Co-pay Network Healthcare:
“Preventive and Co-Pay Network with a Backup Plan”
Intended for our health focused members who want protection that’s more like a traditional healthcare plan design. All Preventive care, both Primary and Specialist office visits, Urgent Care, Labs and even MRI’s are covered by co-payments when using the PHCS network. See Specifications for details.
Select doctors and/or facilities from a network list of providers. Should your “Need” (a large medical expense) be more than the Initial Unshared Amount (similar to a deductible) you selected, Medical Cost Sharing will take over and pay the full amount at 100%.
You’re in control but not alone. Your MPowering Benefits Concierge is with you every step of the way. They’ll assist in researching doctors, facilities and hospital should you need care. With their numerous transparency and technology tools they’ll help assure you’ll obtain “Fair Priced, Quality Service”.
How this Plan Option uses our Healthy Care Medical Expense Control Strategy.
The foundation of any Program designed to help CONTROL Medical COSTS should be to AVOID them, this is accomplished with Education and a Wellness Program. These Products and Services are provided by My Academy of Health Excellence and MPowering Benefits.
• Single Point of Access for Services
• Fully Integrated Health and Wellness Program
• Wellness Assessment Program (health risk assessment to inform you re your current health status)
• QR For Life Code for Emergencies and Personal Medical Vault
• WellFit Community (on-line forum for blogs and group interaction)
• Twelve Habits of Highly Healthy People
• Artificial Intelligence Based on Functional Medicine (functional medicine-based risk assessment,
personalized recommendations, and coaching service)
• Online Resource Center (webinars, podcasts, interviews with experts, newsletters and e-books)
• Healthy Rewards Program
Covers all 64 mandated preventive services required by the ACA.
- All 18 Preventive Services for Adults
- All 26 Preventive Services for Women
- All 27 Preventive Services for Children
The best way to MANAGE your money with this option is the HMA (Health Matching Account).
Once you have a “Need” these programs and technology are available to help MITIGATE the costs.
- Teladoc (Video and Telemedicine)
- 2nd MD (Second Opinion Program)
- Patient Advocacy
- Medical Tourism
We CONTAIN medical expenses with Medical Cost Sharing by Sedera Health. A Benevolence Organization of like-minded and health-focused individuals and families.
For “curative care” issues, Sedera facilitates the sharing of health care costs among its members that have medical “Needs”. A “Need” is a medical expense caused by an accident or illness above an amount you can comfortably afford to pay (I.U.A. – Initial Unshared Amount).
The Sedera community philosophy is that we’re meant to help carry one another’s burdens. Our method of sharing medical expenses among members and supporting each other along the way shows this principle in action. Services include:
- Personal Member Advisor
- Medical Bill Negotiation
- WELLNESS Platform: by My Academy of Health Excellence with Healthy Rewards Program
- PREVENTIVE Network: PHCS Network
- PREVENTIVE Covered at 1st dollar: Cover all 64 mandated preventive services required by the ACA.
- PRIMARY Care Network: PHCS Network
- SMALL Medical Expenses: managed with Teladoc and Co-Pays
- LARGE Medical Expenses: managed with Medical Cost Sharing by Sedera Health
- I.U.A. Options: Initial Unshared Amounts available $500, $1000, $1500, $2500, $5000
- Maximum I.U.A.’s Annually: 3 per individual, 5 for all others
- Prescription Drugs Coverage – Curative Medications (Antibiotics, Chemotherapy, etc.): normal sharing rules apply
- Prescription Drugs Coverage – Maintenance Medications (Blood Pressure, Cholesterol, etc.): Sharing eligible for 1st 120 days following new diagnosis
- Pre-existing Conditions: 36 month lookback, $0 coverage 1st 12 months, $15k yr 2, $30k yr 3, then unlimited.
- Maternity Benefits: $5,000 Initial Unshared Amount
- Therapies & TMJ: various range from $1.5k to $2.5k
- Psychiatric & Behavioral Health: $5k inpatient max/ need – $1.5 Outpatient max/ need
- Tobacco Use: $75 surcharge per Family Unit – plus a $25k sharing restriction for members age 50+ (conditions with restrictions; cancer, stroke, heart conditions and COPD)
- Sharing Limits: NO Lifetime Limits
- MONEY Management: HMA (Health Matching Account) optional