PLANS | CSR VARIATION TYPE | DOCUMENTS | DRUG COSTS |
---|---|---|---|
Silver | |||
Sendero IdealCare Silver 100 | Off Exchange | English | Lookup Cost |
Sendero IdealCare Silver 101 | On Exchange | English | Lookup Cost |
Sendero IdealCare Silver 102 | AI/AN Zero Cost Sharing | English | Lookup Cost |
Sendero IdealCare Silver 103 | AI/AN Limited Cost Sharing | English | Lookup Cost |
Sendero IdealCare Silver 73 | 73% AV | English | Lookup Cost |
Sendero IdealCare Silver 87 | 87% AV | English | Lookup Cost |
Sendero IdealCare Silver 94 | 94% AV | English | Lookup Cost |
Gold | |||
Sendero IdealCare Gold 200 | Off Exchange | English | Lookup Cost |
Sendero IdealCare Gold 201 | On Exchange | English | Lookup Cost |
Sendero IdealCare Gold 202 | AI/AN Zero Cost Sharing | English | Lookup Cost |
Sendero IdealCare Gold 203 | AI/AN Limited Cost Sharing | English | Lookup Cost |
Bronze | |||
Sendero IdealCare Bronze 300 | Off Exchange | English | Lookup Cost |
Sendero IdealCare Bronze 301 | On Exchange | English | Lookup Cost |
Sendero IdealCare Bronze 302 | AI/AN Zero Cost Sharing | English | Lookup Cost |
Sendero IdealCare Bronze 303 | AI/AN Limited Cost Sharing | English | Lookup Cost |
Silver Direct | |||
Sendero IdealCare Silver Direct 500 | Off Exchange | English | Lookup Cost |
Platinum | |||
Sendero IdealCare Platinum 600 | Off Exchange | English • Spanish | Lookup Cost |
Bronze High Deductible | |||
Sendero IdealCare Bronze High Deductible 700 | Off Exchange | English | Lookup Cost |
Sendero IdealCare Bronze High Deductible 701 | On Exchange | English | Lookup Cost |
Sendero IdealCare Bronze High Deductible 702 | AI/AN Zero Cost Sharing | English | Lookup Cost |
Sendero IdealCare Bronze High Deductible 703 | AI/AN Limited Cost Sharing | English | Lookup Cost |
Expanded Bronze | |||
Sendero IdealCare Bronze 800 | Off Exchange | English | Lookup Cost |
Sendero IdealCare Bronze 801 | On Exchange | English | Lookup Cost |
Sendero IdealCare Bronze 802 | AI/AN Zero Cost Sharing | English | Lookup Cost |
Sendero IdealCare Bronze 803 | AI/AN Limited Cost Sharing | English | Lookup Cost |
Silver – Standardized Plans | |||
Sendero IdealCare Silver 1700 | Off Exchange | English | Lookup Cost |
Sendero IdealCare Silver 1701 | On Exchange | English | Lookup Cost |
Sendero IdealCare Silver 1702 | AI/AN Zero Cost Sharing | English | Lookup Cost |
Sendero IdealCare Silver 1703 | AI/AN Limited Cost Sharing | English | Lookup Cost |
Sendero IdealCare Silver 1773 | 73% AV | English | Lookup Cost |
Sendero IdealCare Silver 1787 | 87% AV | English | Lookup Cost |
Sendero IdealCare Silver 1794 | 94% AV | English | Lookup Cost |
Gold – Standardized Plans | |||
Sendero IdealCare Gold 1800 | Off Exchange | English | Lookup Cost |
Sendero IdealCare Gold 1801 | On Exchange | English | Lookup Cost |
Sendero IdealCare Gold 1802 | AI/AN Zero Cost Sharing | English | Lookup Cost |
Sendero IdealCare Gold 1803 | AI/AN Limited Cost Sharing | English | Lookup Cost |
Bronze – Standardized Plans | |||
Sendero IdealCare Bronze 1900 | Off Exchange | English | Lookup Cost |
Sendero IdealCare Bronze 1901 | On Exchange | English | Lookup Cost |
Sendero IdealCare Bronze 1902 | AI/AN Zero Cost Sharing | English | Lookup Cost |
Sendero IdealCare Bronze 1903 | AI/AN Limited Cost Sharing | English | Lookup Cost |
Expanded Bronze – Standardized Plans | #colspan# | ||
Sendero IdealCare Bronze 2000 | Off Exchange | English | Lookup Cost |
Sendero IdealCare Bronze 2001 | On Exchange | English | Lookup Cost |
Sendero IdealCare Bronze 2002 | AI/AN Zero Cost Sharing | English | Lookup Cost |
Sendero IdealCare Bronze 2003 | AI/AN Limited Cost Sharing | English | Lookup Cost |
PLANS | CSR VARIATION TYPE | Medical-Surgical and Behavioral Health Substance Abuse Disorder Schedule of Coverage | Pharmacy Benefits Schedule of Coverage |
---|---|---|---|
Silver | |||
Sendero IdealCare Silver 100 | Off Exchange | English | English |
Sendero IdealCare Silver 101 | On Exchange | English | English |
Sendero IdealCare Silver 102 | AI/AN Zero Cost Sharing | English | English |
Sendero IdealCare Silver 103 | AI/AN Limited Cost Sharing | English | English |
Sendero IdealCare Silver 73 | 73% AV | English | English |
Sendero IdealCare Silver 87 | 87% AV | English | English |
Sendero IdealCare Silver 94 | 94% AV | English | English |
Gold | |||
Sendero IdealCare Gold 200 | Off Exchange | English | English |
Sendero IdealCare Gold 201 | On Exchange | English | English |
Sendero IdealCare Gold 202 | AI/AN Zero Cost Sharing | English | English |
Sendero IdealCare Gold 203 | AI/AN Limited Cost Sharing | English | English |
Bronze | |||
Sendero IdealCare Bronze 300 | Off Exchange | English | English |
Sendero IdealCare Bronze 301 | On Exchange | English | English |
Sendero IdealCare Bronze 302 | AI/AN Zero Cost Sharing | English | English |
Sendero IdealCare Bronze 303 | AI/AN Limited Cost Sharing | English | English |
Silver Direct | |||
Sendero IdealCare Silver Direct 500 | Off Exchange | English | English |
Platinum | |||
Sendero IdealCare Platinum 600 | Off Exchange | English | English |
Bronze High Deductible | |||
Sendero IdealCare Bronze High Deductible 700 | Off Exchange | English | English |
Sendero IdealCare Bronze High Deductible 701 | On Exchange | English | English |
Sendero IdealCare Bronze High Deductible 702 | AI/AN Zero Cost Sharing | English | English |
Sendero IdealCare Bronze High Deductible 703 | AI/AN Limited Cost Sharing | English | English |
Expanded Bronze | |||
Sendero IdealCare Bronze 800 | Off Exchange | English | English |
Sendero IdealCare Bronze 801 | On Exchange | English | English |
Sendero IdealCare Bronze 802 | AI/AN Zero Cost Sharing | English | English |
Sendero IdealCare Bronze 803 | AI/AN Limited Cost Sharing | English | English |
Silver – Standardized Plans | |||
Sendero IdealCare Silver 1700 | Off Exchange | English | English |
Sendero IdealCare Silver 1701 | On Exchange | English | English |
Sendero IdealCare Silver 1702 | AI/AN Zero Cost Sharing | English | English |
Sendero IdealCare Silver 1703 | AI/AN Limited Cost Sharing | English | English |
Sendero IdealCare Silver 1773 | 73% AV | English | English |
Sendero IdealCare Silver 1787 | 87% AV | English | English |
Sendero IdealCare Silver 1794 | 94% AV | English | English |
Gold – Standardized Plans | |||
Sendero IdealCare Gold 1800 | Off Exchange | English | English |
Sendero IdealCare Gold 1801 | On Exchange | English | English |
Sendero IdealCare Gold 1802 | AI/AN Zero Cost Sharing | English | English |
Sendero IdealCare Gold 1803 | AI/AN Limited Cost Sharing | English | English |
Bronze – Standardized Plans | |||
Sendero IdealCare Bronze 1900 | Off Exchange | English | English |
Sendero IdealCare Bronze 1901 | On Exchange | English | English |
Sendero IdealCare Bronze 1902 | AI/AN Zero Cost Sharing | English | English |
Sendero IdealCare Bronze 1903 | AI/AN Limited Cost Sharing | English | English |
Expanded Bronze – Standardized Plans | |||
Sendero IdealCare Bronze 2000 | Off Exchange | English | English |
Sendero IdealCare Bronze 2001 | On Exchange | English | English |
Sendero IdealCare Bronze 2002 | AI/AN Zero Cost Sharing | English | English |
Sendero IdealCare Bronze 2003 | AI/AN Limited Cost Sharing | English | English |
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