Frequently Asked Questions
What is Sedera?
Sedera is a not-for-profit Medical Cost Sharing community that offers an innovative, non-insurance approach to managing large healthcare costs. As a not-for-profit organization, Sedera is focused on serving our members and carrying out our community-centric mission. Sedera Members join a community of like-minded individuals who are active and engaged participants in their healthcare decision making. Together, we are tapping the power of community to create a new normal in healthcare that is high-quality, human, and transparent.
Is Sedera available in all states?
Membership in the Sedera Medical Cost Sharing Community is available in almost every state. Sedera, however, is currently not accepting new Members in Illinois, New York, Vermont, and Washington. We will update this page as soon as new states become available.
What kind of company is Sedera?
The Sedera Medical Cost Sharing Community is a not-for-profit Medical Cost Sharing community, focused on serving the engaged healthcare consumer. Sedera facilitates the direct sharing of medical costs among our participating Members (the Community).
What other features are included with a Sedera Medical Cost Sharing Community membership?
Sedera membership also comes with access to additional tools including convenient telehealth services for basic healthcare needs, expert second opinions, wellness support and resources to help Members live their healthiest lives, and medical bill negotiation services when necessary to ensure the Members are not overpaying for their healthcare costs.
Is Sedera an 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. 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 neither the Sedera, Inc. nor the Sedera Medical Cost Sharing Community members are assuming financial liability for any other member’s risk. Unlike insurance, the focus of the Sedera Medical Cost Sharing membership is on how our members help one another with their immediate needs.
Is Sedera a Health Care Sharing Ministry?
The Sedera Medical Cost Sharing Community meets the legal definition of a health care sharing ministry in a number of states that recognize HCSMs.
Does Sedera Community membership satisfy federal or state level individual mandates?
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 employers and individuals who are Sedera members who do not otherwise meet federal and/or state coverage mandates.
Can I choose my own doctors and hospitals without being penalized?
Absolutely! Having the freedom to choose the medical providers of your choice is fundamental to Sedera’s values. Sedera’s Member Advisors will be happy to provide quality information to help you decide on the best provider(s). Because Sedera is not insurance and does not have a network of providers, there are no “out-of-network” penalties.
Does Sedera use deductibles and co-insurance like traditional health insurance?
No. Remember, Sedera is not insurance, so Sedera’s process differs significantly from insurance practices in this regard—to our Members’ 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-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 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.
Does Sedera charge monthly premiums?
Because Sedera’s Medical Cost Sharing membership is not 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.” Your Share is deposited directly into your individual or household bank account that is specifically dedicated to Medical Cost Sharing.
What happens when a provider requires payment up front for services?
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, as doing so impacts the Community’s ability to negotiate with medical providers. In cases where Members pay more than their IUA, they can submit the amount that exceeds their IUA to the Sedera Community for sharing.
Additionally, 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.
How does Sedera handle medical expenses submitted for sharing?
Because Members do not transfer risk to each other or to the Sedera’s Medical Cost Sharing Community, no request for sharing is ever guaranteed. Members always remain responsible for their medical expenses. When Members incur medical expenses that exceed their IUA, they submit proof of their medical expenses to Sedera. The medical expenses are then evaluated to make sure the need qualifies for sharing under the Community’s applicable Guidelines.
What is the process for paying my medical bills when I have a Need?
At the time of service, Members should disclose to their medical providers (doctors, laboratories, clinics, hospitals, etc.) that they are “cash pay” patients. The providers will, in turn, bill the Member directly. The Member then organizes their bills, goes online to sederamcs.org/login, completes the online Needs Submittal Process and submits everything online, including providing copies of all relevant medical bills and any proof of payments made towards their Initial Unshareable Amount (IUA). Our 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. This member-to-member sharing model is conducted through individual bank accounts, which provide easy access to funds.
How long does it take Sedera to process a medical Need?
The sharing turnaround time normally ranges from 14-60 days from receipt of your bills and required information. If you complete the Needs Submittal Process, submit all the necessary documentation, and there are no ongoing financial negotiations with a provider, your Need will normally be shared within 14-30 days after receipt. Please note that larger bills may take longer to negotiate.
Does the Sedera Community share medical costs that were incurred outside of the United States?
Yes. Members’ eligible needs, wherever incurred, are eligible to be shared with the broader Sedera Community in the same fashion as medical expenses incurred in the U.S.
What are Sedera’s Membership requirements?
Members must agree to abide by each of the Sedera Community’s ten Ethical Beliefs and Principles. Sedera’s Member Guidelines includes other details of Membership requirements.
Is there a lifetime or yearly maximum amount that is eligible for sharing for any one person or family?
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. Additionally, no single Need may consume more than one third (1/3) of the total number of Shares available in order to assure ample Shares are available for the Needs of all Members.
How can I be sure that Sedera really works?
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.
What happens if there are more medical Needs than available shares in a month?
Sedera’s 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 percent of the Needs submitted for a particular month, only 90 percent 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.
Can my Membership be dropped if I have very high medical 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
What kinds of Needs do Sedera Members share?
In general, Needs for 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 6-9 of the applicable Member Guidelines for details.
How can I know if a Need qualifies for sharing?
The types of Needs that qualify for sharing can be found in the applicable Member Guidelines. Consult Section 10 to familiarize yourself with the general procedures for submitting your Need, and Sections 6-9 for the specific requirements for sharing certain types of Needs. If you have any questions, do not hesitate to call your Member Services Advisor at 1-855-973-3372.
How does Sedera handle very large medical expenses?
There is no maximum limit to the amount that will be shared towards a specific medical Need. However, the Need must be within the scope of the Guidelines before it will be eligible for sharing. Because of the economic impact of very large medical bills (e.g., those over $150,000), Sedera has devised an internal mechanism to ensure that adequate shares are available to meet both our Members’ normal and high-cost Needs. For the very large medical expenses that occur from time to time, Sedera makes provision by allocating 15% of Members’ monthly shares to remain available. 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.
Are there any specific medical conditions that have an exclusion or waiting period?
Most medical expenses are eligible for sharing. There are, however, a number of types of medical expenses that 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 Guidelines.
As Sedera is intended to share costs associated with larger and, unexpected illnesses and injuries, many expenses related to routine preventative care, prescriptions, cosmetic surgery, dental care, are generally not shareable. Additionally, medical expenses resulting from the use of illegal drugs, or while participating in unlawful activities are not shareable.
How does the Sedera Community share expenses related to Pre-Existing Medical Conditions?
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, however, 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 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 Guidelines.