Cost sharing is caring

Sedera Members commit to sharing one another’s medical burdens. Members choose their Initial Unshareable Amount (IUA) during enrollment. This is the amount Members are required to pay per injury, illness or medical event without help from the Community. Members make monthly contributions to the Community and when a Member has an eligible medical expense that exceeds their IUA, the Community shares from the contributed funds to help pay the remaining balance.

Sedera ACCESS+ is a good fit for DPC patients who generally commit to a healthy lifestyle. Sedera is very specific about the medical needs that are eligible for sharing and your patients should review the ACCESS+ Membership Guidelines, Membership Summary, and FAQs to ensure ACCESS+ is right for their needs.

ACCESS+ is an individual or family membership available for DPC patients. It is not available through an employer group.

The Hint Core platform makes it easy to offer Sedera ACCESS+ to your patients— once it’s turned on in your account, it’s as simple as the click of a button. Your patients will be billed each month for both your DPC membership fee and for Sedera. However, if you don’t have Hint, your patients can enroll on Sedera.com or contact Sedera directly for more information.

The Sedera product that pairs with Direct Primary Care is called Sedera ACCESS+. Right now, Sedera ACCESS+ can only be offered by doctors who meet certain requirements. Support for other kinds of direct care practices is coming soon.

All DPCs are eligible to refer Sedera to patients. In addition, Sedera hasa cross-referral program for approved DPCs. Approved DPCs are included on Sedera’s DPC Finder Map and Sedera Members who pair their membership with an approved DPC receive a discount on their monthly member contribution rate.

Insurance arrangements are a contract whereby one party agrees to be legally responsible for and accept another party’s risk of loss in exchange for a payment—a premium. Medical cost sharing is an arrangement whereby Members agree to share one-another’s medical expenses through an act of voluntary giving. Sedera is not licensed or registered by any insurance board or department since Sedera is not practicing the business of insurance. Sedera does not assess applicants’ health risks, because neither Sedera nor their Members are assuming financial liability for any other member’s risk. Unlike insurance, the focus of Sedera’s medical cost sharing program is on how Members help each other with their immediate needs.

If shareable Needs are ever significantly greater than shares available in any given month, the Sedera MCS Community may prorate the Needs amount requested for medical expenses. This involves an across-the-board percentage reduction of Needs payments but does not necessarily mean that all Member Needs will not be met in that month. However, to date, Sedera has not had to prorate any sharing.

A look-back period of 36 months applies to all pre-existing medical conditions for Sedera applicants and is subject to sharing limitations unless 36 months immediately prior to the membership start date has passed without any signs or symptoms of the condition, without any treatment needed, without any medication prescribed or taken, and without any suspicion by the patient or doctors that the condition is resurfacing. 

Pre-existing medical conditions will become eligible for sharing based on the Member’s tenure and a graduating sharing schedule. This schedule and sharing limitations are included in the Membership Guidelines.