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Association Health Plan Overview

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Association Health Plan Overview

  1. 1. American Healthcare Today! Through an innovative layering of healthcare services, we enable individuals and families access to high quality healthcare that is affordable, flexible and effective
  2. 2. Every Member is able to Build Their Own Healthcare Plan Because we all have different needs
  3. 3. Our Healthy Care Strategy to Control your Medical Costs has (5) five Components that combined together create Our Health Excellence Plus™ Plans
  4. 4. All plans provide Education and Wellness to Medical Costs Control medical costs with lifestyle modification. We believe that the # 1 Reason people don’t reach their health goals is the everyday interruptions of Life. Our Wellness Coordinators use a multi-touch outreach program to engage members with • The MyAHE Secure Members Communication Portal • “Welcome Call” onboarding every member personally • Secure Audio and Video Connections, • Direct Mail, Email Campaigns, Text Messaging, • Webinars and Seminars • “MPowering Benefit Association” Newsletter • The Health Rewards Program and more…
  5. 5. My Academy of Health Excellence and MPowering Benefits combine together to provide the most innovative and effective Member Education, Engagement and Wellness Platform in the Industry. The MPB 1-1-1 Access to Services Program MPB Member and Concierge Services The US Corporate Wellness Platform “Welcome Call” onboarding every member personally QR for Life Code for Emergencies & Medical Vault The Wellfit Community (Facebook for Wellness) Twelve Habits of Highly Healthy People (sponsored by Mayo Clinic) “Seven Normals” Rewards Program (modeled after the Cleveland Clinic’s) REDUCING member monthly amount Pharmacy Consulting Services (including World Meds, Canadian Drugs and GoodRx) And More...
  6. 6. and Medical Cost Sharing to Medical Costs Eliminates the chance of financial catastrophe from bad health. Sedera Health (Sedera) is a group healthcare solutions and benevolence organization. It’s modeled after a number of proven and highly successful medical sharing ministries that have facilitated the sharing of their member’s healthcare expenses for more than two decades within the confines of the Christian community.
  7. 7. Sedera Health (Sedera) is a group healthcare solutions and benevolence organization. It’s modeled after a number of proven and highly successful medical sharing ministries that have facilitated the sharing of their member’s healthcare expenses for more than two decades within the confines of the Christian community. In addition to sharing medical expenses, Sedera provides access to: • Valuable Counseling • Medical Bill Negotiation • Telemedicine • Expert Second Opinion • Personal Member Advisor services to all members.
  8. 8. Medical Cost Sharing – a Fast Growing Health Solution
  9. 9. Medical Cost Sharing – a Better Way Health Care through Community vs Health Care through Insurance Industry Wide Estimate: 1 Billion in Sharing 1 Million Members Freedom from Networks Big Savings Over Health Insurance Sharing begins at $500, $1000, $1500, $2500 or $5000 per need you decide Promotes a Healthy Lifestyle Medical cost sharing by Sedera Health is not insurance and is specific to the Sedera Health membership community. “Industry-wide statistic source: www.healthcaresharing.org
  10. 10. Medical Cost Sharing is “Need” Based Defining a “Need” and how it works A “Need” is one or more medical expenses caused by a SINGLE accident or illness Initial Unshared Amount (IUA) What members pay before Sharing begins for the Need Needs over the IUA ($500, $1000, $1500, $2500 or $5000) Limiting your out-of-pocket costs Fully Shared with the Community Three (3) for Individual and five (5) when there are family members participating. Everything is fully shareable after that point.
  11. 11. Medical Cost Sharing in Real Life Comparing $5000/Family Member Insurance Deductible vs a $500 Initial Unshareable Amount For Example, a family’s two year old daughter had a persistent ear infection. Their deductible was $5,000/per family member threshold Care for the child required: 1. A series of antibiotics and booster injections 2. Visit with an ENT specialist who inserted tubes in the child’s ear at a local hospital Cost of an average family insurance policy with a Primary of 45 and a $5000 deductible is $1450.00 per month, a $500 IUA Healthy Care Strategy is $783.00/mn
  12. 12. Medical Cost Sharing in Real Life (continued) Members pay for visits and treatments up to the IUA, costs are fully shared thereafter.
  13. 13. Pre-Existing Conditions Pre-existing Conditions: When well controlled, these conditions DO NOT have sharing restrictions • High Blood Pressure • High Cholesterol • Sleep Apnea • Non-Insulin Dependent Diabetes Pre-existing Conditions: Sharing Restrictions* A condition is considered pre-existing if a member had symptoms or treatment in the last 36 months at the time of joining the community. • Year 1: No Sharing for the Condition • Year 2: $15,000 sharing limit • Year 3: $30,000 sharing limit • Year 4: Fully Shareable * Standard sharing restrictions apply when joining the community for genetic defects and/or hereditary disease. There are also restrictions on existing pregnancies when joining the community. Please see the Sedera Member Access Membership Guidelines for more information..
  14. 14. Prescription Drug Coverage Medications: Cure Examples: Antibiotics, pain medications related to a care accident or post pregnancy, chemotherapy drugs + Same sharing rules apply Maintenance Examples: Blood pressure medication, cholesterol medications + Sharing eligible for first 120 days following a new diagnosis + After 120 days on a new diagnosis (or for an existing diagnosis): Our Pharmacy Consultant has good resources for securing discounted prices for maintenance medications (paid from pre-tax HSA or Health Matching Account HMA)
  15. 15. Combined with the other (3) three layers of the Healthy Care Strategy to Control Medical Costs & Creates the Core Health Excellence Plus Healthcare Plans Preventive Care Money Management Advocacy & Technology with with
  16. 16. The Core Health Excellence Plus™ Healthcare Plans are broken into two Major Categories
  17. 17. Self-Managed Healthy Care Plans are designed for our healthiest Members who are living a “Lifestyle” of nutritious eating and regular exercise. They are Self-Pay Patients with a backup plan and as such will receive the “Best Cash Price”. Physicians & Hospitals will be happy do give them a 30-70% discount because they don’t have to wait several months to receive payment as with health insurance. Should a “Need” (i.e. large medical expense) be more than the Initial Unshared Amount (similar to a deductible) they selected, the Medical Cost Sharing Community will pay the full amount at 100%.
  18. 18. Limited Coverage Self-Pay Patient (Optional) HMA Health Matching Account Teladoc Bill Negotiations Advocacy Colonoscopy Mammograms Immunizations only Self-Directed Healthcare
  19. 19. Self-Pay Patient Teladoc Bill Negotiations Advocacy (optional) HSA Health Savings Account HMA Health Matching Account Partially-Directed Healthcare Minimum Essential Coverage 64 Preventive Services PHCS Network
  20. 20. are designed for our health-focused Members who desire a strategy that is more like a traditional health plan. They prefer to pay a little higher amount each month to have pre-defined pricing for their small and medium sized medical expenses. Choose from a co-pay program with a large PPO network, a Direct Primary Care Doctor, or a Provider Directed Access Program whichever is best for you. Should a “Need” (i.e. large medical expense) be more than the Initial Unshared Amount (similar to a deductible) they selected, the Medical Cost Sharing Community will pay the full amount at 100%. Physician-Managed Healthy Care Plans
  21. 21. PHCS Network PHCS Network Office Visits, Labs, Imaging Teladoc Bill Negotiations Advocacy PHCS Network Co-Pay Network Healthcare Minimum Essential Coverage 64 Preventive Services (Optional) HMA Health Matching Account
  22. 22. All Covered by Direct Primary Care DPC-Direct Primary Healthcare Direct Primary Care Direct Primary Care Office Visits, Labs, Imaging Bill Negotiations Advocacy (Optional) HMA Health Matching Account
  23. 23. All Covered by Redirect Health Redirect Health Office Visits, Labs, Imaging Chiropractic Bill Negotiations Advocacy Provider-Directed Healthcare Redirect Health (Optional) HMA Health Matching Account
  24. 24. found on www.MPoweringBenefits.org Use our “Healthcare Needs Analysis” or talk it through with your Agent to determine which of the five core Health Excellence Plus™ Plans is best for you.

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