Medical Cost Sharing

Sedera’s process differs significantly from insurance practices in this regard; to our Member’s advantage. Traditional 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-sharing measures can amount to thousands of dollars in out-of-pocket costs to insurance policyholders annually. Conversely, when Sedera Members incur an eligible medical expense that exceeds their Initial Unshareable Amount (IUA), any remaining balance relative to that specific Need would be eligible for sharing, effectively reducing the Member’s portion to the selected IUA for any single Need.

Sedera Members are eligible through their employment, membership, or participation in a Sponsoring Entity. Members must agree to abide by each of the nine Principles of Membership. See Sections 1 and 2 of the Member Guidelines for the details of Membership requirements. Members understand that medical expenses resulting from the use of illegal drugs, or while participating in unlawful activities will not be shared.

Because there is no “transfer of risk” with Sedera’s Medical Cost Sharing, no “claim” is ever guaranteed. When Members incur medical expenses that exceed their IUA there is simply a medical "Need". Sedera Members submit proof of their medical expenses to Sedera where they are evaluated in accordance with the Guidelines. Qualified Needs are then designated for sharing based on the amount of shares collected from Members each month. Each Member’s monthly share is voluntary but also a requirement in order to remain an active participant in the membership.

In general, Needs for illnesses or injuries resulting in visits to licensed medical providers, emergency rooms, diagnostic testing facilities, laboratory, or hospitals charges are shared on a per person, per incident basis. See Sections 6-9 of the Member Guidelines for details.