Frequently Asked Questions
Sedera is a nonprofit Medical Cost Sharing Community that offers a non-insurance approach for managing large and unexpected medical expenses through direct Member-to-Member sharing. Sedera Members belong to a Community of individuals who are active and engaged participants in their healthcare decision-making, dedicated to a healthy lifestyle, and united by shared values.
While Sedera operates in most states, there are a few exceptions. Click here to learn more.
The Sedera Medical Cost Sharing Community is a nonprofit Medical Cost Sharing Community that offers a non-insurance approach for managing large and unexpected medical expenses and is focused on serving the engaged healthcare consumer. Sedera facilitates the direct sharing of medical costs among our participating Members (the Community).
A Sedera membership includes access to additional tools including convenient telehealth services for basic healthcare needs, expert second opinions, a cash pay marketplace, and medical bill negotiation services when needed to ensure the Members are not overpaying for their healthcare costs.
Some Memberships may include add-ons and/or additional products that are not owned, operated, serviced, or maintained by Sedera. Sedera makes no warranty regarding the websites, resources, materials, products, transactions, and services provided by third parties. Sedera makes no representations or warranties that every or all Memberships include any add-on/additional product(s). Members can utilize the Member Portal for more information on what their Membership includes.
No. Sedera is a nonprofit Medical Cost Sharing Community that offers a non-insurance approach for managing large and unexpected medical expenses through direct Member-to-Member sharing. Insurance arrangements are a contract whereby one party agrees to be legally responsible for and accept another party’s risk of loss in exchange for a payment — a premium. Medical cost sharing is an arrangement whereby members agree to share medical expenses through an act of voluntary giving. The Sedera MCS Community is not licensed or registered by any insurance board or department. The Sedera MCS Community does not assess applicants’ health risks, because the Sedera Medical Cost Sharing Community Members are assuming financial liability for any other Member’s risk.
The Sedera Medical Cost Sharing Community meets the legal definition of a health care sharing ministry in a number of states that recognize HCSMs.
No. Membership in the Sedera Medical Cost Sharing Community is not minimum essential coverage (MEC) and does not make an individual compliant with the federal ACA mandate or any state-level individual mandate that requires individuals to purchase health insurance. Any and all applicable penalties still apply for individuals who are Sedera Members who do not otherwise meet federal and/or state coverage mandates.
Absolutely! Freedom of choice is fundamental to Sedera’s values. Sedera has no network restrictions which means Members are free to select their providers based on personal preference, value, cost, and convenience and there are no “out-of-network” penalties. Sedera’s Member Advisors are available to help Members locate cash pay friendly medical professionals and we go where Members go, worldwide.
No. Because Sedera is not health insurance, Sedera’s process differs significantly from insurance practices. Health insurance deductibles are cumulative over the course of a plan year. Co-insurance is the portion of the medical expense owed by the patient. These insurance cost-shifting measures can amount to thousands of dollars in out-of-pocket costs to insurance policyholders annually. With Sedera, when Members incur an eligible medical expense that exceeds their Initial Unshareable Amount (IUA) for a specific eligible Need, any remaining balance relative to that specific Need is eligible for sharing with the Community, effectively reducing the Member’s portion to the selected IUA for any single Need.
No. Because a Sedera Medical Cost Sharing membership is not health insurance, there are no premiums. Sedera Members assist other Members with their medical expenses by contributing a predetermined amount each month; called a monthly “Medical Cost Sharing Amount” or “Share.” That Share is deposited directly into the Member’s individual FDIC-insured bank account specifically dedicated to Member-to-Member sharing.
When a provider requires a Member to pay in advance for medical services, Sedera advises its Members to avoid paying more than their IUA toward the cost of any medical need so that Sedera can negotiate costs with medical providers if needed. In cases where Members pay more than their IUA, they can submit the amount that exceeds their IUA to the Sedera Community for sharing.
In certain limited circumstances, the Sedera MCS Community provides direct up-front payment to the Member for proposed services. The most common example of prepayment is with maternity cases. Sedera may prepay the Member for maternity needs, based on the provider’s cash pay rates, in advance of the baby’s delivery.
When Members incur medical expenses that exceed their IUA, they submit proof of their medical expenses to Sedera. The medical expenses are evaluated to make sure the Need qualifies for sharing under the applicable Member Guidelines. A Sedera medical bill negotiator may contact providers to discuss the appropriate payment for the services that were performed and determine if negotiations are necessary or available for the billed amounts. Because Members do not transfer risk to each other or to the Sedera Medical Cost Sharing Community, no request for sharing is ever guaranteed. Members always remain responsible for their medical expenses.
At the time of service, Members inform their medical providers (doctors, laboratories, clinics, hospitals, etc.) that they are “cash pay” patients. The providers will, in turn, bill the Member directly. Members organize their bills, log into their Member portal, complete the online Needs Submittal Process, and submit copies of all relevant medical bills and any proof of payments made towards their Initial Unshareable Amount (IUA). Sedera’s team of medical bill negotiators may contact the providers to discuss the appropriate payment for the services that were performed and determine if negotiations are necessary or available for the billed amounts.
Sedera will review the Need and help administer a process whereby community funds are shared with the Member, less the Member’s IUA (as applicable), which the Member then uses to pay their medical provider. Because Members do not transfer risk to each other or to the Sedera Medical Cost Sharing Community, no request for sharing is ever guaranteed. Members always remain responsible for their medical expenses.
Sharing turnaround time normally ranges from 14-60 days from the receipt of bills and required information. Generally, after the Needs Submittal Process and the submission of required documentation is complete, and if there are no ongoing financial negotiations with a provider, a Need will be shared within 14-30 days after receipt. Please note that larger bills may take longer to negotiate.
Yes. With Sedera there are no network restrictions. We go where our Members go, worldwide. Members’ eligible needs, wherever incurred, are eligible to be shared with the Sedera Community in the same fashion as medical expenses incurred in the U.S. If a Member has a Sharable Needs Case that occurs outside of the United States, the Member will be required to provide Sedera the itemized Medical Bill translated into English and the price converted into U.S. Dollars.
Sedera is inclusive and welcomes people from all walks of life who agree with and commit to the Ethical Beliefs and Principles of the Sedera Community. Sedera’s Member Guidelines include other details of Membership requirements.
There is no annual maximum dollar amount or lifetime maximum limits per Member, though certain dollar amounts and/or visit limits apply to specific types of medical care and therapies. Sharing is only limited by the amount available for sharing by the Community.
Sedera’s Member Guidelines clearly state that payment is never guaranteed but is always based on the commitment of the Members to each other. For example, if there are only enough shares available for 90% of the Needs submitted for a particular month, only 90% of the Needs for that month will be shared. Sedera may overlap Needs from multiple months so that there are adequate shares for all Needs. However, if all Needs cannot be met, Sedera uses a prorating method to evenly distribute the burden. However, to date, Sedera has not had to prorate any sharing.
The concept of Medical Cost Sharing has been highly successful in the context of faith-based groups for more than 25 years. More than one million members have shared over a billion dollars in medical expenses over that span of time, demonstrating a strong track record of success. We believe that a community of health-conscious people who care for one another can successfully participate in the sharing of each other’s medical burdens. However, it is important to note that past successes by faith-based sharing groups does not guarantee the future success of similar programs. There is no promise or contract by Sedera or the Members to contribute toward any Need a Member might have in the future. The only promise Sedera makes is to facilitate the distribution of shares given through the medical cost sharing process. Sedera distributes these monthly Shares on behalf of those Members with Needs.
No. Members cannot be dropped from the membership due to their medical Needs. Neither your membership nor your monthly share is affected by the amount of medical expenses you or any of your family members may have.
In general, Needs for eligible illnesses or injuries resulting in visits to licensed medical providers, emergency rooms, diagnostic testing facilities, and laboratory or hospital charges are shared on a per person, per incident basis. See Sections 6-7 of the applicable Member Guidelines for details.
The types of Needs that qualify for sharing can be found in the applicable Member Guidelines. Consult Sections 6-7 for the specific requirements for sharing certain types of Needs. If you have any questions, please call Member Services at 1-855-973-3372.
There is no maximum limit to the amount that will be shared by the Community toward a specific medical Need. However, the Need must be within the scope of the Member Guidelines before it will be considered eligible for sharing. Sedera reserves the right to negotiate medical expenses with providers, and to prorate available shares, as necessary, in order to address all Member’s medical expenses. However, to date, Sedera has not had to prorate any sharing.
Most medical expenses are eligible for sharing. However, some types of medical expenses are not eligible for sharing with the Sedera Community or are limited in the amounts that the Community shares. Details of the medical expenses that are not shareable and other limitations can be found in the Community’s applicable Membership Guidelines.
As Sedera is a Medical Cost Sharing Community that shares large and unexpected medical expenses, some expenses including those related to routine preventative care, prescriptions, cosmetic surgery, and dental care, are generally not shareable. Additionally, medical expenses resulting from using illegal drugs or participating in unlawful activities are not shareable.
No prospective member is turned away for having Pre-Existing Medical Conditions, and Sedera does provide a path to sharing medical expenses associated with a Pre-Existing Medical Condition. The Sedera Community does have a look-back period of 36 months that applies to all Pre-Existing Medical Conditions for Sedera applicants. A Pre-Existing Medical Condition is any medical condition that existed prior to membership (diagnosed, suspected, or producing observable signs or symptoms). Needs that result from Pre-Existing Medical Conditions are subject to sharing limitations unless 36 months immediately prior to the membership effective date has passed without any signs or symptoms of the condition, without any treatment needed, without any medication prescribed or taken, and without any suspicion by the patient or doctors that the condition is resurfacing. This applies whether or not the cause of the symptoms is unknown or misdiagnosed. Pre-Existing Medical Conditions will become eligible for sharing based on the Member’s tenure with Sedera, as indicated by the applicable Membership Guidelines.
Members are responsible for the costs of routine and preventative care costs other than the larger, high-cost routine diagnostic procedures of screening colonoscopy, screening mammogram, childhood immunizations to age 18, and annual flu vaccines subject to the applicable Membership Guidelines for age, membership period and/or monetary limits for certain preventative care. Many Sedera Members choose to also become members of Direct Primary Care (DPC) practices for routine healthcare. To find a DPC, visit our DPC Finder.
There is no annual or lifetime sharing maximum on eligible Needs as outlined in the applicable Membership Guidelines. Community Members may share funds for eligible medical expenses that exceed a Member’s IUA, regardless of the duration of care for eligible Needs.