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2023 Plans and Benefits

PLANSCSR VARIATION TYPEDOCUMENTSDRUG COSTS
Silver
Sendero IdealCare Silver 100Off ExchangeEnglishLookup Cost
Sendero IdealCare Silver 101On ExchangeEnglishLookup Cost
Sendero IdealCare Silver 102AI/AN Zero Cost SharingEnglishLookup Cost
Sendero IdealCare Silver 103AI/AN Limited Cost SharingEnglishLookup Cost
Sendero IdealCare Silver 7373% AVEnglishLookup Cost
Sendero IdealCare Silver 87 87% AV EnglishLookup Cost
Sendero IdealCare Silver 94 94% AV EnglishLookup Cost
Gold
Sendero IdealCare Gold 200Off ExchangeEnglishLookup Cost
Sendero IdealCare Gold 201On ExchangeEnglishLookup Cost
Sendero IdealCare Gold 202AI/AN Zero Cost SharingEnglishLookup Cost
Sendero IdealCare Gold 203AI/AN Limited Cost SharingEnglishLookup Cost
Bronze
Sendero IdealCare Bronze 300Off ExchangeEnglishLookup Cost
Sendero IdealCare Bronze 301On ExchangeEnglishLookup Cost
Sendero IdealCare Bronze 302AI/AN Zero Cost SharingEnglishLookup Cost
Sendero IdealCare Bronze 303AI/AN Limited Cost SharingEnglishLookup Cost
Silver Direct
Sendero IdealCare Silver Direct 500Off ExchangeEnglishLookup Cost
Platinum
Sendero IdealCare Platinum 600Off ExchangeEnglish • SpanishLookup Cost
Bronze High Deductible
Sendero IdealCare Bronze High Deductible 700Off ExchangeEnglishLookup Cost
Sendero IdealCare Bronze High Deductible 701On ExchangeEnglishLookup Cost
Sendero IdealCare Bronze High Deductible 702AI/AN Zero Cost SharingEnglishLookup Cost
Sendero IdealCare Bronze High Deductible 703AI/AN Limited Cost SharingEnglishLookup Cost
Expanded Bronze
Sendero IdealCare Bronze 800Off ExchangeEnglishLookup Cost
Sendero IdealCare Bronze 801On ExchangeEnglishLookup Cost
Sendero IdealCare Bronze 802AI/AN Zero Cost SharingEnglishLookup Cost
Sendero IdealCare Bronze 803AI/AN Limited Cost SharingEnglishLookup Cost
Silver – Standardized Plans
Sendero IdealCare Silver 1700Off ExchangeEnglishLookup Cost
Sendero IdealCare Silver 1701On ExchangeEnglishLookup Cost
Sendero IdealCare Silver 1702AI/AN Zero Cost SharingEnglishLookup Cost
Sendero IdealCare Silver 1703AI/AN Limited Cost SharingEnglishLookup Cost
Sendero IdealCare Silver 177373% AVEnglishLookup Cost
Sendero IdealCare Silver 178787% AVEnglishLookup Cost
Sendero IdealCare Silver 179494% AVEnglishLookup Cost
Gold – Standardized Plans
Sendero IdealCare Gold 1800Off ExchangeEnglishLookup Cost
Sendero IdealCare Gold 1801On ExchangeEnglishLookup Cost
Sendero IdealCare Gold 1802AI/AN Zero Cost SharingEnglishLookup Cost
Sendero IdealCare Gold 1803AI/AN Limited Cost SharingEnglishLookup Cost
Bronze – Standardized Plans
Sendero IdealCare Bronze 1900Off ExchangeEnglishLookup Cost
Sendero IdealCare Bronze 1901On ExchangeEnglishLookup Cost
Sendero IdealCare Bronze 1902AI/AN Zero Cost SharingEnglishLookup Cost
Sendero IdealCare Bronze 1903AI/AN Limited Cost SharingEnglishLookup Cost
Expanded Bronze – Standardized Plans#colspan#
Sendero IdealCare Bronze 2000Off ExchangeEnglishLookup Cost
Sendero IdealCare Bronze 2001On ExchangeEnglishLookup Cost
Sendero IdealCare Bronze 2002AI/AN Zero Cost SharingEnglishLookup Cost
Sendero IdealCare Bronze 2003AI/AN Limited Cost SharingEnglishLookup Cost

PLANSDOCUMENTS
IdealCare Bronze, Silver and Gold PlansEnglish
IdealCare Platinum PlanEnglish

PLANSCSR VARIATION TYPEMedical-Surgical and Behavioral Health
Substance Abuse Disorder
Schedule of Coverage
Pharmacy Benefits
Schedule of Coverage
Silver
Sendero IdealCare Silver 100Off ExchangeEnglishEnglish
Sendero IdealCare Silver 101On ExchangeEnglishEnglish
Sendero IdealCare Silver 102AI/AN Zero Cost SharingEnglishEnglish
Sendero IdealCare Silver 103AI/AN Limited Cost SharingEnglishEnglish
Sendero IdealCare Silver 7373% AVEnglishEnglish
Sendero IdealCare Silver 8787% AVEnglishEnglish
Sendero IdealCare Silver 9494% AVEnglishEnglish
Gold
Sendero IdealCare Gold 200Off ExchangeEnglishEnglish
Sendero IdealCare Gold 201On ExchangeEnglishEnglish
Sendero IdealCare Gold 202AI/AN Zero Cost SharingEnglishEnglish
Sendero IdealCare Gold 203AI/AN Limited Cost SharingEnglishEnglish
Bronze
Sendero IdealCare Bronze 300Off ExchangeEnglishEnglish
Sendero IdealCare Bronze 301On ExchangeEnglishEnglish
Sendero IdealCare Bronze 302AI/AN Zero Cost SharingEnglishEnglish
Sendero IdealCare Bronze 303AI/AN Limited Cost SharingEnglishEnglish
Silver Direct
Sendero IdealCare Silver Direct 500Off ExchangeEnglishEnglish
Platinum
Sendero IdealCare Platinum 600Off ExchangeEnglishEnglish
Bronze High Deductible
Sendero IdealCare Bronze High Deductible 700Off ExchangeEnglishEnglish
Sendero IdealCare Bronze High Deductible 701On ExchangeEnglishEnglish
Sendero IdealCare Bronze High Deductible 702AI/AN Zero Cost SharingEnglishEnglish
Sendero IdealCare Bronze High Deductible 703AI/AN Limited Cost SharingEnglishEnglish
Expanded Bronze
Sendero IdealCare Bronze 800Off ExchangeEnglishEnglish
Sendero IdealCare Bronze 801 On ExchangeEnglishEnglish
Sendero IdealCare Bronze 802AI/AN Zero Cost SharingEnglishEnglish
Sendero IdealCare Bronze 803AI/AN Limited Cost SharingEnglishEnglish
Silver – Standardized Plans
Sendero IdealCare Silver 1700Off ExchangeEnglishEnglish
Sendero IdealCare Silver 1701On ExchangeEnglishEnglish
Sendero IdealCare Silver 1702AI/AN Zero Cost SharingEnglishEnglish
Sendero IdealCare Silver 1703AI/AN Limited Cost SharingEnglishEnglish
Sendero IdealCare Silver 177373% AVEnglishEnglish
Sendero IdealCare Silver 178787% AVEnglishEnglish
Sendero IdealCare Silver 179494% AVEnglishEnglish
Gold – Standardized Plans
Sendero IdealCare Gold 1800Off ExchangeEnglishEnglish
Sendero IdealCare Gold 1801On ExchangeEnglishEnglish
Sendero IdealCare Gold 1802AI/AN Zero Cost SharingEnglishEnglish
Sendero IdealCare Gold 1803AI/AN Limited Cost SharingEnglishEnglish
Bronze – Standardized Plans
Sendero IdealCare Bronze 1900Off ExchangeEnglishEnglish
Sendero IdealCare Bronze 1901On ExchangeEnglishEnglish
Sendero IdealCare Bronze 1902AI/AN Zero Cost SharingEnglishEnglish
Sendero IdealCare Bronze 1903AI/AN Limited Cost SharingEnglishEnglish
Expanded Bronze – Standardized Plans
Sendero IdealCare Bronze 2000Off ExchangeEnglishEnglish
Sendero IdealCare Bronze 2001On ExchangeEnglishEnglish
Sendero IdealCare Bronze 2002AI/AN Zero Cost SharingEnglishEnglish
Sendero IdealCare Bronze 2003AI/AN Limited Cost SharingEnglishEnglish
DESCRIPTIONDOCUMENTS
Member HandbookEnglish 
Quick Reference GuideEnglish • Spanish
FormularyEnglish
Plan BrochureEnglish

*This amount was announced in June 2022.