Your DPC is there for needs that can be taken care of within the practice.
Sedera Health is there for medical expenses outside of the DPC relationship.
Sedera includes the following preventative screenings and features that are not subject to the Member's Initial Unshared Amount - IUA
*:Screening Mammograms (over age 40),
*Screening Colonoscopies (over age 50),
*Childhood and * Seasonal flu vaccines. (any age)
Highlights from the video above,
A "need" is one or more medical expenses caused by a single accident or illness.
The Initial Unshared Amount (IUA) is what the member pays before sharing begins for the Need.
You choose what your IUA will be when you join.
Needs that exceed the members chosen IUA of
$500, $1,000, $1,500, $2,500 or $5,000 are shareable with the community.
No mater how long a Need goes on, the member is only responsible once for the Initial Unshared Amount and the rest is shared.
A new Need is only considered if it has been over 12 months since
symptoms or treatment for the need has occurred
To further protect members, Individuals who have met 3 IUA's and couples or families that have met 5 IUA's have any further medical expenses shared at dollar one!
The method of sharing on a NEED is favorable to the member versus the traditional health insurance model of an annual deductible.
Sedera's Member Services also include:
*Expert 2nd Opinion Service- Great for any new issue, chronic issue and actually required if the member is scheduling a non emergency surgery.
The member is always free to choose their choice of opinion to go with.
The goal is equip the member to make a fully informed decision.
*3 Counseling sessions with Head to Heart
*Conceirge Level Member services
Pre-Existing Conditions - Definition and Sharing Schedule:
A pre-existing condition is a chronic or recurrent medical condition that has shown signs, symptoms or needed treatment within the last 36 months before joining Sedera..
Pre-existing conditions are gradually shared based on tenure with Sedera
Year 1- No sharing for the condition
Year 2 - $15,000 sharing limit for the condition.
Year 3 - $30,000 sharing limit for the condition.
Year 4 -Shareable - No Sharing restrictions.
Tobacco users typically experience higher medical costs.
Sedera requires that households with one or more tobacco users contribute an additional $75.
Unless members age 50 and over are confirmed tobacco free for 12 months they have a sharing limit of $25,000 for Cancer, Heart conditions, COPD and Stroke.
New Members will receive:
A member welcome packet with instructional resources, and an invitation to join a new member webinar. Monthly webinars are hosted the first Tuesday of every month so members can continue to learn and get the most out of their membership.
Maternity expenses are fully shareable with the Sedera community that have a due date of at least 12 months after the members enrollment date.
Vaginal Deliveries and Emergency C-section deliveries have a fixed IUA of $5,000.
Planned C-Section deliveries have an IUA of $7,500.
A member's maternity IUA will be reduced by 50% for utilizing a birthing center.
Planned Home Births have a fixed IUA of $500.
Medical needs resulting from a miscarraige revert to the member's standard IUA.
Please see Sedera's full Sharing Guidelines for more information.
Curative Medications are included in the costs associated with the Need.
Medications that may become maintenance medications, are shareable for the first 3 month as part of the Need..
After 3 months, the member is responsible for the cost of their medication.
Sedera Member Services can assist the member with a myriad of low cost solutions as well as other resources available to help any member.
This Includes Goodrx.com, discount programs, mail order, international sourcing, patient assistance programs for very expensive medications and Prescription Containment memberships,
The member will have access to an array of options should the expense
of an ongoing medication warranted it.
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