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Sendero Health Austin512 Silver / $40 PCP / $75 Specialist / $15 Generic Drugs / $0 Deductible
Sendero Health Plans, Local Nonprofit · 2026 plan year
Silver
- Ind. deductible
- $0
- Family deductible
- $0
- Ind. OOP max
- $9,200
- Family OOP max
- $18,400
Other cost-sharing reduction variants for this plan:
More Sendero Health Plans, Local Nonprofit plans in TX
Monthly premiums by age
Rating Area 3
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $399 | $399 |
| 21 | $521 | $547 |
| 30 | $592 | $678 |
| 40 | $666 | $835 |
| 50 | $931 | $1,267 |
| 60 | $1,415 | $2,077 |
| 64 and over | $1,564 | $2,346 |
Live premium estimate
Benefits & cost sharing
Primary Care
| Benefit | In-network |
|---|---|
| Preventive Care/Screening/Immunization | See plan details |
| Primary Care Visit to Treat an Injury or Illness | $40.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $75.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | $900.00 |
| Inpatient Hospital Services (e.g., Hospital Stay) | $3100.00 Copay per Stay |
| Outpatient Surgery Physician/Surgical Services | $400.00 |
| Urgent Care Centers or Facilities | $60.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Preferred Brand Drugs | $75.00 |
| Prescription Drugs Other | 20.00% |
| Generic Drugs | $15.00 |
| Non-Preferred Brand Drugs | $150.00 |
| Off Label Prescription Drugs | 20.00% |
| Specialty Drugs | $350.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Mental Health Other | $10.00 |
| Mental/Behavioral Health Inpatient Services | $3100.00 Copay per Stay |
| Mental/Behavioral Health Outpatient Services | $110.00 |
Other
| Benefit | In-network |
|---|---|
| Durable Medical Equipment | 20.00% |
| Emergency Transportation/Ambulance | $900.00 |
| Prenatal and Postnatal Care | $10.00 |
| Diabetes Care Management | $50.00 |
| Diabetes Education | 20.00% |
| Dialysis | $250.00 |
| Chiropractic Care | $60.00 |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | $3,100.00 |
| Dental Check-Up for Children | 20.00% |
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | 20.00% |
| Acupuncture | Not covered |
| Allergy Testing | 20.00% |
| Autism Spectrum Disorders | $10.00 |
| Bariatric Surgery | Not covered |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | 20.00% |
| Brain Injury | 20.00% |
| Cardiovascular Disease | 20.00% |
| Chemotherapy | $250.00 |
| Eye Glasses for Children | 20.00% |
| Habilitation Services | $70.00 |
| Hearing Aids | 20.00% |
| Home Health Care Services | No charge |
| Hospice Services | 20.00% |
| Imaging (CT/PET Scans, MRIs) | $350.00 |
| Infertility Treatment | Not covered |
| Infusion Therapy | $250.00 |
| Inherited Metabolic Disorder - PKU | 20.00% |
| Inpatient Physician and Surgical Services | 20.00% |
| Laboratory Outpatient and Professional Services | $60.00 |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | Not covered |
| Major Dental Care - Child | 20.00% |
| Mammography | $250.00 |
| Nutritional Counseling | $5.00 |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | 20.00% |
| Osteoporosis | 20.00% |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $20.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | $400.00 |
| Outpatient Rehabilitation Services | $70.00 |
| Pediatric Services Other | 20.00% |
| Post-Mastectomy Care | 20.00% |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | $250.00 |
| Radiation | $250.00 |
| Reconstructive Surgery | 30.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $100.00 |
| Rehabilitative Speech Therapy | $100.00 |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | Not covered |
| Routine Eye Exam for Children | $45.00 |
| Routine Foot Care | $45.00 |
| Skilled Nursing Facility | $300.00 Copay per Stay |
| Substance Abuse Disorder Inpatient Services | $3100.00 Copay per Stay |
| Substance Abuse Disorder Outpatient Services | $110.00 |
| Transplant | 20.00% |
| Transplant Donor Coverage | 20.00% |
| Treatment for Temporomandibular Joint Disorders | 20.00% |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | See plan details |
| X-rays and Diagnostic Imaging | $125.00 |
Service area
This plan covers 8 geographic areas.
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