2025 Sonder Chronic Special Needs Plans (C-SNPs)

Benefits you want. Plans you need.

We know what you need is unique to you. Sonder Health Plans offers four plans to fit your health and lifestyle.

Explore our plans to find the right fit for you! You can see more details about each plan on the Summary of Benefits.

$0 Premiums on All Plans

$0 Copay on Your PCP Visits

$0 Copay on Specialist Visits

when you become a Sonder member

24/7 Nurse Hotline Access

Vision, Hearing and Dental Benefits in Every Plan

$0 Premiums on All Plans

$0 Copay on Your PCP Visits

$0 Copay on Specialist Visits

when you become a Sonder Diabetes Wellness member

24/7 Nurse Hotline Access

Vision, Hearing and Dental Benefits in Every Plan

Sonder Chronic Condition Plan Details

Click on icons below to view and compare plan details.

C-SNP - H1748003
Sonder
Diabetes Wellness

(HMO C-SNP) – H1748003

Sonder Diabetes Wellness

For Diabetes Mellitus

Plan Highlights

Unless indicated, benefits are per service or per year.
*Only for members who have qualifying chronic medical conditions.
Please see Summary of Benefits for full list of conditions.

Deductible & Max Out-of-Pocket
Deductible$0
MOOP$3,950
Part A
Inpatient Acute$350 days 1-5; $0 days 6-90
Inpatient Psych$350 days 1-5; $0 days 6-90
SNF$0 days 1-20; $184 days 21-100
Home Health$10
Part B
Cardiac & Pulmonary Rehab$0 (including Intensive Cardiac Rehab and SET for PAD)
PT/OT/ST$40.00
ER$120.00
Urgent Care$25.00
PCP$0.00
Chiro$20.00
Specialist$0.00
Mental Health$40.00
Podiatry$0.00
Other Health Care Professional$35.00
Psychiatry$40.00
Outpatient Lab$0.00
X-Rays$0.00
Diagnostic Radiology$0 for diagnostic imaging (e.g., sonagrams, ultrasounds, Dexa) – $275 for advanced imaging (e.g., CT, MRI, PET)
Therapeutic Radiology20.0%
Outpatient Hospital Services$280.00
Outpatient Hospital Observation$350.00
ASC$180.00
Outpatient Substance Abuse$75.00
Ambulance – Ground$225.00
Ambulance – Air$450.00
DME20.0%
Prosthetics20.0%
Medical Supplies20.0%
Diabetic Supplies$0.00
Therapeutic Shoes or Inserts$0.00
Renal Dialysis$0.00
Chemotherapy Drugs20.0%
Part B Drugs20.0%
Part D
Deductible$0
ICL$2,000
Tier 1 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Retail 30/Retail 90/Mail$15/$45/$0
Tier 3 Retail 30/Retail 90/Mail$47/$141/$141
Tier 4 Retail 30/Retail 90/Mail$100/$300/$300
Tier 5 Retail 30/Retail 90/Mail33%/33%/33%
Tier 6 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Insulin$0/$0/$0
Tier 3 Insulin$0/$0/$0
Tier 4 Insulin$0/$0/$0
Supplemental Benefits
Worldwide EmergencyUp to $10,000 Maximum
Non-Emergency Transportation12 one-way trips
OTC$150 per quarter
Meals2 meals a day for 14 days provided immediately following each surgery or inpatient hospitalization. Up to 4 times per year
FitnessSilver & Fit
Nursing HotlineCovered
SSBCI
Flex Card $250 / Month to apply towards list below (amount does NOT roll over):
-Gas Card
-Home Safety/Access Modifications
-Social and Active Club Membership
-Internet / Cell Data
-Sports License (hunting/fishing)
-Pet Supplies
Members also get:
-$130 Grocery Card
-Meals: Routine – 10 per month
-50 non medical one way trips
Other (SSBCI Not required)
In Home Support – $0 4 hour per day, up to max 104 hours per year (including home safety assessment, caregiver, social support and medication reconciliation)
Personal Emergency Response System
Routine foot care $0 – 6 visit per year
Routine Chiro – $0 Copay 12 visits per year
Dental, Vision, Hearing Flex Card: $500
Platelet Rich Plasma – 6 visits / year
Dental
Dental – Preventative
Annual Max Benefit Amount: $2500 combined with Comprehensive
Exams: 1 every 6 months
Prophylaxis: 1 every 6 months
Flouride: 1 every 6 months
X-Rays: 1 every 2 years
Dental – Comprehensive
Annual Max Benefit Amount: $2500 combined with Preventative
Non-Routine Services: Unlimited
Diagnostic Services: Unlimited
Restorative Services: Unlimited
Endodontics: Unlimited
Periodontics: Unlimited
Extractions: Unlimited
Prosthodontics, Other Oral/Maxillofacial Surgery: Unlimited
Vision
Vision – Exams
Medicare Covered – $30, 1 Routine Exam / year – $0
Vision – Hardware
Annual Max Benefit Amount: $200
Contact Lenses
Eyeglasses (lenses and frames)
Hearing
Hearing – ExamsMedicare Covered – $30, 1 Routine Exam / year – $0
Hearing – Aids$699 or $999 copay per hearing aid, depending on device
HMO –H1748011
Sonder
Mind Matters

(HMO C-SNP) – H1748011

Sonder Mind Matters

Chronic Special Needs Plan for Dementia Conditions

Plan Highlights

Unless indicated, benefits are per service or per year.
*Only for members who have qualifying chronic medical conditions.
Please see Summary of Benefits for full list of conditions.

Deductible & Max Out-Of-Pocket
Deductible$0
MOOP$3,950
Part A
Inpatient Acute$350 days 1-5;$0 days 6-90
Inpatient Psych$350 days 1-5;$0 days 6-90
SNF$0 days 1-20;$184 days 21-100
Home Health$10
Part B
Cardiac & Pulmonary Rehab$0.00
PT/OT/ST$40.00
ER$120.00
Urgent Care$25.00
PCP$0.00
Chiro$20.00
Specialist$0.00
Mental Health$40.00
Podiatry$40.00
Other Health Care Professional$35.00
Psychiatry$40.00
Outpatient Lab$0.00
X-Rays$0.00
Diagnostic Radiology$0 for diagnostic imaging (e.g., sonagrams, ultrasounds, DEXA) – $275 for advanced imaging (e.g., CT, MRI, PET)
Therapeutic Radiology20%
Outpatient Hospital Services$280.00
Outpatient Hospital Observation$350.00
ASC$180.00
Outpatient Substance Abuse$75.00
Ambulance – Ground$225.00
Ambulance – Air$450.00
DME20%
Prosthetics20%
Medical Supplies20%
Diabetic Supplies20%
Therapeutic Shoes or Inserts20%
Renal Dialysis20%
Chemotherapy Drugs20%
Part B Drugs20%
Part D
Deductible$0
ICL$2,000
Tier 1 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Retail 30/Retail 90/Mail$15/$45/$0
Tier 3 Retail 30/Retail 90/Mail$47/$141/$141
Tier 4 Retail 30/Retail 90/Mail$100/$300/$300
Tier 5 Retail 30/Retail 90/Mail33%/33%/33%
Tier 6 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Insulin$15/$45/$0
Tier 3 Insulin$35/$70/$70
Tier 4 Insulin$35/$70/$70
Supplemental Benefits
Worldwide EmergencyUp to $10,000 Maximum
Non-Emergency Transportation12 one-way trips
OTC$200 per quarter
Meals2 meals a day for 14 days provided immediately following each surgery or inpatient hospitalization. Up to 4 times per year
Nursing HotlineCovered
SSBCI
Flex Card $325 / Month to apply towards list below (amount does NOT roll over):
-Adult Day Care
-Home Safety/Access Modifications
-Internet / Cell Data
-Pet Supplies
Members also get:
$100 Grocery Card
Meals: Routine – 10 per month
10 non medical one way trips
Other (SSBCI Not required)
In Home Support – $0 4 hour per day, up to max 208 hours per year (including home safety assessment, caregiver, social support and medication reconciliation)
Personal Emergency Response System
Routine foot care $0 – 6 visit per year
Routine Chiro – $0 Copay 12 visits per year
Dental, Vision, Hearing Flex Card: $200
Platelet Rich Plasma – 6 visits / year
Dental
Dental – Preventative
Annual Max Benefit Amount: $1000 combined with Comprehensive
Exams: 1 every 6 months
Prophylaxis: 1 every 6 months
Flouride: 1 every 6 months
X-Rays: 1 every 2 years
Dental – Comprehensive
Annual Max Benefit Amount: $1000 combined with Preventative
Non-Routine Services: Unlimited
Diagnostic Services: Unlimited
Restorative Services: Unlimited
Endodontics: Unlimited
Periodontics: Unlimited
Extractions: Unlimited
Vision
Vision – Exams:
Medicare Covered – $30, 1 Routine Exam / year – $0
Vision – Hardware:
Annual Max Benefit Amount: $200
Contact Lenses
Eyeglasses (lenses and frames)
Hearing
Hearing – ExamsMedicare Covered – $30, 1 Routine Exam / year – $0
Hearing – Aids$699 or $999 copay per hearing aid, depeding on device
C-SNP – H1748012
Sonder
Renal Health

(HMO C-SNP) – H1748012

Sonder Renal Health (ESRD)

Chronic Special Needs Plan for ESRD Conditions

Plan Highlights

Unless indicated, benefits are per service or per year.
*Only for members who have qualifying chronic medical conditions.
Please see Summary of Benefits for full list of conditions.

Deductible & Max Out-Of-Pocket
Deductible$0
MOOP$3,950
Part A
Inpatient Acute$350 days 1-5;$0 days 6-90
Inpatient Psych$350 days 1-5;$0 days 6-90
SNF$0 days 1-20;$184 days 21-100
Home Health$10
Part B
Cardiac & Pulmonary Rehab$0 (including Intensive Cardiac Rehab and SET for PAD)
PT/OT/ST$40.00
ER$120.00
Urgent Care$25.00
PCP$0.00
Chiro$20.00
Specialist$0.00
Mental Health$40.00
Podiatry$0.00
Other Health Care Professional$35.00
Psychiatry$40.00
Outpatient Lab$0.00
X-Rays$0.00
Diagnostic Radiology$0 for diagnostic imaging (e.g., sonagrams, ultrasounds, DEXA) – $275 for advanced imaging (e.g., CT, MRI, PET)
Therapeutic Radiology20%
Outpatient Hospital Services$280.00
Outpatient Hospital Observation$350.00
ASC$180.00
Outpatient Substance Abuse$75.00
Ambulance – Ground$225.00
Ambulance – Air$450.00
DME20%
Prosthetics20%
Medical Supplies20%
Diabetic Supplies$0.00
Therapeutic Shoes or Inserts$0.00
Renal Dialysis0%
Chemotherapy Drugs20%
Part B Drugs20%
Part D
Deductible$0
ICL$2,000
Tier 1 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Retail 30/Retail 90/Mail$15/$45/$0
Tier 3 Retail 30/Retail 90/Mail$47/$141/$141
Tier 4 Retail 30/Retail 90/Mail$100/$300/$300
Tier 5 Retail 30/Retail 90/Mail33%/33%/33%
Tier 6 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Insulin$0/$0/$0
Tier 3 Insulin$0/$0/$0
Tier 4 Insulin$0/$0/$0
Supplemental Benefits
Worldwide EmergencyUp to $10,000 Maximum
Non-Emergency TransportationUnlimited one-way trips
OTC$200 per quarter
Meals2 meals a day for 14 days provided immediately following each surgery or inpatient hospitalization. Up to 4 times per year
FitnessSilver & Fit
Nursing HotlineCovered
SSBCI
Flex Card $240 / Month to apply towards list below (amount does NOT roll over):
-Gas Card
-Home Safety/Access Modifications
-Social and Active Club Membership
-Internet / Cell Data
-Pet Supplies
Members also get:
$200 Grocery Card
Meals: Routine – 10 per month
50 non medical one way trips
Other (SSBCI Not required)
In Home Support – $0 4 hour per day, up to max 208 hours per year (including home safety assessment, caregiver, social support and medication reconciliation)
Personal Emergency Response System
Routine foot care $0 – 6 visit per year
Routine Chiro – $0 Copay 12 visits per year
Dental, Vision, Hearing Flex Card: $500
Dental
Dental – Preventative
Annual Max Benefit Amount: $2500 combined with Comprehensive
Exams: 1 every 6 months
Prophylaxis: 1 every 6 months
Flouride: 1 every 6 months
X-Rays: 1 every 2 years
Dental – Comprehensive
Annual Max Benefit Amount: $2500 combined with Preventative
Non-Routine Services: Unlimited
Diagnostic Services: Unlimited
Restorative Services: Unlimited
Endodontics: Unlimited
Periodontics: Unlimited
Extractions: Unlimited
Prosthodontics, Other Oral/Maxillofacial Surgery: Unlimited
Vision
Vision – Exams:
Medicare Covered – $30, 1 Routine Exam / year – $0
Vision – Hardware:
Annual Max Benefit Amount: $200
Contact Lenses
Eyeglasses (lenses and frames)
Hearing
Hearing – ExamsMedicare Covered – $30, 1 Routine Exam / year – $0
Hearing – Aids$699 or $999 copay per hearing aid, depending on device
HMO – H1748013
Sonder
Breathe Well

(HMO C-SNP) – H1748013

Sonder Breathe Well

Chronic Special Needs Plan for COPD Conditions

Plan Highlights

Unless indicated, benefits are per service or per year.
*Only for members who have qualifying chronic medical conditions.
Please see Summary of Benefits for full list of conditions.

Deductible & Max Out-Of-Pocket
Deductible$0
MOOP$3,950
Part A
Inpatient Acute$350 days 1-5;$0 days 6-90
Inpatient Psych$350 days 1-5;$0 days 6-90
SNF$0 days 1-20;$184 days 21-100
Home Health$10
Part B
Cardiac & Pulmonary Rehab$20 (including Intensive Cardiac Rehab and SET for PAD), $0 for Pulmonary rehab
PT/OT/ST$40.00
ER$120.00
Urgent Care$25.00
PCP$0.00
Chiro$20.00
Specialist$0.00
Mental Health$40.00
Podiatry$40.00
Other Health Care Professional$35.00
Psychiatry$40.00
Outpatient Lab$0.00
X-Rays$0.00
Diagnostic Radiology$0 for diagnostic imaging (e.g., sonagrams, ultrasounds, DEXA) – $275 for advanced imaging (e.g., CT, MRI, PET)
Therapeutic Radiology20%
Outpatient Hospital Services$280.00
Outpatient Hospital Observation$350.00
ASC$180.00
Outpatient Substance Abuse$75.00
Ambulance – Ground$225.00
Ambulance – Air$450.00
DME20%, oxygen at 0%
Prosthetics20%
Medical Supplies20%
Diabetic Supplies20%
Therapeutic Shoes or Inserts20%
Renal Dialysis20%
Chemotherapy Drugs20%
Part B Drugs20%
Part D
Deductible$0
ICL$2,000
Tier 1 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Retail 30/Retail 90/Mail$15/$45/$0
Tier 3 Retail 30/Retail 90/Mail$47/$141/$141
Tier 4 Retail 30/Retail 90/Mail$100/$300/$300
Tier 5 Retail 30/Retail 90/Mail33%/33%/33%
Tier 6 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Insulin$15/$45/$0
Tier 3 Insulin$35/$70/$70
Tier 4 Insulin$35/$70/$70
Supplemental Benefits
Worldwide EmergencyUp to $10,000 Maximum
Non-Emergency Transportation50 one-way trips
OTC$200 per quarter
Meals2 meals a day for 14 days provided immediately following each surgery or inpatient hospitalization. Up to 4 times per year
FitnessSilver & Fit
Nursing HotlineCovered
SSBCI
Flex Card $260 / Month to apply towards list below (amount does NOT roll over):
-Gas Card
-Home Safety/Access Modifications
-Social and Active Club Memberships
-Internet / Cell Data
-Pet Supplies
Members also get:
$200 Grocery Card
Meals: Routine – 10 per month
50 non medical one way trips
Other (SSBCI Not required)
In Home Support – $0 4 hour per day, up to max 104 hours per year (including home safety assessment, caregiver, social support and medication reconciliation)
12 visit Comprehensive Smoking Cessation Program
Personal Emergency Response System
Routine foot care $0 – 6 visit per year
Routine Chiro – $0 Copay 12 visits per year
Dental, Vision, Hearing Flex Card: $500
Platelet Rich Plasma – 6 visits / year
Dental
Dental – Preventative
Annual Max Benefit Amount: $2500 combined with Comprehensive
Exams: 1 every 6 months
Prophylaxis: 1 every 6 months
Flouride: 1 every 6 months
X-Rays: 1 every 2 years
Dental – Comprehensive
Annual Max Benefit Amount: $2500 combined with Preventative
Non-Routine Services: Unlimited
Diagnostic Services: Unlimited
Restorative Services: Unlimited
Endodontics: Unlimited
Periodontics: Unlimited
Extractions: Unlimited
Prosthodontics, Other Oral/Maxillofacial Surgery: Unlimited
Vision
Vision – Exams:
Medicare Covered – $30, 1 Routine Exam / year – $0
Vision – Hardware:
Annual Max Benefit Amount: $200
Contact Lenses
Eyeglasses (lenses and frames)
Hearing
Hearing – ExamsMedicare Covered – $30, 1 Routine Exam / year – $0
Hearing – Aids$699 or $999 copay per hearing aid, depeding on device
C-SNP - H1748004
Sonder
Heart Healthy

(HMO C-SNP) – H1748004

Sonder Heart Healthy

For Cardiovascular Disorders

Plan Highlights

Unless indicated, benefits are per service or per year.
*Only for members who have qualifying chronic medical conditions.
Please see Summary of Benefits for full list of conditions.

Deductible & Max Out-Of-Pocket
Deductible$0
MOOP$3,950
Part A
Inpatient Acute$350 days 1-5;$0 days 6-90
Inpatient Psych$350 days 1-5;$0 days 6-90
SNF$0 days 1-20;$184 days 21-100
Home Health$10
Part B
Cardiac & Pulmonary Rehab$0 (including Intensive Cardiac Rehab and SET for PAD)
PT/OT/ST$40.00
ER$120.00
Urgent Care$25.00
PCP$0.00
Chiro$20.00
Specialist$0.00
Mental Health$40.00
Podiatry$40.00
Other Health Care Professional$35.00
Psychiatry$40.00
Outpatient Lab$0.00
X-Rays$0.00
Diagnostic Radiology$0 for diagnostic imaging (e.g., sonagrams, ultrasounds, DEXA) – $275 for advanced imaging (e.g., CT, MRI, PET)
Therapeutic Radiology20%
Outpatient Hospital Services$280.00
Outpatient Hospital Observation$350.00
ASC$180.00
Outpatient Substance Abuse$75.00
Ambulance – Ground$225.00
Ambulance – Air$450.00
DME20%
Prosthetics20%
Medical Supplies20%
Diabetic Supplies$0.00
Therapeutic Shoes or Inserts$0.00
Renal Dialysis20%
Chemotherapy Drugs20%
Part B Drugs20%
Part D
Deductible$0
ICL$2,000
Tier 1 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Retail 30/Retail 90/Mail$15/$45/$0
Tier 3 Retail 30/Retail 90/Mail$47/$141/$141
Tier 4 Retail 30/Retail 90/Mail$100/$300/$300
Tier 5 Retail 30/Retail 90/Mail33%/33%/33%
Tier 6 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Insulin$15/$45/$0
Tier 3 Insulin$35/$70/$70
Tier 4 Insulin$35/$70/$70
Supplemental Benefits
Worldwide EmergencyUp to $10,000 Maximum
Non-Emergency Transportation12 one-way trips
OTC$150 per quarter
Meals2 meals a day for 14 days provided immediately following each surgery or inpatient hospitalization. Up to 4 times per year
FitnessSilver & Fit
Nursing HotlineCovered
SSBCI
Flex Card $250 / Month to apply towards list below (amount does NOT roll over):
-Gas Card
-Home Safety/Access Modifications
-Social and Active Club Membership
-Internet / Cell Data
-Sports License (hunting/fishing)
-Pet Supplies*
Members also get:
-$130 Grocery Card
-Meals: Routine – 10 per month
-50 non medical one way trips
Other (SSBCI Not required)
In Home Support – $0 4 hour per day, up to max 104 hours per year (including home safety assessment, caregiver, social support and medication reconciliation)
Personal Emergency Response System
Routine foot care $0 – 6 visit per year
Routine Chiro – $0 Copay 12 visits per year
Dental, Vision, Hearing Flex Card: $500
Platelet Rich Plasma – 6 visits / year
Dental
Dental – Preventative
Annual Max Benefit Amount: $2500 combined with Comprehensive
Exams: 1 every 6 months
Prophylaxis: 1 every 6 months
Flouride: 1 every 6 months
X-Rays: 1 every 2 years
Dental – Comprehensive
Annual Max Benefit Amount: $2500 combined with Preventative
Non-Routine Services: Unlimited
Diagnostic Services: Unlimited
Restorative Services: Unlimited
Endodontics: Unlimited
Periodontics: Unlimited
Extractions: Unlimited
Prosthodontics, Other Oral/Maxillofacial Surgery: Unlimited
Vision
Vision – Exams:
Medicare Covered – $30, 1 Routine Exam / year – $0
Vision – Hardware:
Annual Max Benefit Amount: $200
Contact Lenses
Eyeglasses (lenses and frames)
Hearing
Hearing – ExamsMedicare Covered – $30, 1 Routine Exam / year – $0
Hearing – Aids$699 or $999 copay per hearing aid, depeding on device

(HMO C-SNP) – H1748003

Sonder Diabetes Wellness

For Diabetes Mellitus

Plan Highlights

Unless indicated, benefits are per service or per year.
*Only for members who have qualifying chronic medical conditions.
Please see Summary of Benefits for full list of conditions.

Deductible & Max Out-of-Pocket
Deductible$0
MOOP$3,950
Part A
Inpatient Acute$350 days 1-5; $0 days 6-90
Inpatient Psych$350 days 1-5; $0 days 6-90
SNF$0 days 1-20; $184 days 21-100
Home Health$10
Part B
Cardiac & Pulmonary Rehab$0 (including Intensive Cardiac Rehab and SET for PAD)
PT/OT/ST$40.00
ER$120.00
Urgent Care$25.00
PCP$0.00
Chiro$20.00
Specialist$0.00
Mental Health$40.00
Podiatry$0.00
Other Health Care Professional$35.00
Psychiatry$40.00
Outpatient Lab$0.00
X-Rays$0.00
Diagnostic Radiology$0 for diagnostic imaging (e.g., sonagrams, ultrasounds, Dexa) – $275 for advanced imaging (e.g., CT, MRI, PET)
Therapeutic Radiology20.0%
Outpatient Hospital Services$280.00
Outpatient Hospital Observation$350.00
ASC$180.00
Outpatient Substance Abuse$75.00
Ambulance – Ground$225.00
Ambulance – Air$450.00
DME20.0%
Prosthetics20.0%
Medical Supplies20.0%
Diabetic Supplies$0.00
Therapeutic Shoes or Inserts$0.00
Renal Dialysis$0.00
Chemotherapy Drugs20.0%
Part B Drugs20.0%
Part D
Deductible$0
ICL$2,000
Tier 1 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Retail 30/Retail 90/Mail$15/$45/$0
Tier 3 Retail 30/Retail 90/Mail$47/$141/$141
Tier 4 Retail 30/Retail 90/Mail$100/$300/$300
Tier 5 Retail 30/Retail 90/Mail33%/33%/33%
Tier 6 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Insulin$0/$0/$0
Tier 3 Insulin$0/$0/$0
Tier 4 Insulin$0/$0/$0
Supplemental Benefits
Worldwide EmergencyUp to $10,000 Maximum
Non-Emergency Transportation12 one-way trips
OTC$150 per quarter
Meals2 meals a day for 14 days provided immediately following each surgery or inpatient hospitalization. Up to 4 times per year
FitnessSilver & Fit
Nursing HotlineCovered
SSBCI
Flex Card $250 / Month to apply towards list below (amount does NOT roll over):
-Gas Card
-Home Safety/Access Modifications
-Social and Active Club Membership
-Internet / Cell Data
-Sports License (hunting/fishing)
-Pet Supplies
Members also get:
-$130 Grocery Card
-Meals: Routine – 10 per month
-50 non medical one way trips
Other (SSBCI Not required)
In Home Support – $0 4 hour per day, up to max 104 hours per year (including home safety assessment, caregiver, social support and medication reconciliation)
Personal Emergency Response System
Routine foot care $0 – 6 visit per year
Routine Chiro – $0 Copay 12 visits per year
Dental, Vision, Hearing Flex Card: $500
Platelet Rich Plasma – 6 visits / year
Dental
Dental – Preventative
Annual Max Benefit Amount: $2500 combined with Comprehensive
Exams: 1 every 6 months
Prophylaxis: 1 every 6 months
Flouride: 1 every 6 months
X-Rays: 1 every 2 years
Dental – Comprehensive
Annual Max Benefit Amount: $2500 combined with Preventative
Non-Routine Services: Unlimited
Diagnostic Services: Unlimited
Restorative Services: Unlimited
Endodontics: Unlimited
Periodontics: Unlimited
Extractions: Unlimited
Prosthodontics, Other Oral/Maxillofacial Surgery: Unlimited
Vision
Vision – Exams
Medicare Covered – $30, 1 Routine Exam / year – $0
Vision – Hardware
Annual Max Benefit Amount: $200
Contact Lenses
Eyeglasses (lenses and frames)
Hearing
Hearing – ExamsMedicare Covered – $30, 1 Routine Exam / year – $0
Hearing – Aids$699 or $999 copay per hearing aid, depending on device

(HMO C-SNP) – H1748011

Sonder Mind Matters

Chronic Special Needs Plan for Dementia Conditions

Plan Highlights

Unless indicated, benefits are per service or per year.
*Only for members who have qualifying chronic medical conditions.
Please see Summary of Benefits for full list of conditions.

Deductible & Max Out-Of-Pocket
Deductible$0
MOOP$3,950
Part A
Inpatient Acute$350 days 1-5;$0 days 6-90
Inpatient Psych$350 days 1-5;$0 days 6-90
SNF$0 days 1-20;$184 days 21-100
Home Health$10
Part B
Cardiac & Pulmonary Rehab$0.00
PT/OT/ST$40.00
ER$120.00
Urgent Care$25.00
PCP$0.00
Chiro$20.00
Specialist$0.00
Mental Health$40.00
Podiatry$40.00
Other Health Care Professional$35.00
Psychiatry$40.00
Outpatient Lab$0.00
X-Rays$0.00
Diagnostic Radiology$0 for diagnostic imaging (e.g., sonagrams, ultrasounds, DEXA) – $275 for advanced imaging (e.g., CT, MRI, PET)
Therapeutic Radiology20%
Outpatient Hospital Services$280.00
Outpatient Hospital Observation$350.00
ASC$180.00
Outpatient Substance Abuse$75.00
Ambulance – Ground$225.00
Ambulance – Air$450.00
DME20%
Prosthetics20%
Medical Supplies20%
Diabetic Supplies20%
Therapeutic Shoes or Inserts20%
Renal Dialysis20%
Chemotherapy Drugs20%
Part B Drugs20%
Part D
Deductible$0
ICL$2,000
Tier 1 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Retail 30/Retail 90/Mail$15/$45/$0
Tier 3 Retail 30/Retail 90/Mail$47/$141/$141
Tier 4 Retail 30/Retail 90/Mail$100/$300/$300
Tier 5 Retail 30/Retail 90/Mail33%/33%/33%
Tier 6 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Insulin$15/$45/$0
Tier 3 Insulin$35/$70/$70
Tier 4 Insulin$35/$70/$70
Supplemental Benefits
Worldwide EmergencyUp to $10,000 Maximum
Non-Emergency Transportation12 one-way trips
OTC$200 per quarter
Meals2 meals a day for 14 days provided immediately following each surgery or inpatient hospitalization. Up to 4 times per year
Nursing HotlineCovered
SSBCI
Flex Card $325 / Month to apply towards list below (amount does NOT roll over):
-Adult Day Care
-Home Safety/Access Modifications
-Internet / Cell Data
-Pet Supplies
Members also get:
$100 Grocery Card
Meals: Routine – 10 per month
10 non medical one way trips
Other (SSBCI Not required)
In Home Support – $0 4 hour per day, up to max 208 hours per year (including home safety assessment, caregiver, social support and medication reconciliation)
Personal Emergency Response System
Routine foot care $0 – 6 visit per year
Routine Chiro – $0 Copay 12 visits per year
Dental, Vision, Hearing Flex Card: $200
Platelet Rich Plasma – 6 visits / year
Dental
Dental – Preventative
Annual Max Benefit Amount: $1000 combined with Comprehensive
Exams: 1 every 6 months
Prophylaxis: 1 every 6 months
Flouride: 1 every 6 months
X-Rays: 1 every 2 years
Dental – Comprehensive
Annual Max Benefit Amount: $1000 combined with Preventative
Non-Routine Services: Unlimited
Diagnostic Services: Unlimited
Restorative Services: Unlimited
Endodontics: Unlimited
Periodontics: Unlimited
Extractions: Unlimited
Vision
Vision – Exams:
Medicare Covered – $30, 1 Routine Exam / year – $0
Vision – Hardware:
Annual Max Benefit Amount: $200
Contact Lenses
Eyeglasses (lenses and frames)
Hearing
Hearing – ExamsMedicare Covered – $30, 1 Routine Exam / year – $0
Hearing – Aids$699 or $999 copay per hearing aid, depeding on device

(HMO C-SNP) – H1748012

Sonder Renal Health (ESRD)

Chronic Special Needs Plan for ESRD Conditions

Plan Highlights

Unless indicated, benefits are per service or per year.
*Only for members who have qualifying chronic medical conditions.
Please see Summary of Benefits for full list of conditions.

Deductible & Max Out-Of-Pocket
Deductible$0
MOOP$3,950
Part A
Inpatient Acute$350 days 1-5;$0 days 6-90
Inpatient Psych$350 days 1-5;$0 days 6-90
SNF$0 days 1-20;$184 days 21-100
Home Health$10
Part B
Cardiac & Pulmonary Rehab$0 (including Intensive Cardiac Rehab and SET for PAD)
PT/OT/ST$40.00
ER$120.00
Urgent Care$25.00
PCP$0.00
Chiro$20.00
Specialist$0.00
Mental Health$40.00
Podiatry$0.00
Other Health Care Professional$35.00
Psychiatry$40.00
Outpatient Lab$0.00
X-Rays$0.00
Diagnostic Radiology$0 for diagnostic imaging (e.g., sonagrams, ultrasounds, DEXA) – $275 for advanced imaging (e.g., CT, MRI, PET)
Therapeutic Radiology20%
Outpatient Hospital Services$280.00
Outpatient Hospital Observation$350.00
ASC$180.00
Outpatient Substance Abuse$75.00
Ambulance – Ground$225.00
Ambulance – Air$450.00
DME20%
Prosthetics20%
Medical Supplies20%
Diabetic Supplies$0.00
Therapeutic Shoes or Inserts$0.00
Renal Dialysis0%
Chemotherapy Drugs20%
Part B Drugs20%
Part D
Deductible$0
ICL$2,000
Tier 1 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Retail 30/Retail 90/Mail$15/$45/$0
Tier 3 Retail 30/Retail 90/Mail$47/$141/$141
Tier 4 Retail 30/Retail 90/Mail$100/$300/$300
Tier 5 Retail 30/Retail 90/Mail33%/33%/33%
Tier 6 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Insulin$0/$0/$0
Tier 3 Insulin$0/$0/$0
Tier 4 Insulin$0/$0/$0
Supplemental Benefits
Worldwide EmergencyUp to $10,000 Maximum
Non-Emergency TransportationUnlimited one-way trips
OTC$200 per quarter
Meals2 meals a day for 14 days provided immediately following each surgery or inpatient hospitalization. Up to 4 times per year
FitnessSilver & Fit
Nursing HotlineCovered
SSBCI
Flex Card $240 / Month to apply towards list below (amount does NOT roll over):
-Gas Card
-Home Safety/Access Modifications
-Social and Active Club Membership
-Internet / Cell Data
-Pet Supplies
Members also get:
$200 Grocery Card
Meals: Routine – 10 per month
50 non medical one way trips
Other (SSBCI Not required)
In Home Support – $0 4 hour per day, up to max 208 hours per year (including home safety assessment, caregiver, social support and medication reconciliation)
Personal Emergency Response System
Routine foot care $0 – 6 visit per year
Routine Chiro – $0 Copay 12 visits per year
Dental, Vision, Hearing Flex Card: $500
Dental
Dental – Preventative
Annual Max Benefit Amount: $2500 combined with Comprehensive
Exams: 1 every 6 months
Prophylaxis: 1 every 6 months
Flouride: 1 every 6 months
X-Rays: 1 every 2 years
Dental – Comprehensive
Annual Max Benefit Amount: $2500 combined with Preventative
Non-Routine Services: Unlimited
Diagnostic Services: Unlimited
Restorative Services: Unlimited
Endodontics: Unlimited
Periodontics: Unlimited
Extractions: Unlimited
Prosthodontics, Other Oral/Maxillofacial Surgery: Unlimited
Vision
Vision – Exams:
Medicare Covered – $30, 1 Routine Exam / year – $0
Vision – Hardware:
Annual Max Benefit Amount: $200
Contact Lenses
Eyeglasses (lenses and frames)
Hearing
Hearing – ExamsMedicare Covered – $30, 1 Routine Exam / year – $0
Hearing – Aids$699 or $999 copay per hearing aid, depending on device

(HMO C-SNP) – H1748013

Sonder Breathe Well

Chronic Special Needs Plan for COPD Conditions

Plan Highlights

Unless indicated, benefits are per service or per year.
*Only for members who have qualifying chronic medical conditions.
Please see Summary of Benefits for full list of conditions.

Deductible & Max Out-Of-Pocket
Deductible$0
MOOP$3,950
Part A
Inpatient Acute$350 days 1-5;$0 days 6-90
Inpatient Psych$350 days 1-5;$0 days 6-90
SNF$0 days 1-20;$184 days 21-100
Home Health$10
Part B
Cardiac & Pulmonary Rehab$20 (including Intensive Cardiac Rehab and SET for PAD), $0 for Pulmonary rehab
PT/OT/ST$40.00
ER$120.00
Urgent Care$25.00
PCP$0.00
Chiro$20.00
Specialist$0.00
Mental Health$40.00
Podiatry$40.00
Other Health Care Professional$35.00
Psychiatry$40.00
Outpatient Lab$0.00
X-Rays$0.00
Diagnostic Radiology$0 for diagnostic imaging (e.g., sonagrams, ultrasounds, DEXA) – $275 for advanced imaging (e.g., CT, MRI, PET)
Therapeutic Radiology20%
Outpatient Hospital Services$280.00
Outpatient Hospital Observation$350.00
ASC$180.00
Outpatient Substance Abuse$75.00
Ambulance – Ground$225.00
Ambulance – Air$450.00
DME20%, oxygen at 0%
Prosthetics20%
Medical Supplies20%
Diabetic Supplies20%
Therapeutic Shoes or Inserts20%
Renal Dialysis20%
Chemotherapy Drugs20%
Part B Drugs20%
Part D
Deductible$0
ICL$2,000
Tier 1 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Retail 30/Retail 90/Mail$15/$45/$0
Tier 3 Retail 30/Retail 90/Mail$47/$141/$141
Tier 4 Retail 30/Retail 90/Mail$100/$300/$300
Tier 5 Retail 30/Retail 90/Mail33%/33%/33%
Tier 6 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Insulin$15/$45/$0
Tier 3 Insulin$35/$70/$70
Tier 4 Insulin$35/$70/$70
Supplemental Benefits
Worldwide EmergencyUp to $10,000 Maximum
Non-Emergency Transportation50 one-way trips
OTC$200 per quarter
Meals2 meals a day for 14 days provided immediately following each surgery or inpatient hospitalization. Up to 4 times per year
FitnessSilver & Fit
Nursing HotlineCovered
SSBCI
Flex Card $260 / Month to apply towards list below (amount does NOT roll over):
-Gas Card
-Home Safety/Access Modifications
-Social and Active Club Memberships
-Internet / Cell Data
-Pet Supplies
Members also get:
$200 Grocery Card
Meals: Routine – 10 per month
50 non medical one way trips
Other (SSBCI Not required)
In Home Support – $0 4 hour per day, up to max 104 hours per year (including home safety assessment, caregiver, social support and medication reconciliation)
12 visit Comprehensive Smoking Cessation Program
Personal Emergency Response System
Routine foot care $0 – 6 visit per year
Routine Chiro – $0 Copay 12 visits per year
Dental, Vision, Hearing Flex Card: $500
Platelet Rich Plasma – 6 visits / year
Dental
Dental – Preventative
Annual Max Benefit Amount: $2500 combined with Comprehensive
Exams: 1 every 6 months
Prophylaxis: 1 every 6 months
Flouride: 1 every 6 months
X-Rays: 1 every 2 years
Dental – Comprehensive
Annual Max Benefit Amount: $2500 combined with Preventative
Non-Routine Services: Unlimited
Diagnostic Services: Unlimited
Restorative Services: Unlimited
Endodontics: Unlimited
Periodontics: Unlimited
Extractions: Unlimited
Prosthodontics, Other Oral/Maxillofacial Surgery: Unlimited
Vision
Vision – Exams:
Medicare Covered – $30, 1 Routine Exam / year – $0
Vision – Hardware:
Annual Max Benefit Amount: $200
Contact Lenses
Eyeglasses (lenses and frames)
Hearing
Hearing – ExamsMedicare Covered – $30, 1 Routine Exam / year – $0
Hearing – Aids$699 or $999 copay per hearing aid, depeding on device

(HMO C-SNP) – H1748004

Sonder Heart Healthy

For Cardiovascular Disorders

Plan Highlights

Unless indicated, benefits are per service or per year.
*Only for members who have qualifying chronic medical conditions.
Please see Summary of Benefits for full list of conditions.

Deductible & Max Out-Of-Pocket
Deductible$0
MOOP$3,950
Part A
Inpatient Acute$350 days 1-5;$0 days 6-90
Inpatient Psych$350 days 1-5;$0 days 6-90
SNF$0 days 1-20;$184 days 21-100
Home Health$10
Part B
Cardiac & Pulmonary Rehab$0 (including Intensive Cardiac Rehab and SET for PAD)
PT/OT/ST$40.00
ER$120.00
Urgent Care$25.00
PCP$0.00
Chiro$20.00
Specialist$0.00
Mental Health$40.00
Podiatry$40.00
Other Health Care Professional$35.00
Psychiatry$40.00
Outpatient Lab$0.00
X-Rays$0.00
Diagnostic Radiology$0 for diagnostic imaging (e.g., sonagrams, ultrasounds, DEXA) – $275 for advanced imaging (e.g., CT, MRI, PET)
Therapeutic Radiology20%
Outpatient Hospital Services$280.00
Outpatient Hospital Observation$350.00
ASC$180.00
Outpatient Substance Abuse$75.00
Ambulance – Ground$225.00
Ambulance – Air$450.00
DME20%
Prosthetics20%
Medical Supplies20%
Diabetic Supplies$0.00
Therapeutic Shoes or Inserts$0.00
Renal Dialysis20%
Chemotherapy Drugs20%
Part B Drugs20%
Part D
Deductible$0
ICL$2,000
Tier 1 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Retail 30/Retail 90/Mail$15/$45/$0
Tier 3 Retail 30/Retail 90/Mail$47/$141/$141
Tier 4 Retail 30/Retail 90/Mail$100/$300/$300
Tier 5 Retail 30/Retail 90/Mail33%/33%/33%
Tier 6 Retail 30/Retail 90/Mail$0/$0/$0
Tier 2 Insulin$15/$45/$0
Tier 3 Insulin$35/$70/$70
Tier 4 Insulin$35/$70/$70
Supplemental Benefits
Worldwide EmergencyUp to $10,000 Maximum
Non-Emergency Transportation12 one-way trips
OTC$150 per quarter
Meals2 meals a day for 14 days provided immediately following each surgery or inpatient hospitalization. Up to 4 times per year
FitnessSilver & Fit
Nursing HotlineCovered
SSBCI
Flex Card $250 / Month to apply towards list below (amount does NOT roll over):
-Gas Card
-Home Safety/Access Modifications
-Social and Active Club Membership
-Internet / Cell Data
-Sports License (hunting/fishing)
-Pet Supplies*
Members also get:
-$130 Grocery Card
-Meals: Routine – 10 per month
-50 non medical one way trips
Other (SSBCI Not required)
In Home Support – $0 4 hour per day, up to max 104 hours per year (including home safety assessment, caregiver, social support and medication reconciliation)
Personal Emergency Response System
Routine foot care $0 – 6 visit per year
Routine Chiro – $0 Copay 12 visits per year
Dental, Vision, Hearing Flex Card: $500
Platelet Rich Plasma – 6 visits / year
Dental
Dental – Preventative
Annual Max Benefit Amount: $2500 combined with Comprehensive
Exams: 1 every 6 months
Prophylaxis: 1 every 6 months
Flouride: 1 every 6 months
X-Rays: 1 every 2 years
Dental – Comprehensive
Annual Max Benefit Amount: $2500 combined with Preventative
Non-Routine Services: Unlimited
Diagnostic Services: Unlimited
Restorative Services: Unlimited
Endodontics: Unlimited
Periodontics: Unlimited
Extractions: Unlimited
Prosthodontics, Other Oral/Maxillofacial Surgery: Unlimited
Vision
Vision – Exams:
Medicare Covered – $30, 1 Routine Exam / year – $0
Vision – Hardware:
Annual Max Benefit Amount: $200
Contact Lenses
Eyeglasses (lenses and frames)
Hearing
Hearing – ExamsMedicare Covered – $30, 1 Routine Exam / year – $0
Hearing – Aids$699 or $999 copay per hearing aid, depeding on device

Do You Have Plan & Benefit Questions?

We are here to help!

If you are a Sonder Health Plans member and have questions about your benefits, please contact the Toll-Free Sonder Member Services Center
1 (888) 428-4440
TTY/TDD 711

Monday through Friday, 8:00 a.m. to 6:00 p.m.

If you are a prospective Sonder Health Plans member and are interested in learning more about us, please call a licensed agent at

(888) 217-7110 7 days a week 8:00 a.m. to 6:00 p.m.

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