Medical Cost Sharing
How it Works
The Sedera Health medical cost sharing model boldly challenges the insurance status quo. Through an innovative layering of healthcare services, we enable individuals and families access to high quality healthcare that is affordable, flexible and effective.
In addition to sharing medical expenses, Sedera provides access to valuable Counseling, Medical Bill Negotiation, Telemedicine, Expert Second Opinion, and Personal Member Advisor services to all members.
Sedera’s members can meet the Affordable Care Act (ACA) standard separately through an employer-sponsored self-insurance arrangement that includes Minimum Essential Coverage (MEC). This plan provides coverage for preventive services and well care visits and keeps you in compliance with the law.
Businesses like yours are looking for an alternative to the insurance status quo. That’s where medical cost sharing comes in.
What is Medical Cost Sharing?
Instead of paying monthly premiums to an insurance company, members share a given amount on a monthly basis and draw from community funds as medical Needs arise.
Monthly shares are generally lower than typical insurance premiums. Through Sedera’s medical cost sharing model, members save between 30 – 50% of the costs that are typically incurred with health insurance plans.
Sedera Health’s core medical cost sharing model is supported by several additional services which enhance value and contribute to member quality of life.
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What Members Say
Employer and employee members share their experiences.
“…Sedera’s help in finding the best cost on treatment and prescriptions resulted in one employee paying a tenth of what they were paying monthly with our insurer’s prescription benefit program.”
“Now having entered our third year with Sedera Health, I can confidently say Sedera is an excellent option to help drive down healthcare costs for my business and employees, while providing a high-quality healthcare solution.”
“After years of dealing with insurance companies, we finally have someone on our side who is looking out for our best interests.”
“I told the doctor my symptoms, then he prescribed an antibiotic and a steroid to control my coughing. An hour later the prescription was at my local pharmacy.”
Frequently Asked Questions
Isn’t Sedera really just another health insurance company?
No. 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. Sedera is not licensed or registered by any insurance board or department since we are not practicing the business of insurance. We do not assess applicants’ health risks, because neither Sedera nor our Members are assuming financial liability for any other member’s risk. Unlike insurance, the focus of Sedera’s Medical Cost Sharing membership is on how our Members help one another with their immediate needs.
What’s the advantage of Sedera not being a health insurance company?
When health care costs are paid by someone other than the person receiving care, typically an insurance company or government entity, the health care model can be undermined. We believe many of the current problems with the healthcare system are the direct result of restricting personal freedom and responsibility through dependence on third-party payors. Sedera is designed to allow Members to help one another while maintaining freedom of choice and personal responsibility.
Why doesn't Sedera have deductibles or co-insurance?
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.
What are Sedera's membership requirements?
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.
How does Sedera handle medical claims?
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.
What kinds of needs do Sedera Health Members share?
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.
Are there any specific medical conditions that have an exclusion or waiting period?
A look-back period of 36 months applies to all prior medical conditions for Sedera applicants. A prior medical condition, as previously defined, is a condition in which the applicant has either received medical treatment, taken medications for, or exhibited observable symptoms. Any prior medical condition that has not exhibited symptoms during the 36 continuous months prior to membership effective date is considered cured and will have no sharing restrictions. Prior medical conditions will become eligible for sharing based on the Member’s tenure with Sedera, as indicated by the Guidelines.
Sharing restrictions do not apply for high blood pressure, as long as the member has not been hospitalized for high blood pressure in the 36 months prior to membership and the condition is controlled through medication and/ or diet. However, medication for treatment of high blood pressure as a chronic condition will not be shared.
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