Sendero IdealCare Bronze 1900 / $11 Gen Rx + Free Wellness & Preventive Screening + Free Dedicated Healthcare Team + 24/7 Virtual MDVisits + No Pre-existing Condition Restrictions - 71837TX0010019 Health Insurance Plan

Sendero Health Plans, Inc. health insurance plan with the Plan ID 71837TX0010019. The plan is called Sendero IdealCare Bronze 1900 / $11 Gen Rx + Free Wellness & Preventive Screening + Free Dedicated Healthcare Team + 24/7 Virtual MDVisits + No Pre-existing Condition Restrictions.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 59.86% (we converted the output of AV Calculator to percentage to compare with data provided by Issuer, it shows the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 40.14% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.

Health Insurance Plan ID 71837TX0010019
Health Insurance Plan Year 2023
State Texas
Health Insurance Issuer Sendero Health Plans, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 71837TX0010019-00
Provider Network(s) ['TXN001']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Wed, 27 Mar 2024 12:10 GMT).

Providers Texas All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
Available Variants of the Health Plan

Standard Off Exchange Plan - 71837TX0010019-00

Standard On Exchange Plan - 71837TX0010019-01

Open to Indians below 300% FPL - 71837TX0010019-02

Open to Indians above 300% FPL - 71837TX0010019-03

Last Plan Update Date Thu, 16 Feb 2023 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Benefits of Sendero IdealCare Bronze 1900 / $11 Gen Rx + Free Wellness & Preventive Screening + Free Dedicated Healthcare Team + 24/7 Virtual MDVisits + No Pre-existing Condition Restrictions Health Insurance Plan, 71837TX0010019-00

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited
NO
Accidental Dental
YES

No Charge after deductible

100.00%
Acupuncture
NO
Allergy Testing
YES

No Charge after deductible

100.00%
Autism Spectrum Disorders

Same as Habilitation services above

YES

No Charge after deductible

100.00%
Bariatric Surgery
NO
Basic Dental Care - Adult
NO
Basic Dental Care - Child
YES

No Charge after deductible

100.00%
Brain Injury

Habilitation and Mental/ Behavioral health OP treatment related to Brain injury and acquired brain injury

YES

No Charge after deductible

100.00%
Cardiovascular Disease

Atherosclerosis and abnormal artery structure screening for diabetic enrollees and certain enrollees who have a documented medical risk of developing coronary heart disease

YES

No Charge after deductible

100.00%
Chemotherapy
YES

No Charge after deductible

100.00%
Chiropractic Care

Limit: 35.0 Visit(s) per Year

Limited to combined 35 visits per year, including Chiropractic.

YES

No Charge after deductible

100.00%
Cosmetic Surgery
NO
Delivery and All Inpatient Services for Maternity Care

Will cover 48-hour hospital stay for uncomplicated vaginal delivery and 96-hour hospital stay for uncomplicated caesarean section.

YES

No Charge after deductible

Dental Check-Up for Children
YES

No Charge after deductible

100.00%
Diabetes Care Management
YES

No Charge after deductible

100.00%
Diabetes Education
YES

No Charge after deductible

100.00%
Dialysis
YES

No Charge after deductible

100.00%
Durable Medical Equipment
YES

No Charge after deductible

100.00%
Emergency Room Services
YES

No Charge after deductible

No Charge after deductible
Emergency Transportation/Ambulance
YES

No Charge after deductible

No Charge after deductible
Eye Glasses for Children

Limit: 1.0 Item(s) per Year

Benefit consists of 1 pair of glasses (frames with lenses) per calendar year

YES

No Charge after deductible

100.00%
Gender Affirming Care
NO
Generic Drugs
YES

No Charge after deductible

100.00%
Habilitation Services
YES

No Charge after deductible

100.00%
Hearing Aids

Limit: 1.0 Item(s) per 3 Years

Exclusions: Benefit consists of 1 hearing aid every 3 calendar years

To restore or correction of impaired speech or hearing loss.

YES

No Charge after deductible

100.00%
Home Health Care Services

Limit: 60.0 Visit(s) per Year

Exclusions: No limit on private duty nursing when medically necessary.

YES

No Charge after deductible

100.00%
Hospice Services

Preauthorization is required.

YES

No Charge after deductible

100.00%
Imaging (CT/PET Scans, MRIs)
YES

No Charge after deductible

100.00%
Infertility Treatment
NO
Infusion Therapy
YES

No Charge after deductible

100.00%
Inherited Metabolic Disorder - PKU

Amnio acid-based formulas only

YES

No Charge after deductible

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)

All usual Hospital services and supplies, including semiprivate room, intensive care, and coronary care units; Preauthorization is required.

YES

No Charge after deductible

100.00%
Inpatient Physician and Surgical Services
YES

No Charge after deductible

100.00%
Laboratory Outpatient and Professional Services
YES

No Charge after deductible

100.00%
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult
NO
Major Dental Care - Child
YES

No Charge after deductible

100.00%
Mammography

Including 2D and 3D (breast tomosynthesis) for women age 35 and older on an annual basis

YES

No Charge after deductible

100.00%
Mental/Behavioral Health Inpatient Services

Preauthorization is required.

YES

No Charge after deductible

100.00%
Mental/Behavioral Health Outpatient Services

Preauthorization is required.

YES

No Charge after deductible

100.00%
Mental Health Other

Clinically-based mental/nervous disorders

YES

No Charge after deductible

100.00%
Non-Preferred Brand Drugs
YES

No Charge after deductible

100.00%
Nutritional Counseling
YES
Off Label Prescription Drugs

Off label drugs

YES

No Charge after deductible

100.00%
Orthodontia - Adult
NO
Orthodontia - Child
YES

No Charge after deductible

100.00%
Osteoporosis
YES

No Charge after deductible

100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
YES

No Charge after deductible

100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
YES

No Charge after deductible

100.00%
Outpatient Rehabilitation Services
YES

No Charge after deductible

100.00%
Outpatient Surgery Physician/Surgical Services
YES

No Charge after deductible

100.00%
Pediatric Services Other

reconstructive surgery for craniofacial abnormalities in a child

YES

No Charge after deductible

100.00%
Post-Mastectomy Care

Mastecctomy or lymp node dissection, minimus stay

YES

No Charge after deductible

100.00%
Preferred Brand Drugs
YES

No Charge after deductible

100.00%
Prenatal and Postnatal Care
YES

No Charge after deductible

100.00%
Prescription Drugs Other

Oral anticancer medications

YES

No Charge after deductible

100.00%
Preventive Care/Screening/Immunization
YES

0.00%

100.00%
Primary Care Visit to Treat an Injury or Illness
YES

No Charge after deductible

100.00%
Private-Duty Nursing
NO
Prosthetic Devices

Replacement Prosthetic Appliances except those necessitated by growth due to maturity of the participant. Also, prosthetics provided for the treatment of the temporomandibular joint and all adjacent or related muscles and nerves. Medically necessary foot orthotics are not subject to a calendar year maximum.

YES

No Charge after deductible

100.00%
Radiation
YES

No Charge after deductible

100.00%
Reconstructive Surgery

Examples of covered services include: Treatment provided for reconstructive surgery following cancer surgery; Reconstruction of the breast on which mastectomy has been performed.

YES

No Charge after deductible, 0.00%

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy
YES

No Charge after deductible

100.00%
Rehabilitative Speech Therapy
YES

No Charge after deductible

Routine Dental Services (Adult)
NO
Routine Eye Exam (Adult)
NO
Routine Eye Exam for Children

Limit: 1.0 Visit(s) per Year

YES

No Charge after deductible

100.00%
Routine Foot Care
YES
Skilled Nursing Facility

Limit: 25.0 Visit(s) per Year

YES

No Charge after deductible

100.00%
Specialist Visit
YES

No Charge after deductible

100.00%
Specialty Drugs
YES

No Charge after deductible

100.00%
Substance Abuse Disorder Inpatient Services

Preauthorization is required.

YES

No Charge after deductible

100.00%
Substance Abuse Disorder Outpatient Services

Certain services require preauthorization.

YES

No Charge after deductible

100.00%
Transplant

Preauthorization is required.

YES

No Charge after deductible

100.00%
Transplant Donor Coverage

Exclusions: Donor expenses for a Participant in connection with an organ and tissue transplant if the recipient is not covered under this Plan.

YES

No Charge after deductible

100.00%
Treatment for Temporomandibular Joint Disorders

Any non-surgical (dental restorations, orthodontics, or physical therapy) or non-diagnostic services or supplies (oral appliances, oral splints, oral orthotics, devices, or prosthetics) provided for the treatment of the temporomandibular joint and all adjacent or related muscles and nerves.Though state law only mandates coverage for temporomandibular joint (TMJ) disorders for large group plans and HMOs, the benchmark plan covers TMJ. Therefore, it is considered part of the EHB package for Texas.

YES

No Charge after deductible

100.00%
Urgent Care Centers or Facilities
YES

No Charge after deductible

100.00%
Weight Loss Programs
NO
Well Baby Visits and Care
YES

No Charge

100.00%
X-rays and Diagnostic Imaging
YES

No Charge after deductible

100.00%

Sendero IdealCare Bronze 1900 / $11 Gen Rx + Free Wellness & Preventive Screening + Free Dedicated Healthcare Team + 24/7 Virtual MDVisits + No Pre-existing Condition Restrictions Health Insurance Plan Variant 71837TX0010019-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.598552346
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2023
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Bronze Off Exchange Plan
Dental Only Plan No
Design Type Design 1
Disease Management Programs Offered Asthma, Depression, Diabetes
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID TXF001
Formulary URL URL
HIOS Product ID 71837TX001
Import Date 2/16/2023 1:02
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 0
HSA Eligible No
New/Existing Plan New
Notice Required for Pregnancy Yes
Is a Referral Required for Specialist? Yes
Issuer ID 71837
Issuer Marketplace Marketing Name Sendero Health Plans, Local Nonprofit
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Bronze
Multiple In Network Tiers No
National Network No
Network ID TXN001
Out of Country Coverage No
Out of Service Area Coverage No
Plan Brochure URL
Plan Effective Date 1/1/2023
Plan ID (Standard Component ID with Variant) 71837TX0010019-00
Plan Marketing Name Sendero IdealCare Bronze 1900 / $11 Gen Rx + Free Wellness & Preventive Screening + Free Dedicated Healthcare Team + 24/7 Virtual MDVisits + No Pre-existing Condition Restrictions
Plan Type HMO
Plan Variant Marketing Name Sendero IdealCare Bronze 1900 / $11 Gen Rx + Free Wellness & Preventive Screening + Free Dedicated Healthcare Team + 24/7 Virtual MDVisits + No Pre-existing Condition Restrictions
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $1,500
SBC Scenario, Having a Baby, Limit $0
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $4,600
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $0
SBC Scenario, Treatment of a Simple Fracture, Deductible $800
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID TXS001
Source Name HIOS
Specialist Requiring a Referral Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System), Allergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes), Neurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney), Endocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal Surgery (Bowels),Thoracic Surgery (Chest Surgery),Hepatology (Liver),Vascular Surgery (Operations of the Blood Vessels)
Plan ID 71837TX0010019
State Code TX
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group $18200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person $9100 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $9,100
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group $18200 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person $9100 per person
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual $9,100
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 0.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $18200 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $9100 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $9,100
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group per group not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person per person not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Individual Not Applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $18200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $9100 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,100
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person per person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual Not Applicable
Unique Plan Design No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered Yes

Copay & Coinsurance of Sendero IdealCare Bronze 1900 / $11 Gen Rx + Free Wellness & Preventive Screening + Free Dedicated Healthcare Team + 24/7 Virtual MDVisits + No Pre-existing Condition Restrictions Health Insurance Plan, 71837TX0010019

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about Sendero IdealCare Bronze 1900 / $11 Gen Rx + Free Wellness & Preventive Screening + Free Dedicated Healthcare Team + 24/7 Virtual MDVisits + No Pre-existing Condition Restrictions, 71837TX0010019 Health Insurance Plan, 71837TX0010019

  • Does Sendero IdealCare Bronze 1900 / $11 Gen Rx + Free Wellness & Preventive Screening + Free Dedicated Healthcare Team + 24/7 Virtual MDVisits + No Pre-existing Condition Restrictions Health Insurance Plan, 71837TX0010019 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (71837TX0010019) Health Insurance Plan, Variant (71837TX0010019-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Depression, Diabetes

    Does (71837TX0010019) Health Insurance Plan, Variant (71837TX0010019-00) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).

    Does (71837TX0010019) Health Insurance Plan, Variant (71837TX0010019-00) have Out of Service Area Coverage?

    No, unfortunately there is no Out of Service Area Coverage for this Health Insurance Plan (variant of plan).

    Does (71837TX0010019) Health Insurance Plan, Variant (71837TX0010019-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Depression, Diabetes

    Does Sendero IdealCare Bronze 1900 / $11 Gen Rx + Free Wellness & Preventive Screening + Free Dedicated Healthcare Team + 24/7 Virtual MDVisits + No Pre-existing Condition Restrictions Health Insurance Plan, Variant (71837TX0010019-00) offer Disease Management Programs for Asthma?

    Yes, the Sendero IdealCare Bronze 1900 / $11 Gen Rx + Free Wellness & Preventive Screening + Free Dedicated Healthcare Team + 24/7 Virtual MDVisits + No Pre-existing Condition Restrictions Health Insurance Plan Variant 71837TX0010019-00 offers Disease Management Program for Asthma.

    Does Sendero IdealCare Bronze 1900 / $11 Gen Rx + Free Wellness & Preventive Screening + Free Dedicated Healthcare Team + 24/7 Virtual MDVisits + No Pre-existing Condition Restrictions Health Insurance Plan, Variant (71837TX0010019-00) offer Disease Management Programs for Depression?

    Yes, the Sendero IdealCare Bronze 1900 / $11 Gen Rx + Free Wellness & Preventive Screening + Free Dedicated Healthcare Team + 24/7 Virtual MDVisits + No Pre-existing Condition Restrictions Health Insurance Plan Variant 71837TX0010019-00 offers Disease Management Program for Depression.

    Does Sendero IdealCare Bronze 1900 / $11 Gen Rx + Free Wellness & Preventive Screening + Free Dedicated Healthcare Team + 24/7 Virtual MDVisits + No Pre-existing Condition Restrictions Health Insurance Plan, Variant (71837TX0010019-00) offer Disease Management Programs for Diabetes?

    Yes, the Sendero IdealCare Bronze 1900 / $11 Gen Rx + Free Wellness & Preventive Screening + Free Dedicated Healthcare Team + 24/7 Virtual MDVisits + No Pre-existing Condition Restrictions Health Insurance Plan Variant 71837TX0010019-00 offers Disease Management Program for Diabetes.

 

Disclaimer: This is based on the import(Date: Wed, 27 Mar 2024 12:10 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API