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What is medical cost sharing

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The Health Excellence Plus - Healthy Care Strategy to Control Health Care Costs uses Sedera Health Medical Cost Sharing to CONTAIN them.

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What is medical cost sharing

  1. 1. Join the Association and be part of our group. What is Medical Cost Sharing?
  2. 2. Our Healthy Care Strategy uses Medical Cost Sharing to Eliminates the chance of financial catastrophe from bad health. Healthcare Expenses
  3. 3. 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.
  4. 4. For the benefit of the shareholders that own the Insurance Company
  5. 5. For the benefit of the members that share in the Community Funds
  6. 6. Medical Cost Sharing – a Fast Growing Health Solution
  7. 7. 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
  8. 8. 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.
  9. 9. 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
  10. 10. Medical Cost Sharing in Real Life (continued) Members pay for visits and treatments up to the IUA, costs are fully shared thereafter.
  11. 11. 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..
  12. 12. 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)
  13. 13. 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.

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