There’s a new way to pay for healthcare.
Medical cost sharing is an alternative approach to managing large, unexpected medical costs through a membership-based community. Members support one another’s physical and financial health.
How Sedera Medical Cost Sharing Works
1
Select an Initial Unshareable Amount (IUA), the amount you’re comfortable paying without Community funds.
2
Sign Membership Commitments, Principles, Beliefs and provide existing medical condition information.
3
When you have a Need*, open a Needs Case in your Member Portal.
4
Shop for the treatment and value-driven provider of your choice.
5
Receive Community funds that exceed your IUA. Only pay 3 IUAs per membership year.
6
Pay your provider with funds from the Community.
Sharing Rules
General Medical Sharing Rules
Services provided for:
- Medical incidents
- Injuries
- Illnesses
And receiving treatment from:
- Licensed medical providers
- Outpatient surgery centers (for physician ordered treatments)
- Emergency rooms
- Diagnostic facilities
- Hospitals
- Specialists
Existing Medical Condition Sharing
Conditions for which symptoms and/or treatment existed within 36 months prior to membership.
- Year 1: No cost sharing for the condition
- Year 2: A $25,000 sharing limit for condition
- Year 3: A $50,000 sharing limit for condition
- Year 4: Condition eligible for full sharing
Medication Sharing Rules
Regular, Routine Medicines (“Maintenance”):
- Sharing eligible for first 120 days following a new diagnosis
Hospital Administered Medications:
- Fully shareable as part of an eligible Need
Medicines to Recover from Illness or Injury (“Curative”):
- Fully shareable as part of an eligible Need
Tobacco/Vape Sharing Rules
- Sedera Medical Cost Sharing households with one or more Tobacco/Vape Users1 contribute an additional $75.00 per month.
- If the Member is a Tobacco/Vape User and over the age of 50, then the Medical Needs for that Member are limited to $25,000 for certain related illnesses.2
Maternity Sharing Rules
- Maternity Specific Initial Unshareable Amount applies: 2x the Member’s selected IUA up to a maximum of $5,000.3
- Newborn Members must be added to a household no later than 30 days after birth to be eligible for shared funds.
Will My Medical Expenses Be Shared?
- Is considered medically appropriate
- Has been submitted within 6 months from Date of Service
- Performed by a licensed Medical Professional
- Meets Membership Guidelines
Member Resources
Sedera is committed to simplifying the Member experience and bringing the support, tools, and choices that assist in the day-to-day activities of managing your health. You’re able to shop for the best value, quality, and price for most things in life — shouldn’t you do the same with your healthcare?
Savvos Self Pay Marketplace
- Shop for imaging, outpatient surgery, labs, diagnostics & more
- Simplified communication, approvals, scheduling & payment
- And, enjoy a reduced IUA for utilizing Savvos
Get Real Support
- Real live experts
- Assist with sharing questions
- Guide you every step of the way
24/7 Telemedicine
- Add-on service
- Unlimited access to physicians
- Virtual care at your fingertips
The RX Marketplace Tool*
- This powerful shopping tool helps you find the best prices on medications
- Over 67,000 pharmacies to choose from, both local and home delivery available
Medical Shopping Concierge
- Service to help Members find self pay providers in their area and value-driven pricing for care
- Recommendations within 3-5 days