |
| Labor, delivery, hospital stay | $2,000 copay |
Pharmacy, Drugs, and Medication
| Generic | $20 copay |
| Brand | $75 copay after deductible |
| Non-preferred Brand | $140 copay |
| Specialty | 20% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | $125 copay |
| Imaging (CT/PET/MRI) | 20% coinsurance after deductible |
| Blood work | $60 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $150 copay |
| Psychiatric hospital stay | $2000 copay per Stay after deductible |
Health Plan Provider Information
| Health Plan Benefits | http://senderohealth.com/files/2024/71837TX001002101.pdf |
| Drug and medication plan formulary | https://senderohealth.com/files/2024/Formulary.pdf |
| Search doctor list | https://www.senderohealth.com/dbsearch/menu_new |
