DPC – Direct Primary Healthcare:
“DPC Doctor for Preventive and Small Medical Expense with a Backup Plan”
Designed for our Health focused Members who want a plan to cover medical services NOT provided by their DPC – Direct Primary Care Doctor. Preventive Care is double covered by a MEC and the DPC Doctor to avoid the tax penalty imposed by the Affordable Care Act (when the penalty is eliminated on 1/1/19 members can consider removing the MEC from their DPC- Direct Primary Healthcare plan). All Primary care as well as some urgent care and labs may be covered by the DPC for no additional cost other than the monthly fee for service depending of the DPC. See Specifications for details.
You can select any Doctors or Facilities without regards to a network should your “Need” (large medical expense) require a specialist and/or be more than the initial unshared amount (similar to a deductible) you selected. These expenses are covered with Medical Cost Sharing and are paid 100% above the initial unshared amount.
You’re in Control but Not Alone. Your MPowering Benefits Concierge assistance program is with you ever step of the way researching doctors, facilities and hospitals should you have a need beyond primary care. With their numerous transparency and technology tools to assist you in selecting “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 avilable 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: Direct Primary Care Doctor
- PREVENTIVE Covered at 1st dollar: All Direct Primary Care Services
- PRIMARY Care Network: Direct Primary Care Doctor
- SMALL Medical Expenses: managed with Direct Primary Care Doctor and Teladoc
- 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
- Preexisting Conditions: Eligible for Sharing after 36 month look back, $0 coverage 1st 12 months, $15k yr 2, $30k yr 3, then unlimited. Direct Primary Care will provide immediate coverage for Preexisting Conditions.
- 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