Texas health plan · 2025

Sendero Health Austin512 Silver / $40 PCP / $75 Specialist / $15 Generic Drugs / $0 Deductible · 71837TX0010022

Sendero Health Plans, Inc. offers this marketplace health insurance plan (Plan ID 71837TX0010022) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: HMO CSR: 87% AV Level Silver Plan Issuer: Sendero Health Plans, Inc.
Telehealth Data pending HSA eligible No Dental Child Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 87.62% (12.38% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$348 – $1363

Before subsidies

Estimate after subsidies

Deductible

$0

$0 per group

See deductible details

Max out-of-pocket

$2,800

$5600 per group

Review MOOP rules

Office visits

Primary care $20.00
Specialist $40.00
HSA Not eligible

Drug tiers

Generic $10.00
Preferred brand $25.00

View formulary tiers

$476 / mo before subsidies

≈ $5715 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1509 / mo before subsidies

≈ $18109 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1828 / mo before subsidies

≈ $21931 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1161 / mo before subsidies

≈ $13938 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

nan

Emergency Room Services

$700.00

Durable Medical Equipment

20.00%

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Texas). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • 87% AV Level Silver Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

nan

Emergency Room Services

$700.00

Durable Medical Equipment

20.00%

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 71837TX0010022
Coverage year 2025
State Texas
Issuer Sendero Health Plans, Inc.
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 71837TX0010022-05
Available variants

Standard Off Exchange Plan · 71837TX0010022-00

Standard On Exchange Plan · 71837TX0010022-01

Open to Indians below 300% FPL · 71837TX0010022-02

Open to Indians above 300% FPL · 71837TX0010022-03

73% AV Silver Plan · 71837TX0010022-04

87% AV Silver Plan · 71837TX0010022-05

94% AV Silver Plan · 71837TX0010022-06
Last plan update Wed, 14 Aug 2024 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Texas N/A
PCPs in Texas N/A
Telehealth support Data pending
Nationwide providers N/A

Provider network(s)

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

Drug coverage overview

5,952 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
NON-PREFERRED-GENERIC 2,551
NON-PREFERRED-BRAND 2,016
SPECIALTY-DRUGS 889
MEDICAL-SERVICE-DRUGS 496
Prior authorization Drugs
Required 1,066
Not Required 4,886
Step therapy Drugs
Required 103
Not Required 5,849
Quantity limits Drugs
Has Limit 1,269
No Limit 4,683

Customer highlights

What stands out for members

  • Issuer: Sendero Health Plans, Inc. · Plan ID 71837TX0010022 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 71837TX0010022-05 (87% AV Silver Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$60.00
Tier 1 in-network $60.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

Limited to combined 35 visits per year, including Chiropractic.

Exclusions: nan

Diabetes Care Management

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Diabetes Education

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

nan

Exclusions: nan

Home Health Care Services

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Year

nan

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

Laboratory Outpatient and Professional Services

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

nan

Exclusions: nan

Preventive Care/Screening/Immunization

100.00%
Out-of-network 100.00%

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

This category also applies to mental health, substance abuse office visits

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

nan

Exclusions: nan

Rehabilitative Speech Therapy

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

nan

Exclusions: nan

Specialist Visit

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

nan

Exclusions: nan

Urgent Care Centers or Facilities

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

nan

Exclusions: nan

X-rays and Diagnostic Imaging

$100.00
Tier 1 in-network $100.00
Out-of-network 100.00%

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

$2,500.00
Tier 1 in-network $2,500.00
Out-of-network 100.00%

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

Exclusions: nan

Dialysis

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Durable Medical Equipment

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

nan

Exclusions: nan

Emergency Room Services

$700.00
Tier 1 in-network $700.00
Out-of-network $700.00

nan

Exclusions: nan

Emergency Transportation/Ambulance

$700.00
Tier 1 in-network $700.00
Out-of-network $700.00

nan

Exclusions: nan

Hospice Services

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Preauthorization is required.

Exclusions: nan

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

$1700.00 Copay per Stay
Tier 1 in-network $1700.00 Copay per Stay
Out-of-network 100.00%

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

Exclusions: nan

Inpatient Physician and Surgical Services

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

$1700.00 Copay per Stay
Tier 1 in-network $1700.00 Copay per Stay
Out-of-network 100.00%

Preauthorization is required.

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

Preauthorization is required.

Exclusions: nan

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

$300.00
Tier 1 in-network $300.00
Out-of-network 100.00%

nan

Exclusions: nan

Outpatient Rehabilitation Services

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

nan

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

$300.00
Tier 1 in-network $300.00
Out-of-network 100.00%

nan

Exclusions: nan

Radiation

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

nan

Exclusions: nan

Skilled Nursing Facility

$250.00 Copay per Stay
Tier 1 in-network $250.00 Copay per Stay
Out-of-network 100.00%

Limit: 25.0 Visit(s) per Year

nan

Exclusions: nan

Substance Abuse Disorder Inpatient Services

$1700.00 Copay per Stay
Tier 1 in-network $1700.00 Copay per Stay
Out-of-network 100.00%

Preauthorization is required.

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

Certain services require preauthorization.

Exclusions: nan

Transplant

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Preauthorization is required.

Exclusions: nan

Transplant Donor Coverage

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

nan

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

Mental health & substance use

Behavioral health visits and substance use treatment.

Autism Spectrum Disorders

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Same as Habilitation services above

Exclusions: nan

Mental Health Other

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Clinically-based mental/nervous disorders

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

nan

Exclusions: nan

Hearing Aids

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Limit: 1.0 Item(s) per 3 Years

To restore or correction of impaired speech or hearing loss.

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

Major Dental Care - Child

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

nan

Exclusions: nan

Prenatal and Postnatal Care

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

nan

Exclusions: nan

Routine Eye Exam for Children

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Limit: 1.0 Visit(s) per Year

nan

Exclusions: nan

Well Baby Visits and Care

100.00%
Out-of-network 100.00%

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

nan

Exclusions: nan

Non-Preferred Brand Drugs

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

nan

Exclusions: nan

Off Label Prescription Drugs

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Off label drugs

Exclusions: nan

Preferred Brand Drugs

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

nan

Exclusions: nan

Prescription Drugs Other

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Oral anticancer medications

Exclusions: nan

Specialty Drugs

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

nan

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

nan

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

nan

Exclusions: nan

Infusion Therapy

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

nan

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

$5.00, No Charge
Tier 1 in-network $5.00, No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

nan

Exclusions: nan

Prosthetic Devices

$10.00
Tier 1 in-network $10.00
Out-of-network 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.

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

nan

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

nan

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Brain Injury

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

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

Exclusions: nan

Cardiovascular Disease

20.00%
Tier 1 in-network 20.00%
Out-of-network 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

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

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

Exclusions: nan

Gender Affirming Care

Coverage details pending

nan

Exclusions: nan

Habilitation Services

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

nan

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

$250.00
Tier 1 in-network $250.00
Out-of-network 100.00%

nan

Exclusions: nan

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Inherited Metabolic Disorder - PKU

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Amnio acid-based formulas only

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Mammography

$0.00, No Charge
Tier 1 in-network $0.00, No Charge
Out-of-network 100.00%

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

Exclusions: nan

Osteoporosis

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

nan

Exclusions: nan

Pediatric Services Other

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

reconstructive surgery for craniofacial abnormalities in a child

Exclusions: nan

Post-Mastectomy Care

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Mastecctomy or lymp node dissection, minimus stay

Exclusions: nan

Private-Duty Nursing

Coverage details pending

nan

Exclusions: nan

Reconstructive Surgery

20.00%
Tier 1 in-network 20.00%
Out-of-network 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.

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

$30.00
Tier 1 in-network $30.00
Out-of-network 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.

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

20.00%
Tier 1 in-network 20.00%
Out-of-network 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.

Exclusions: nan

Variant attributes

Sendero Health Austin512 Silver / $40 PCP / $75 Specialist / $15 Generic Drugs / $0 Deductible · Variant 71837TX0010022-05

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

87% AV Level Silver Plan

HIOS Product ID

71837TX001

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

71837TX0010022-05

Plan Marketing Name

Sendero Health Austin512 Silver / $40 PCP / $75 Specialist / $15 Generic Drugs / $0 Deductible

Plan Variant Marketing Name

Sendero Health Austin512 Silver 87 / $20 PCP / $40 Specialist / $10 Generic Drugs / $0 Deductible

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

71837

Issuer Marketplace Marketing Name

Sendero Health Plans, Local Nonprofit

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

TXN001

Out of Country Coverage

No

Out of Service Area Coverage

No

Service Area ID

TXS001

State Code

TX

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.87623665162439

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$300

SBC Scenario, Having a Baby, Copayment

$2,100

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$700

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$50

SBC Scenario, Treatment of a Simple Fracture, Copayment

$1,700

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

$5600 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

$2800 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

$2,800

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

20.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$5600 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$2800 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$2,800

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

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

TXF001

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$0

SBC Scenario, Having Diabetes, Limit

$0

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

2

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes

EHB Percent of Total Premium

1.0

First Tier Utilization

100%

Import Date

2024-08-14 01:01:35

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

Yes

Is a Referral Required for Specialist?

Yes

Plan Effective Date

2025-01-01

Plan Type

HMO

QHP/Non QHP

Both

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

71837TX0010022

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

$0 per group

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

$0 per person

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

$0

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$0

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

Unique Plan Design

No

Wellness Program Offered

Yes

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Texas?

Sendero Health Austin512 Silver / $40 PCP / $75 Specialist / $15 Generic Drugs / $0 Deductible (71837TX0010022) is a Silver HMO from Sendero Health Plans, Inc. in Texas for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Sendero Health Austin512 Silver / $40 PCP / $75 Specialist / $15 Generic Drugs / $0 Deductible support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Sendero Health Austin512 Silver / $40 PCP / $75 Specialist / $15 Generic Drugs / $0 Deductible HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental add-ons: Child.

Vision add-ons: Child.

Does Sendero Health Austin512 Silver / $40 PCP / $75 Specialist / $15 Generic Drugs / $0 Deductible support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Sendero Health Austin512 Silver / $40 PCP / $75 Specialist / $15 Generic Drugs / $0 Deductible?

The issuer lists disease management resources for: Asthma, Depression, Diabetes.

Is there out-of-country coverage for Sendero Health Austin512 Silver / $40 PCP / $75 Specialist / $15 Generic Drugs / $0 Deductible?

No, out-of-country services are not covered for this plan.

Does Sendero Health Austin512 Silver / $40 PCP / $75 Specialist / $15 Generic Drugs / $0 Deductible cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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