Partially Self-Directed Healthcare:
“Preventive Network and Self-Pay Patient with a Backup Plan”
Designed for Members who are living a Healthy Lifestyle, and want to be in compliance with the Affordable Care Act by adding a minimum essential coverage network for preventive services. If you’re already taking all the necessary steps to qualify for our healthy rewards program consider this option for your healthcare plan.
This is the ONLY Option structured to allow access to an HSA (Health Savings Account). A HSA is a type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses.
The Preventive Care network is very large and provides coverage for all 64 services required by the ACA (Affordable Care Act). These services are offered in network at $0 co-pay. This element of the Healthy Care Strategy meets the requirements of the ACA – which eliminates any Tax Penalty.
All services you require, other than Preventive Care, you can choose any Doctor or Facility. No Network – just tell the provider that you are Self-Pay Patient with a backup plan and as such would like their “Best Cash Price”. They will be happy do give you a 30-70% discount because they don’t have to wait several months to receive payment as with health insurance.
Should your “Need” (medical expense) be more than your selected Initial Unshared Amount (similar to a deductible), Medical Cost Sharing will take over and pay the full amount at 100%.
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 Hospital should you need care. With numerous transparency and quality 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
A MEC Plus – Minimum Essential Coverage provides coverage for 64 preventive services such as Annual Physicals, Mammograms, Colonoscopies, etc. at no $0 co-pay.
A MEC Plus Plan is a self-funded PPO administered by a third party administrator. There’s no charge for in-network preventive services determined by the U.S. Preventive Services Task Force as required to be covered by ACA (Obamacare) plans. The member pays 130% of Medicare for preventive services provided by out-of-network providers.
This solution provides an alternative that satisfies the federal statute without compromising the moral and spiritual beliefs of members. To comply with the federal law, Health Excellence Plus establishes a qualifying self-insurance plan known as Minimum Essential Coverage Plus.
Once you have a “Need” (is a medical expense caused by an accident or illness) 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.
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 63 mandated preventive services required by the ACA.
- PRIMARY Care Network: None
- SMALL Medical Expenses: managed with 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
- Pre-Existing Conditions: 36 month look back, $0 coverage 1st 12 months, $15k yr 2, $30k yr 3, then unlimited.
- Maternity Benefits: $5,000 Initial Unshared Amount
- Therapies & TMJ: range from $1.5k to $2.5k/need
- 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: HSA (Health Savings Account) access or HMA (Health Matching Account) optional or both