Sendero Health Original Silver 87 / $10 PCP / $8 Gen Rx / $20 Specialist – HMO

Description

This plan has 87% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type	HMO
Deductible	$1,050 per person $1,050 per person
Out-of-pocket max	$3,000 per person $6,000 per family
Metal tier	Silver

Visit Copay

Primary care visit	$10 copay
Specialist visit	$20 copay
Preventive care visit	No data available

Urgent, Emergency Care, and Hospital Care

Urgent care	$40 copay
Emergency room	$350 copay after deductible
Ambulance	$350 copay after deductible
Hospital stay (facility)	$300 copay per Stay after deductible
Hospital stay (physician)	20% coinsurance after deductible
Outpatient procedure (facility)	15% coinsurance after deductible
Outpatient procedure (physician)	15% coinsurance after deductible
Physical rehabilitation	$60 copay after deductible

Maternitowny and Pregnancy

Well baby care	No data available
Labor, delivery, hospital stay	$300 copay after deductible

Pharmacy, Drugs, and Medication

Generic	$8 copay
Brand	$32 copay
Non-preferred Brand	$50 copay after deductible
Specialty	30% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	$30 copay
Imaging (CT/PET/MRI)	20% coinsurance after deductible
Blood work	20% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	10% coinsurance after deductible
Psychiatric hospital stay	$300 copay per Stay after deductible

Health Plan Provider Information

Health Plan Benefits	http://senderohealth.com/files/2024/71837TX001000105.pdf
Drug and medication plan formulary	https://senderohealth.com/files/2024/Formulary.pdf
Search doctor list	https://www.senderohealth.com/dbsearch/menu_new