Sendero Health Reliable Bronze High Deductible

71837TX0010007
Bronze
HMO

Sendero Health Reliable Bronze High Deductible is a Bronze HMO plan by Sendero Health Plans, Local Nonprofit.

IMPORTANT: You are viewing the 2024 version of Sendero Health Reliable Bronze High Deductible 71837TX0010007. You can enroll in this plan during open enrollment 2024, which starts November 1st and ends January 15th, 2023, in most states.

Locations

Sendero Health Reliable Bronze High Deductible is offered in the following counties.

Plan Overview

This is a plan overview for 2024 version of Sendero Health Reliable Bronze High Deductible 71837TX0010007.
Insurer: Sendero Health Plans, Local Nonprofit
Network Type: HMO
Metal Type: Bronze
HSA Eligible?: No
Plan ID: 71837TX0010007

Cost-Sharing Overview

Sendero Health Reliable Bronze High Deductible offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for Sendero Health Reliable Bronze High Deductible?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

Sendero Health Reliable Bronze High Deductible offers the following features and referral requirements.

Wellness Program: Yes
Disease Program: Asthma, Depression, Diabetes
Notice Pregnancy: Yes
Referral Specialist: Yes
Specialist Requiring 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 Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what Sendero Health Reliable Bronze High Deductible covers when you are out of the service area or out of the country.

Out of Country Coverage: No
Out of Country Coverage Description:
Out of Service Area Coverage: No
Out of Service Area Coverage Description:
National Network: No

Additional Benefits and Cost-Sharing

Sendero Health Reliable Bronze High Deductible includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Primary Care Visit to Treat an Injury or Illness
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Specialist Visit
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Hospice Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Preauthorization is required.
Routine Dental Services (Adult)
Not Covered
Infertility Treatment
Not Covered
Long-Term/Custodial Nursing Home Care
Not Covered
Private-Duty Nursing
Not Covered
Routine Eye Exam (Adult)
Not Covered
Urgent Care Centers or Facilities
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Home Health Care Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%60.0 Visit(s) per Year No limit on private duty nursing when medically necessary.
Emergency Room Services
Covered
No Charge after deductible Not ApplicableNo Charge after deductible Not Applicable
Emergency Transportation/Ambulance
Covered
No Charge after deductible Not ApplicableNo Charge after deductible Not Applicable
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% All usual Hospital services and supplies, including semiprivate room, intensive care, and coronary care units; Preauthorization is required.
Inpatient Physician and Surgical Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Bariatric Surgery
Not Covered
Cosmetic Surgery
Not Covered
Skilled Nursing Facility
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%25.0 Visit(s) per Year
Prenatal and Postnatal Care
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Delivery and All Inpatient Services for Maternity Care
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Will cover 48-hour hospital stay for uncomplicated vaginal delivery and 96-hour hospital stay for uncomplicated caesarean section.
Mental/Behavioral Health Outpatient Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Preauthorization is required.
Mental/Behavioral Health Inpatient Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Preauthorization is required.
Substance Abuse Disorder Outpatient Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Certain services require preauthorization.
Substance Abuse Disorder Inpatient Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Preauthorization is required.
Generic Drugs
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Preferred Brand Drugs
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Non-Preferred Brand Drugs
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Specialty Drugs
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Outpatient Rehabilitation Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Habilitation Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Chiropractic Care
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%35.0 Visit(s) per Year Limited to combined 35 visits per year, including Chiropractic.
Durable Medical Equipment
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Hearing Aids
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%1.0 Item(s) per 3 Years Benefit consists of 1 hearing aid every 3 calendar years To restore or correction of impaired speech or hearing loss.
Imaging (CT/PET Scans, MRIs)
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Preventive Care/Screening/Immunization
Covered
Not Applicable Not ApplicableNot Applicable 100.00%
Routine Foot Care
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Excluded for any services or supplies in connection with routine foot care, including the removal of warts, corns, or calluses, or the cutting and trimming of toenails, in the absence of diabetes, circulatory disorders of the lower extremities, peripheral vascular disease, peripheral neuropathy, or chronic arterial or venous insufficiency.
Acupuncture
Not Covered
Weight Loss Programs
Not Covered
Routine Eye Exam for Children
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%1.0 Visit(s) per Year
Eye Glasses for Children
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%1.0 Item(s) per Year Benefit consists of 1 pair of glasses (frames with lenses) per calendar year
Dental Check-Up for Children
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Rehabilitative Speech Therapy
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Well Baby Visits and Care
Covered
Not Applicable Not ApplicableNot Applicable 100.00%
Laboratory Outpatient and Professional Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
X-rays and Diagnostic Imaging
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Basic Dental Care – Child
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Orthodontia – Child
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Major Dental Care – Child
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Basic Dental Care – Adult
Not Covered
Orthodontia – Adult
Not Covered
Major Dental Care – Adult
Not Covered
Abortion for Which Public Funding is Prohibited
Not Covered
Transplant
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Preauthorization is required.
Accidental Dental
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Dialysis
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Allergy Testing
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Chemotherapy
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Radiation
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Diabetes Education
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Prosthetic Devices
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% 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.
Infusion Therapy
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Treatment for Temporomandibular Joint Disorders
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% 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.
Nutritional Counseling
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Reconstructive Surgery
Covered
No Charge after deductible 0.00%Not Applicable 100.00% Examples of covered services include: Treatment provided for reconstructive surgery following cancer surgery; Reconstruction of the breast on which mastectomy has been performed.
Gender Affirming Care
Not Covered
Mammography
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Including 2D and 3D (breast tomosynthesis) for women age 35 and older on an annual basis
Cardiovascular Disease
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Atherosclerosis and abnormal artery structure screening for diabetic enrollees and certain enrollees who have a documented medical risk of developing coronary heart disease
Osteoporosis
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Diabetes Care Management
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Inherited Metabolic Disorder – PKU
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Amnio acid-based formulas only
Off Label Prescription Drugs
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Off label drugs
Mental Health Other
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Clinically-based mental/nervous disorders
Prescription Drugs Other
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Oral anticancer medications
Post-Mastectomy Care
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Mastecctomy or lymp node dissection, minimus stay
Brain Injury
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Habilitation and Mental/ Behavioral health OP treatment related to Brain injury and acquired brain injury
Pediatric Services Other
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% reconstructive surgery for craniofacial abnormalities in a child
Transplant Donor Coverage
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Donor expenses for a Participant in connection with an organ and tissue transplant if the recipient is not covered under this Plan.
Autism Spectrum Disorders
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Same as Habilitation services above

Free Preventive Services

There is no copayment or coinsurance for any of the following Sendero Health Reliable Bronze High Deductible preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Additional Resources

Below are additional resources for Sendero Health Reliable Bronze High Deductible including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.

Summary of Benefits: Summary of Benefits Link
Plan Brochure: Plan Brochure Link
Formulary: Formulary Link
Premium Payment Website: Premium Payment Link
Ready to sign up for Sendero Health Reliable Bronze High Deductible?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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