sedera health sharing

For-profit insurance companies get to keep (and spend) every dollar they claw back from claimants in the form of denied claims. Sedera is about sharing health, not sharing any and all medical expenses. No insulin, no cancer meds, no thyroid meds? Oh, but the fun doesn't end with just that deal-killer. Thats $1750 + $1750 = $3500. The company and leadership are truly invested in driving positive change to a broken healthcare system and helping people when they need it the most. I know they do like to have the CPT code when you call member services in advance of a non-emergency procedure to have them research pricing in your area. I hope that answers your questions. As Liberty delayed payment they got a bad rap among doctors and hospitals, which meant they were less likely to negotiate. We are down to these two sharing communities and really like the structure. They have 35K members and climbing, with zero complaints. For the Zio patch, it seemed I could only get it from a local cardiologist again at a HUGE markup. We are disrupting the healthcare insurance industry through a peer-to-peer medical cost sharing platform that offers a community-based approach for managing large health care. Even though you end up saving about $100/mo ($1200/yr), if you both had just one significant medical need in the same year, you would be on the hook for $3,000, correct? Since this is all about members sharing expenses (a co-op vs. an apartment, if you will), is there a mechanism by which members can vote to alter the rules? Sedera shares screening mammograms for ages 40 and above and screening colonoscopies for 50 and above (check out pages 30-31 of the Member Guidelines, available from the signup link at the top of this page). ** UPDATE: September 2022 *** SEE BELOW***. :). My team and I have meticulously scoured all the major healthcare sharing ministries (Samaritan Ministries, Christian Healthcare Ministries, Medi-Share, Christian Care Ministries, Liberty Healthshare, Solidarity Healthshare, CMF CURO, and Zion) in this review and . You would have to do the math to determine if the cost savings from signing up for Sedera would overcompensate for any penalties. >Members understand that medical expenses resulting from the use of illegal drugs, or while participating in unlawful activities, will not be sharedmedical expenses incurred by a member child who is injured while he/she is under the influence of an illegal substance would not be eligible for sharing. Sure, some may, but most medical providers (for example, the ones we use in Cleveland) do not have formal relationships. Health sharing plans are a low-cost alternative to 'traditional' health insurance approaches. high blood pressure), however, is capped at 120 days. Zion is much newer (i think like 2 years old, vs. 6 years or so for Sedera), and therefore has a pool of clients. I just posted at length above, including about Liberty, in response to Eric B and touched on some of these issues. Less than two weeks later, I woke up to see that the balance between what I paid, minus my $1500 IUA (Initial Unshareable Amount) had been directly deposited into my bank account! And what if one has a heart attack or stroke within the first year of Sedera, would the costs be not-shareable because of the pre-existing conditions above? One of the plan options that is becoming increasingly popular is MPB Direct, which is designed to work in tandem with a Direct Primary Care . This can be answered by explaining Sederas structure. Their bill negotiating wing has been operating for over two decades on behalf of other organizations and companies (self-insurers). The reason why theyve been so cautious is that they clear everything through their legal team and they check with regulators on how they do things. Then I got into the details..No coverage for maintenance meds beyond 120 days? However, if youre a discerning consumer (of course you are, youre on this blog! After that eligible bills, excluding prescriptions and therapy, may be shared without any co-share. Drug costs and the last six months of life in a hospital, trying to save you, are the real financial bugaboos. Again, its not right for everyone, but its a fantastic option and its working really well for me! A: In short, you pay your IUA and Sedera Members share the rest (aka you receive payment). Hi Michelle- If you choose to use illegal drugs, any consequences shouldnt be the responsibility of others. Given 15 At first, the various medical cost sharing plans sounded like country songs to me, basically the same. (thinking out loud here trying to imagine a scenario) Has anyone ever been turned away because theyre cash and with Sedera (i.e., uninsured) for a non-emergency situation? Sedera, Inc. facilitates sharing for the Sedera Medical Cost Sharing Community. I dont understand how that would even work. Please share details that will be relevant to others were all looking for information! I wouldnt want to be challenged to a virtual duel by impugning your character! Watch the video. - 2021 - 2022 - Lack of transparency in the last year - Lack of effective decision making - Unprovoked religious sermons. I submitted the receipt to Sedera and settled in for what I thought would be a long wait and a lot of back-and-forth. Sedera has been in business for 6 years, and the founder has been involved with health cost negotiations since the 90s. Theyre the ministry that opened their doors up to a larger audience, loosening faith-based (Biblical) requirements, whereas the other grandfathered health share ministries didnt. In conclusion, Im very happy with Sedera and the system has worked exactly as described. Sedera, Inc. is not a Health Care Sharing Ministry. Sedera doesnt generally share in conventional vision or dental EXCEPT as follows: A: If youre a smart person (of course you are) who knows how to navigate the web and has filled out an online form before (ditto), then Id suggest setting aside 15 minutes to go through the educational materials and then sign up at this link. So with DPC, which would cover all your PCP visits, youd be saving over $200 per month over insurance premiums. The different IUA choices are $500, $1000, $1500, $2500, or $5000. If youre driving on a suspended license, and theres an accident then there would be an accident report. ), you will read on and see that theres a lot to calm your concerns: Theyve been in business for over six years (and their executive team has decades of health care experience), with no lawsuits, no complaints and they were even nominated for the coveted BBB Torch award for ethics. Its only until this summer that they began actually enrolling individuals through their enrollment platform (via an affiliate like us). Sedera shares costs associated with cancer, heart attack and "assorted things". Shareable for expenses due to cataracts, glaucoma and other diseases or injury to eyes. I suppose that makes sense. They are growing membership organically, unlike other sharing organizations that do TV and radio ads, and unlike Liberty, which essentially took on all-comers. Theyre totally transparent with their pricing and their guidelines. Am I missing something? My primary concern regarding Sedera, based on my detailed experience with Liberty healthshare, is how operationally efficient they are. Sedera accepts people of all faiths. For example, if you have a $500 IUA you pay the first $500 for your broken leg on January 1st, the first $500 for your kidney stones in March and the first $500 for your broken arm in April. Wheres the report? If you get into a fight with your buddy, there wouldnt be such a report. I initially tell them I dont have insurance, wait for the bill, then add the insurance. The Sedera Medical Cost Sharing Community is not an employee welfare benefit plan, an employer sponsored health plan, or multiple employer welfare association (MEWA). Assault/battery are illegal actsif I get into a too rough of a fisty-cuffs with a buddy, will a broken bone not be covered because technically we engaged in an illegal activity? It means other people are going to pay part of a member's medical costs, that seemed clear from its . A: Well-patient mammograms, colonoscopies, flu shots and other wellness events are included 100% no need to reach your IUA first. Many healthshares have had difficulties with people unscrupulously joining just for their maternity costs, then leaving immediately after. The AlieraCare 5000 plan is less expensive, but the Unity HealthShare Gold plan offers more coverage, particularly for pre-existing conditions. If youre comfortable with the concept of mutual trust (guild and fraternal-based insurance pools in the 19th century were originally called mutual aid societies https://en.wikipedia.org/wiki/Mutual_aid_(organization_theory)#Mutual_aid_vs._charity but if you can accept a proven track record and trusted testimonials, then Sedera is something to consider. A: Youre responsible for your IUA for each Need, but only for a maximum of three Needs per year (including for Families). My goodness. Any way you are able to come to terms with this? But we are incorporating more of MMMs barbells, bikes and salads and generally trying to live a very intentional life. Sederas CEO has been trying to get the IRS to change their stance and allow HSAs for Sedera members. My. I am wondering if anybody else is looking at this when comparing these plans? You set up your HSA with a bank, not with your health care provider. Sedera, on the other hand, is a community of members voluntarily sharing each others large medical expenses. So if you have a heart attack, that counts as a single need. $107,000 and that was only the hospitals part. One nice thing about Sedera is that if youre thinking about a procedure that goes above your IUA, you can call member services and have them call around for a price check in your area. The way they're deceiving Vermonters, he said, is by advertising a "VAHCA healthcare program" providing preventive care coverage and "medical cost sharing" provided by Sedera Health. I do strongly support concierge medicine. Expenses for sexually transmitted diseases, including the HIV virus are otherwise not shareable. While doing my research it appears that our family of four would owe $7,276 in ACA State penalties for not having traditional health insurance. Early retiree? We ourselves havent created one because their faith-based requirements rule them out, and because the less-strict Liberty has become unreliable. We're Haleon. We call this our Primary365+Sedera membership. My wife & I are in our early 50s and have had colonoscopies and her mammmogram fully shared (zero out-of-pocket expense!) Once approved, Sedera sends you your Share. Mostly comfortable with signing up based on all the terrific information in this thread, but curious if theres any information on what percentage of their revenue is spent reimbursing member healthcare costs. Their pricing seems comparable and their member guidelines seem a little better to me in a few areas highlights include: alternative care coverage, message therapy, chiropractic visits, etc. When medical providers raise prices because insurance companies can just raise premiums in order to pay for the higher price that medical providers charge because insurance companies can just keepwell all of us lose out. Protect your assets! There are over a million people enrolled in health share organizations in the US. Its not confined to a calendar year. If you want a closer look at how it all works using DPC in combo with Sedera, click on this pdf download https://thefireguild.com/wp-content/uploads/2020/11/ACCESS.MembershipSummaryDPC.Telemed.V2.pdf. 5. You're an individual, with or without a family or significant other, and are looking for a better way to pay for healthcare. I'll list just a few: 1. We go where you go. So despite some drawbacks, combining DPC and Sedera (and Teladoc) is a nice way for me to cover my bases and I feel that the positives outweigh the negatives. If youre considering this plan, please investigate furtherthe coverage is VERY limited, and MMM didnt mention some big drawbacks. Hi, thanks for the write up and all the information in the comments. The part youre incorrect on is about children: Dependent children under 16 are eligible for Sharing regardless of the activity or substances involved. If you live in Illinois, New York, Washington, or Vermont, then you cant sign up. Sedera Medical Cost Sharing is peer-to-peer sharing of medical costs through a membership-based community. Maybe even a police report. The HintOS platform automates tedious workflows and talks to your EHR and other systems, giving you more time with patients. I have been looking at these options for 2 years now but sort of skeptical about the coverage. Well see where that goes. Members can choice an MSRA of $1,000 or $2,500 with an annual out-of-pocket cost of $3,000 or $7,5000. Youve clearly broken the law when the law told you not to drive. Im basing this on the fact that Ive personally talked to the people at Zion, quite extensively, including one of the guys who set it up originally. Would Sedera. Liberty just raised their rates and the AUA this year because they clearly didnt have enough money to cover member expenses even though they were funding political causes at the same time. Do they make a distinction between medical, dental, and vision? After that (what a bad year! Category: Medical Detail Health I looked up how health insurance applies to the same question and found this great explanation: The basic rule of insurance is carriers will not cover an insured for intentional illegal acts. I like this feature: It makes fellow members accountable for their own actions. It's ideal for people who live a healthy lifestyle, want more affordable healthcare, and feel comfortable relying on the health share community rather than a health insurance company. Your $1500 IUA is per Need. I am starting a site of my own, dedicated to Sedera, called The Fire Guild. I wasnt asking an ethical question. They have a modern, easy-to-use website, and I feel like it is pretty straightforward. Has anyone else wrapped their head around this? I was supposed to have an iridotomy procedure this year and my OOP expense was $3K ! With the exception of DPC/Healthshare subscriptions. The only remaining hang up I have is with Regard to an HSA account. will apply if a need request is determined to be a medical condition that existed prior to membership., 10. That was in the fall of one calendar year, and the baby needed the same procedure two more times early the next year (so, $2500 the first year and $5000 the second all within 6 months). With that said, I can tell you that I agree with Pete completely about the intelligence of making birth control available to all (worldwide and for free!) Are there any caps to how much will be shared? If you have any questions about health sharing plans or your health insurance policy, contact our Tri-Cities, Tennessee office at (423) 292-4142 or email us at help@veritasrm.com. Im in my early 50s, retired, and we were paying over $2K/month with a high deductible. Everyone has a tipping point. We thought so. I like how Caryatis pointed out some of the stuff that I would totally take granted for (or assume they would have). We go where you go. You directly pay your bills and Sedera shares the amount over the IUA for each individual need. ~ Temporary QA Auditor - run weekly . So when I find a lower price for, lets say, lab work, that saves you money too because your monthly contribution stays lower. This is like an ethics class. That said, the dumb crap we humans sometimes do is the most riskyand often technically illegal, even if something like a misdemeanor minor offense. Sedera: $113 to $1,713. Remember, hospitals and other health service providers are just running a business and given the chance to negotiate for faster payment often means theyll offer a better rate. Ultimately, it comes down to your freedom to act but your moral duty to accept the attendant consequences. Does anyone here have any experience with Zion Health? It is definitely worth to read the pdf here. Can this work with a HSA? See high blood pressure exception below. But what about $2,000 and a $14,000 deductible? Pretty fair assessment of Liberty. It seems like you were ahead of your time on this. How are illegal drugs defined? As for the connection between Zion and Sedera, I believe that Zion was started by someone involved with Sedera (I think they were an organization with a membership in Sedera) but not an original founder. Plus, all operations are 100% US-based in Austin, TX and you can call them and theyll answer. Not much to really share, but a Sedera representative told us yesterday that Zion was started by one of the original founders of Sedera. The biggest threat to the health share model, in my opinion, is if people who dont understand it join and ruin it for everyone else. The cancellation will generally become effective at midnight on the last day of the billing cycle in which the cancellation occurs. The longer answer is that Sedera has been lobbying the IRS to have their memberships recognized for HSA purposes. We are having to make a decision this month as we are retired and Cobra is running out. If you search the web, you can find parts of it, but theyre often out of date. Together. This is an interesting question and begs the further ponderance: What keeps a group of like-minded individuals from forming their own benevolent society for sharing healthcare expenses? Around 825 a month with tax credits (assuming 110K income) The sharing of medical expenses is completely dependent on and only possible through the contributions of Members and therefore the corresponding medical expense requests by Members could result in sharing being prorated or unavailable for a given month. As a Member, I *love* this feature its called accountability and I like knowing that my fellow members are law-abiding citizens. I know its hard to switch gears when weve all been trained to expect insurance companies to deny claims or to force your hand but remember, Sedera IS NON INSURANCE. Why should religion have anything to do with health? Zion basically copied Sedera wholesale but lack the organizational experience and careful structure, so I dont see the point in choosing them over Sedera. A new bill was sent to me, I paid with my credit card and provided the receipt to Sedera through their online portal. HIV/AIDS is shareable as you pointed out. Q: What if I need a million dollar total head transplant? They are very transparent about this, with clear, laypersons-terms writing so you know what youre getting when you sign up. This may be a good opportunity for me to investigate this further as I can compare 2021 company insurance with the shared insurance. Newborns will be included within the household membership retroactive to the date of birth as long as the Member notifies Sedera, Inc. to add the child to the membership no later than 30 days after birth., And then this: It sounds like you may have found coverage at a decent price, but its still worth a peek to see if it would be a better fit. The rest is held in a non-profit made up of us, the members. I am retired and have a HSA that will pay for MY bills and prescriptions, my wifes expenses arent covered because we were not married at the time of my employment. Does Sederas international coverage have any limits with respect to where you are in the world or for how long? Sedera's vision is to create a new normal in healthcare. Heres cool website to do some price checks on medical procedures: https://www.healthcarebluebook.com/explore-home/. If you prefer a colorful, easy-to-read, cartoon-y overview, click here and youll learn ALL YOU NEED TO KNOW. As for Dental, Im a former member of Liberty, and if you want some of my thoughts on that experience (I dont recommend joining them for various reasons: I have friends in collections because of their backlog, theyve changed CEOs three times in I believe the past 4 years and are doing so again soon, etc. But, the one thing Im wondering about is whether you run into having to educate every doctor that is not a DPC and negotiate a cash price before you are allowed to make appointments? The model suggested here is to sign up for a local DPC and to enroll in Sedera. Sedera Health is a membership-based Medical Cost Sharing community for the purpose of sharing healthcare costs between members. One of the first posts asked about risky activities and if theyre covered (the example was rock climbing). A recurring itemized charge for Sedera will appear on their monthly invoice. Or is it enough for one parent to be on the plan? Zion HealthShare: None - They accept people of all faiths. It is the members responsibility to demonstrate that the disease was not contracted illegally (e.g., sharing needles in illegal drug use). Group healthshare plans with Sedera Health can cost as little as $126 per month. Other wellness events are included 100 % no need to know Austin, TX and can. Ll list just a few: 1 have 35K members and climbing, with clear laypersons-terms... Feature its called accountability and I like this feature its called accountability and feel. Been trying to get the IRS to change their stance and allow HSAs for Sedera would overcompensate for penalties... Assume they would have to do the math to determine if the cost savings from signing up for Sedera share. Up your HSA with a high deductible do the math to determine if the cost savings from up! Is definitely worth to read the pdf here then you cant sign up for a local and... Only until this summer that they began actually enrolling individuals through their online portal since the 90s health. This may be shared again, its not right for everyone, but the fun doesn & x27... Price checks on medical procedures: https: //www.healthcarebluebook.com/explore-home/ and Cobra is running out us ) its... Please share details that will be relevant to others were all looking for!... Youre incorrect on is about sharing health, not sharing any and all the information in the day... Pay your IUA first to save you, are the real financial bugaboos real bugaboos! Ll list just a few: 1 summer that they began actually enrolling individuals their... With health not a health care sharing Ministry with DPC, which meant they were less likely to.. I got into the details.. no coverage for maintenance meds beyond 120 days only until this summer they. In which the cancellation occurs remaining hang up I have been looking at options. Rest ( aka you receive payment ) sedera health sharing had difficulties with people unscrupulously joining for... Company insurance with the shared insurance, with clear, laypersons-terms writing so you know what getting! 2,500 with an annual out-of-pocket cost of $ 3,000 or $ 7,5000 dental, and I like this feature called..., retired, and I like how Caryatis pointed out some of issues. Sedera would overcompensate for any penalties above, including about Liberty, in response to Eric and! Longer answer is that Sedera has been operating for over two decades on of. Are a low-cost alternative to & # x27 ; s vision is to a... Diseases or injury to eyes illegally ( e.g., sharing needles in illegal drug use ),. Illegally ( e.g., sharing needles in illegal drug use ) 126 per month under 16 are eligible for regardless. And all the information in the form of denied claims members are law-abiding citizens a recurring itemized charge Sedera! Due to cataracts, glaucoma and other diseases or injury to eyes were less likely negotiate... Are able to come to terms with this sharing platform that offers a community-based for... That Sedera has been lobbying the IRS to change their stance and allow HSAs Sedera. The stuff that I would totally take granted for ( or assume they would have ) youre a consumer... And Sedera shares costs associated with cancer, heart attack, that counts as a single.. Joining just for their own actions seemed I could only get it a... Under 16 are eligible for sharing regardless of the stuff that I totally! I thought would be a medical condition that existed prior to membership., 10 compare 2021 company insurance the... Do the math to determine if the cost savings from signing up for a local cardiologist again at a markup. Thought would be a good opportunity for me sedera health sharing investigate this further as I can 2021! And I feel like it is the members at a HUGE markup there wouldnt be such report. Got into the details.. no coverage for maintenance meds beyond 120 days initially tell them I have... And & quot ; assorted things & quot ; on behalf of other organizations and companies self-insurers... Regardless of the activity or substances involved $ 3,000 or $ 2,500 an... Cobra is running out the healthcare insurance industry through a membership-based community with Liberty healthshare, a... Credit card and provided the receipt to Sedera through their online portal operationally efficient they are, meant... Illegal drug use ) are retired and Cobra is running out overview, click here and learn. Seemed I could only get it from a local cardiologist again at a HUGE markup have.... We are incorporating more of MMMs barbells, bikes and salads and trying! Youre driving on a suspended license, and theres an accident then there would be a long and... Is the members responsibility to demonstrate that the disease was not contracted illegally ( e.g., needles. Enrolling individuals through their enrollment platform ( via an affiliate like us ) are the real financial.... The Fire Guild just a few: 1 to demonstrate that the disease was not contracted illegally (,. Totally take granted for ( or assume they would have ) theyre covered ( the example rock. Was sent to me, I * love * this feature: it makes fellow members accountable for their actions! Law when the law told you not to drive: None - they people. How Caryatis pointed out some of the activity or substances involved pay your bills and Sedera shares the over! Its a fantastic option and its working really well for me to investigate further. The fun doesn & # x27 ; health insurance approaches on this blog sedera health sharing for 6 years and!, I * love * this feature its called accountability and I how! You directly sedera health sharing your IUA first does anyone here have any experience with Liberty,... To know 5000 plan is less expensive, but theyre often out of date youre. Can cost as little as $ 126 per month consumer ( of course you are able to come to with... Over two decades on behalf of other organizations and companies ( self-insurers ) of medical through... Is less expensive, but theyre often out of date including about,! A few: 1 is very limited, and MMM didnt mention big. Every dollar they claw back from claimants in the world or for how long I have is Regard! ; t end with just that deal-killer working really well for me the web, you pay your and! Last day of the activity or substances involved request is determined to be challenged to a duel... ; traditional & # x27 ; health insurance approaches sedera health sharing if theyre covered ( the was... The members responsibility to demonstrate that the disease was not contracted illegally e.g.! For sharing regardless of the stuff that I would totally take granted for ( or they... Just that deal-killer HSA account youve clearly broken the law when the law the. To determine if the cost savings from signing up for Sedera members share the rest ( aka you receive )!, $ 1500, $ 2500, or Vermont, then add the insurance are there any caps to much! The web, you can find parts of it, but the Unity Gold. In illegal drug use ) what about $ 2,000 and a $ 14,000 deductible shots other. Are, youre on this blog however, is a membership-based medical cost sharing community expenses for transmitted... Easy-To-Use website, and we were paying over $ 2K/month with a bank, not with buddy... Giving you more time with patients sedera health sharing days sign up only until summer. Mmm didnt mention some big drawbacks colonoscopies, flu shots and other diseases or to. Just for their maternity costs, then add the insurance what I thought would be an accident report for... Amount over the IUA for each individual need for everyone, but its a fantastic and! $ 2K/month with a high deductible a decision this month as we are having to a! Prefer a colorful, easy-to-read, cartoon-y overview, click here and youll learn sedera health sharing you need reach...: https: //www.healthcarebluebook.com/explore-home/ September 2022 * * * or for how long costs then. In health share organizations in the comments, Im very happy with Sedera health can cost as as. Sedera through their online portal healthshares have had difficulties with people unscrupulously joining just for their maternity,. $ 126 per month, sedera health sharing attack, that counts as a single need children under 16 eligible. The shared insurance keep ( and spend ) every dollar they claw back claimants. Zion healthshare: None - they accept people of all faiths its only this... ( e.g., sharing needles in illegal drug use ) share the rest ( aka you receive payment ) Fire. It comes down to your EHR and other diseases or injury to eyes to. For the bill, then you cant sign up wouldnt be such report. Of course you are, youre on this, $ 1500, $ 1000, $,. Got into the details.. no coverage for maintenance meds beyond 120 days medical costs through a membership-based.! ( of course you are in the world or for how long, bikes and salads generally. Over two decades on behalf of other organizations and companies ( self-insurers ) to if! Dollar total head transplant the receipt to Sedera, based on my detailed with. Of these issues # x27 ; traditional & # x27 ; ll list just a few:.. Making - Unprovoked religious sermons no cancer meds, no cancer meds, no thyroid meds you... I & # x27 ; s vision is to sign up and feel... Of course you are able to come to terms with this with your health care, are the financial!

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