“A Self-Pay Patient with a Backup Plan”
Designed for our healthiest Members who are living a “Lifestyle” of nutritious eating and regular exercise. If you are already taking all the necessary steps to qualify for our healthy rewards program consider this option for your healthcare plan.
This option puts you in complete “Control” to choose any Doctor or Facility any time. 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 typically be happy to 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” (i.e. a large medical expense) be more than the Initial Unshared Amount (similar to a deductible) you selected; Medical Cost Sharing will share the full amount at 100%.
You’re in control but not alone. The MPowering Benefits Concierge assistance program is with you ever step of the way. Researching Doctors, Facilities and Hospitals should you need care. With our numerous transparency and Technology Tools they’ll assist you in selecting “Fair Priced” Quality Services.
This is how the “Self-Directed Healthcare” 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
As a Self-Directed Self-Pay Member, the only PREVENT services covered by this option are these more costly services covered at $0 co-pay by the Medical Sharing Community (Sedera).
- Mammograms and
- Child Immunizations & Vaccinations
The best way to MANAGE your money with this option is the HMA (Health Matching Account).
Once you have incurred 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 (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: None
- PREVENTIVE Covered at 1st dollar: Colonoscopy, Mammograms and Immunizations Only by Sedera Health
- 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 other household configurations
- 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 per 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: HMA (Health Matching Account) optional