SHP Gold

Sendero Health Plans, Local Nonprofit · 2027 plan year

Gold

Ind. medical deductible: $350
Rx deductible (separate): $500
Family deductible: $700
Ind. OOP max: $10,000
Family OOP max: $20,000

This plan sets a separate deductible for prescription drugs. The medical deductible shown does not cover prescriptions; they have their own.

Compare with other Gold plans in TX

Side by side: deductibles, out-of-pocket limits and copays.

Wellpoint Heart Healthy Essential Gold 500 ($0 Select Drugs + Incentives)WellPoint · Deductible $500 · Out-of-pocket max $10,500
Blue Advantage Gold HMO℠ - MaxBlue Cross and Blue Shield of Texas · Deductible $550 · Out-of-pocket max $10,500
Blue Advantage Gold HMO℠ - MaxBlue Cross and Blue Shield of Texas · Deductible $550 · Out-of-pocket max $10,500

Compare 4 plans Browse all Gold plans in TX

Other cost-sharing reduction variants for this plan:

Limited Cost Sharing Plan Variation Standard Gold Off Exchange Plan Zero Cost Sharing Plan Variation

More Sendero Health Plans, Local Nonprofit plans in TX

Sendero Health Original Silver / $20 PCP + 2 $0 PCP Visits / $10 Generic Drugs Sendero Health Capital Silver / $40 PCP / $80 Specialist / $20 Generic Drugs Sendero Health Hill Country Gold / $30 PCP / $60 Specialist / $15 Generic Drugs

Monthly premiums by age

Rating Area 3

Age	Individual	Individual + tobacco
Under 15	$475	$475
21	$621	$652
30	$704	$807
40	$793	$995
50	$1,109	$1,509
60	$1,685	$2,473
64 and over	$1,862	$2,793

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	$15.00

Specialist

Benefit	In-network
Specialist Visit	$60.00

Hospital

Benefit	In-network
Emergency Room Services	35.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	35.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	30.00% Coinsurance after deductible
Urgent Care Centers or Facilities	30.00% Coinsurance after deductible

Pharmacy

Benefit	In-network
Generic Drugs	No Charge after deductible
Non-Preferred Brand Drugs	$80.00 Copay with deductible
Off Label Prescription Drugs	20.00% Coinsurance after deductible
Preferred Brand Drugs	$40.00 Copay with deductible
Prescription Drugs Other	20.00% Coinsurance after deductible
Specialty Drugs	35.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Mental Health Other	20.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services	35.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	$15.00

Other

Benefit	In-network
Abortion for Which Public Funding is Prohibited	Not covered
Accidental Dental	20.00% Coinsurance after deductible
Acupuncture	Not covered
Allergy Testing	20.00% Coinsurance after deductible
Autism Spectrum Disorders	30.00% Coinsurance after deductible
Bariatric Surgery	Not covered
Basic Dental Care - Adult	Not covered
Basic Dental Care - Child	20.00% Coinsurance after deductible
Brain Injury	20.00% Coinsurance after deductible
Cardiovascular Disease	20.00% Coinsurance after deductible
Chemotherapy	20.00% Coinsurance after deductible
Chiropractic Care	$35.00
Cosmetic Surgery	Not covered
Delivery and All Inpatient Services for Maternity Care	35.00% Coinsurance after deductible
Dental Check-Up for Children	20.00% Coinsurance after deductible
Diabetes Care Management	20.00% Coinsurance after deductible
Diabetes Education	20.00% Coinsurance after deductible
Dialysis	20.00% Coinsurance after deductible
Durable Medical Equipment	20.00% Coinsurance after deductible
Emergency Transportation/Ambulance	35.00% Coinsurance after deductible
Eye Glasses for Children	20.00% Coinsurance after deductible
Habilitation Services	30.00% Coinsurance after deductible
Hearing Aids	20.00% Coinsurance after deductible
Home Health Care Services	No charge
Hospice Services	20.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)	30.00% Coinsurance after deductible
Infertility Treatment	Not covered
Infusion Therapy	20.00% Coinsurance after deductible
Inherited Metabolic Disorder - PKU	20.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	35.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	20.00% Coinsurance after deductible
Long-Term/Custodial Nursing Home Care	Not covered
Major Dental Care - Adult	Not covered
Major Dental Care - Child	20.00% Coinsurance after deductible
Mammography	$250.00 Copay after deductible
Nutritional Counseling	$5.00
Orthodontia - Adult	Not covered
Orthodontia - Child	20.00% Coinsurance after deductible
Osteoporosis	20.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)	$15.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	30.00% Coinsurance after deductible
Outpatient Rehabilitation Services	$35.00
Pediatric Services Other	20.00% Coinsurance after deductible
Post-Mastectomy Care	20.00% Coinsurance after deductible
Prenatal and Postnatal Care	30.00% Coinsurance after deductible
Private-Duty Nursing	Not covered
Prosthetic Devices	20.00% Coinsurance after deductible
Radiation	20.00% Coinsurance after deductible
Reconstructive Surgery	20.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy	$35.00
Rehabilitative Speech Therapy	$35.00
Routine Dental Services (Adult)	Not covered
Routine Eye Exam (Adult)	Not covered
Routine Eye Exam for Children	20.00% Coinsurance after deductible
Routine Foot Care	20.00% Coinsurance after deductible
Skilled Nursing Facility	20.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	30.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	$15.00
Transplant	20.00% Coinsurance after deductible
Transplant Donor Coverage	20.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders	20.00% Coinsurance after deductible
Weight Loss Programs	Not covered
Well Baby Visits and Care	See plan details
X-rays and Diagnostic Imaging	$20.00