FAQ (Frequently Asked Questions | Sedera Health

FAQ

  1. General FAQs
  2. Group FAQs

General

Does this work internationally?

Sedera service is available in all 50 U.S. states (some discount health benefits may be limited in certain states). Sedera Health Sharing Members may participate in their health care sharing while living abroad. Member Advisory services and discount health services are available in the United States of America. 

Can I choose my own health care providers?

Yes. There are no “preferred providers”, or required networks in regards to Sedera Health Care Sharing. Thus, there are no “out of network” penalties. There are two exceptions to the above:

1) The Discounted Health Services uses participating providers to receive the discounted services.  If a member chooses a provider that doesn’t participate, the discounted services would not be available.

2) The Minimum Essential Coverage (MEC) which is acquired not from Sedera but from a Third Party Administrator (TPA), is part of a program that uses a PPO network.  In this case, costs are covered through the MEC if you go to one of their network providers.  If you go outside the network, the MEC will pay its standard rates to any place you choose, but you may be balance billed if medical provider is not in the network.

I’ve lost my member services booklet and/or card. How do I get a new one?

Simply call Member Services at (855) 973-3372 to request a replacement.  These include printed informational booklets and flyers, Internet educational webinars with our staff, and direct help from the MEC and HSA providers to encourage update and utilization of the many services provided.  Members can also at any time our offices are open speak with our customer service staff over any questions or concerns that they have.

 

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Individuals/Families FAQs

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Groups FAQs

Can I choose my own health care providers?

Yes. There are no “preferred providers”, or required networks in regards to Sedera Health Care Sharing. Thus, there are no “out of network” penalties. There are two exceptions to the above:

1) The Discounted Health Services uses participating providers to receive the discounted services.  If a member chooses a provider that doesn’t participate, the discounted services would not be available.

2) The Minimum Essential Coverage (MEC) which is acquired not from Sedera but from a Third Party Administrator (TPA), is part of a program that uses a PPO network.  In this case, costs are covered through the MEC if you go to one of their network providers.  If you go outside the network, the MEC will pay its standard rates to any place you choose, but you may be balance billed if medical provider is not in the network.

How are claims handled?

One reason Sedera is not an insurance company is that there is no transfer of risk. This means that when a member receives medical care, there is no “claim” that is owed. There is simply a medical need. Sedera members send proof of their medical expenses to Sedera where they are evaluated according to the Guidelines. Then funds are used for qualified needs.

This all sounds too good to be true! Does this really work?

Absolutely!  The Health Care Sharing model has existed for over 25 years and today serves hundreds of thousands of members.

How are Groups invoiced?

All groups are invoiced directly, with the employer making decisions about how much of the health care cost is shared by the employer and how much of the monthly cost is handled by the employee through payroll deduction

How do I ensure my employees have the best care?

The good news is that any member may use the doctors and facilities of their choice, making sure they are confident and comfortable in the care they are receiving. Sedera has no restrictions on providers used.

The Discount Medical Services offered by Sedera will have provider networks to choose from in order to receive discounted services.  See our Discounted Health Services for more information.

How do I present this to my employees?

Sedera has developed materials for you to share with your employees.  These include printed informational booklets and flyers.  Sedera is also happy to assist you in making this presentation to your employees. Contact us if you need more information.

How do we add or drop an employee?

Simply notify your Member Services Team who will make sure that your employee is added or dropped.  Members Services will also inform you regarding how to drop an employee.

What do I do when I have a need that is not taken care of through the MEC?

MEC needs, i.e. Those that are involving preventative care, are all going to be paid through the Third Party Administrator (TPA) on your behalf.  Just show the provider the MEC Insurance card.  But other needs, when you are sick, can be shared through the Health Care Sharing component of your plan. 

Explain to your care providers (doctors, hospitals, etc.) that you do not have insurance and that you are a self-pay patient.  The providers send their bills directly to you.  You organize the bills, complete a Need Handling Form and submit them to Sedera.  Sedera will then direct member funds as appropriate in accordance with the published guidelines.

If I have large amounts of medical expenses, how will that affect my membership?

Neither your membership nor your monthly share is affected by the amount of medical expenses you have.

What happens if there are more medical needs than shares in a month?
Our guidelines have always clarified to the member the reality that payment is never guaranteed, but is always based on the commitment of the members to each other. Sometimes Sedera can overlap needs from two months so that there is enough money for all the needs. However, if all needs cannot be met, Sedera uses a prorating method to evenly distribute the burden. For example, if there is only enough share money for 90 percent of the needs submitted for a particular month, we can only commit to sharing 90 percent of each need.  However, our team will be negotiating the bills as normal, and so if we are able to negotiate your bills below the 90% level, you will still find your whole bills shared.  If we are not able to negotiate your bill below the 90% threshold, you may need to pay the balance directly if required to do so by the medical provider.
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