Q. What is Sedera?

A. Sedera, Inc. is an innovative, non-insurance approach to managing large healthcare costs.  Sedera members join a community of like-minded individuals who are active and engaged participants in their healthcare decision making.  Together, we are tapping the power of community to create a new normal in healthcare that is high-quality, human, and transparent.

Q. Is Sedera an Insurance Company?

No.  Sedera, Inc. is not a licensed insurance company, nor is it in the business of insurance.  Sedera was intentionally founded to serve a broader community of members using the well-established principles of sharing without mandatory faith requirements.  Sedera, Inc. facilitates sharing for the Sedera Medical Cost Sharing Community. 

There are no insurance policies, guarantees, transfer of risk, or promise to pay. Instead, there is a group of like-minded individuals that have come together in community to share medical bills according to agreed to community sharing guidelines.  

Q. What’s the advantage of Sedera not being a health insurance company?

A. When health care costs are paid by someone other than the person receiving care, typically an insurance company or government entity, the health care model can be undermined. 

We believe many of the current problems with the healthcare system are the direct result of restricting personal freedom and responsibility through dependence on third-party payors. 

Sedera is designed to allow Members to help one another while maintaining freedom of choice and personal responsibility.

Q. Does Sedera differ from insurance?

Sedera’s process differs significantly from insurance practices; to our member’s advantage. 

Traditional health insurance deductibles are cumulative over the course of a plan year. Co-insurance is the portion of the medical expense owed by the patient. 

These insurance cost-sharing measures can amount to thousands of dollars in out-of-pocket costs to insurance policyholders annually. 

Conversely, when Sedera Members incur an eligible medical expense that exceeds their Initial Unshareable Amount (IUA), any remaining balance relative to that specific Need would be eligible for sharing, effectively reducing the member’s portion to the selected IUA for any single need. 

A need remains open if there are continued medical expenses for the "need"  and a year has not passed since another expense for that need has been experienced. 

The member meets his or her Initial Unshared amount only once for the "need"  which includes the aggregate of expenses surrounding a new illness or accident.

Q. Will Sedera share medical costs that were incurred outside of the United States?

A. Yes, Members’ eligible needs, wherever incurred, will be handled through your Sedera Membership.

Q. What happens when a provider requires payment up front for services?

A.  Member may be required to pay out-of-pocket for medical services. Sedera advises its Members to avoid paying more than their IUA toward the cost of any medical need, as doing so dilutes Sedera’s ability to negotiate with medical providers. 

In cases where Members pay more than their IUA, they will be promptly reimbursed for the excess amount by the Sedera community.

Additionally, Sedera occasionally provides direct up-front payment for proposed services. 

The most prominent example of pre-payment is with maternity cases. 

Sedera may pre-pay maternity cases, based on the provider’s self-pay rates, in advance of the baby’s delivery. In virtually all cases, needs payments are sent directly to Members, not to medical providers.

Q. Can I choose my own doctors and hospitals without being penalized?

A. Absolutely! Having the personal freedom to choose the medical providers of your choice is fundamental to Sedera’s values. Sedera’s Member Advisors will be happy to assist you in providing quality information to help you decide on the best provider(s), but there are no “out-of-network” penalties.

Q. How does Sedera handle medical claims?

Because there is no “transfer of risk” with Sedera’s Medical Cost Sharing, no “claim” is ever guaranteed. When Members incur medical expenses that exceed their IUA there is simply a medical need.

 Sedera Members submit proof of their medical expenses to Sedera where they are evaluated in accordance with the Guidelines. 

Qualified needs are then designated for sharing based on the amount of shares collected from Members each month. Each member’s monthly share is voluntary but also a requirement in order to remain an active participant in the membership.

Q. What is the process for paying my medical bills when I have a need?

At the time of service, Members should disclose to their medical providers (doctors, laboratories, clinics, hospitals, etc.) that they are “self-pay” patients. The providers will, in turn, bill the Member directly. The Member then organizes their bills, fills out a Need Processing Form (NPF) and submits the NPF, copies of all related medical bills and any proof of payments made towards their Initial Unshareable Amount (IUA). 

Our team of medical bill negotiators may contact the providers to discuss the appropriate payment for the services that were performed and determine if negotiations are necessary or available for the billed amounts. Sedera will review the need and help administer a process whereby community funds are share with the Member, less the Member’s IUA (as applicable), which, in turn, the Members use to pay their medical providers.

Q. If there is no network, what is the method used to secure fair pricing?

All Sedera members are “self-pay patients.” This enables significant leverage in the negotiation of medical bills. Our sister company, The Karis Group (TKG), is a professional patient advocacy and medical bill negotiation company. TKG currently serves nearly one million patient lives throughout the U.S. including negotiating all of the Needs for one of the largest Health Care Sharing Ministries in the nation. 

Sedera outsources the negotiation of all Member medical bills that exceed $500 to TKG. TKG’s average rate reduction exceeds 60% off billed charges. These savings are passed directly to our Members through the low monthly contributions they enjoy.
Learn more about The Karis Group

Q. How would medical emergencies be handled for international travel situations?

A. Medical needs incurred internationally would be sharable with the community in the same way as any other legitimate medical need within the U.S. If the member’s out-of-pocket costs exceeded their Initial Unshareable Amount (IUA) for a particular need while overseas, the Member would simply provide Sedera the details on the costs incurred along with any amount paid by the Member, and Sedera would facilitate sharing the portion that exceeds the member’s IUA.

Q. What are Sedera’s Membership requirements?

Sedera Members are eligible through their employment, membership, or participation in a Sponsoring Entity. Members must agree to abide by each of the nine Principles of Membership. See Sections 1 and 2 of the Member Guidelines for the details of Membership requirements. Members understand that medical expenses resulting from the use of illegal drugs, or while participating in unlawful activities will not be shared.

Q. How long does it take Sedera to process a medical need?

A. The sharing turnaround time normally ranges from 14-60 days from receipt of your bills and required information depending whether negotiation is required or not. 

If your Need Processing Form is correct and complete, and there are no ongoing financial negotiations with providers, your need will normally be shared the second Friday after Sedera receives it. 

Please note that larger bills make take longer to negotiate.

Q. How can I be sure that Sedera really works?

A. The concept of medical cost sharing has been highly successful within the confines of faith-based Christian groups for more than 25 years. More than one million members have shared over a billion dollars in medical expenses over that span of time. Hence, there is strong precedence in the concept. 

We believe that a community of health-conscious people who care for their fellow man can successfully participate in the sharing of one another’s medical burdens. 

It is important to note that past successes by faith-based sharing groups assisting one another is no guarantee of the future success of similar programs. There is no promise or contract by Sedera or the Members to contribute toward any need you might have in the future. The only promise by Sedera is to facilitate the voluntary shares given through the medical cost sharing process. Sedera distributes these monthly contributions on behalf of those Members with needs.

Q. Is there a lifetime or maximum amount that is eligible for sharing for any one person/family?

There is no specific annual maximum dollar amount or lifetime maximum limits per member, though certain dollar amounts and/or visit limits apply to specific types of medical care and therapies. Sharing is only limited to the cumulative contributions received from participating members in any given month. There is, however no limit on the number of needs that an individual member or household may have. Additionally, no single need may consume more than one third (1/3) of the total number of shares available in order to assure ample shares for all members.

Q. Does Sedera charge monthly premiums?

A. Because Sedera’s Medical Cost Sharing membership is not insurance there are no premiums. Sedera Members freely choose to assist other Members with their medical expenses by contributing a predetermined amount each month; called a “share.” 90.1 percent of each member’s monthly shares are designated solely for assisting other member’s needs.

Q. How do Sponsoring Entities pay for the Sedera Program?

All participating entities contribute shares directly on a monthly basis. Sponsoring Entities transfer the appropriate number of shares into their escrow accounts at the Designated Financial Institution.

Individuals may enroll in Sedera via the "Friends In Health" Registered Sedera Association which facilitates participation for it's members for a nominal $25 monthly administrative charge. 

Businesses may access Sedera  directly via Sedera Select.

Learn more about Sedera Select for Businesses

What happens if there are more medical needs than available shares in a month?

A. Sedera’s Guidelines clearly state the reality that payment is never guaranteed, but is always based on the commitment of the Members to each other. Sedera may overlap needs from multiple months so that there adequate shares for all Needs. However, if all needs cannot be met, Sedera uses a prorating method to evenly distribute the burden. For example, if there is only enough shares available for 90 percent of the needs submitted for a particular month, Sedera can only commit to sharing 90 percent of each need.

Q. Can my Membership be dropped if I have very high medical needs?

A. Members cannot be dropped from the membership due to their medical needs. Neither your membership nor your monthly share is affected by the amount of medical expenses you or any family members may have.

Q. What kinds of needs do Sedera Health Members share?

A. In general, needs for illnesses or injuries resulting in visits to licensed medical providers, emergency rooms, diagnostic testing facilities, laboratory or hospitals charges are shared on a per person, per incident basis. See Sections 6-9 of the Member Guidelines for details.

Q. How can I know if a need qualifies for sharing?

A. The types of needs that qualify for sharing can be found in the Member Guidelines. Consult Section 10 to familiarize yourself with the general procedures for submitting your need and Sections 6-9 for the specific requirements for sharing certain types of needs. If you have any questions, do not hesitate to call your Sedera Member Advisor at 1-855-973-3372.

Q. How does Sedera handle very large medical expenses?

A. There is no maximum limit to the amount that Sedera will share towards a specific medical need. However, the need must be within the scope of the Guidelines before it will be eligible for sharing. 

Because of the economic impact of very large medical bills (e.g., those over $150,000), Sedera has devised an internal mechanism to ensure that adequate shares are available to meet both our member’s normal and high-cost needs. 

For the very large medical expenses that occur from time to time, Sedera makes provision by allocating 15% of member’s monthly shares to remain available through a separate escrow fund that participating Sponsoring Entities have established. 

Sedera reserves the right to negotiate medical expenses with providers, and to prorate available shares, as necessary, in order to address all member’s medical expenses.

Q. Are there any specific medical conditions that have an exclusion or waiting period?

A.  A look-back period of 36 months applies to all prior medical conditions for Sedera applicants. A prior medical condition, as previously defined, is a condition in which the applicant has either received medical treatment, taken medications for, or exhibited observable symptoms. Any prior medical condition that has not exhibited symptoms during the 36 continuous months prior to membership effective date is considered cured and will have no sharing restrictions. 
Sharing restrictions do not apply for high blood pressure, as long as the member has not been hospitalized for high blood pressure in the 36 months prior to membership and the condition is controlled through medication and/ or diet. However, medication for treatment of high blood pressure as a chronic condition will not be shared.

Q. Does Sedera Community membership meet the ACA mandate?

A. The requirement of ACA compliance, or the exemption that healthcost sharing ministries have had over these past years, has been lifted in the vast majority of the states.

However, there are some states in the US which have state-level mandates and associated tax penalties for not having qualified insurance coverage. These may include NJ, VT & MA.

Sedera community membership does not make an individual compliant with the federal ACA mandate or any state-level mandate recently passed or being considered in a given state. Any and all applicable penalties would still apply for employers and individuals who do not meet the coverage mandates.

Each potential member will need to understand their state level requirements, any associated penalties, and make the decision that is best for their individual case.

Your Sponsoring Entity (your Employer or the association through which you have access to Sedera) may provide additional products (such as a self-funded insurance plan designed to address preventive care) that complement Sedera and/or satisfy ACA requirements.  

We recommend you connect with your Sponsoring Entity’s contact to obtain the required IRS documentation, if applicable.
Request more information on aquiring an additional MEC plan to satisfy NJ, VT and MA

How does Sedera Handle Maternity Expenses?

In general, maternity needs include expenses for prenatal care, delivery, postnatal care and miscarriage. 

The Guidelines specific to the sharing of maternity needs are referenced in Sections A, B and C below. Medical cost sharing for maternity needs differs from
other shareable medical needs as follows: 

  1. Medical expenses for child birth that have an expected delivery date within the first 12 months of membership are not shareable.
     
  2. Normal vaginal deliveries and emergency Cesarean section deliveries have a an IUA of $5,000. 
  3. Non-emergency/elective Cesarean section deliveries have a total IUA of $7,500. The standard IUA levels of $500 - $5,000 do not apply for Maternity Needs.
  4.  Home births have a IUA of  $500
  5. Members who wish to reduce their IUA’s may seek alternative deliver methods. 
  6. Medical needs resulting from miscarriages will revert to the member’s standard IUA. 
  7. Access to Sedera’s Member Services and Patient Advocacy teams is available to all members, whether or not the member is pregnant at time of membership.

The specific Guidelines for maternity needs that are shareable can be found in Sections A, B and C  

Are Alternative treatments eligible for sharing?

Shareable pending prior written approval by Sedera when:
1. Treated as "Alternative Medical Practices" and
2. Shareable if prescribed by licensed Doctor of Naturopathy. 

3. Pending prior written approval by Sedera. Member is required to demonstrate the proposed value of the prescribed alternative treatment; monetary savings, less-invasive treatment, shortened treatment protocol, et al. 


Q. Are annual wellness check ups included?

A. If you are a member of a Direct Care Practice the cost of your Annual Wellness is generally included or substantial discounts or resources for discounted services are given.


Through your Sedera Membership, Expenses such as routine physicals, checkups, vaccinations, flu shots, long-term maintenance prescriptions and other routine medical expenses are generally not shareable. Some exceptions exist for specific preventive screening procedures that are medically appropriate for the member’s age, gender and condition. 


Exception: Diagnostic procedures prescribed on a regularly scheduled basis for the purpose of screening and monitoring known risk situations or cured medical conditions when ordered by a licensed medical provider (e.g. colonoscopies, mammograms, endoscopies, et al.). Pre-existing condition limitation rules apply. Member’s selected IUA applies in all cases. 

How are prescriptions handled?

     

Prescriptions for medication related to a qualifying medical condition are shareable for the customary cost of the first 120 days. (Treatments for cancer and sublingual immunotherapy —a curative treatment for allergies—are not subject to this limitation; medications related to organ transplants are limited to 12 months duration) All medication, prescribed or not, administered during inpatient hospital stays will be shareable. Sedera employs various mechanisms in order to substantially reduce the cost of maintenance medications, including the use of a mail-order pharmacy program (buy-up option). 

Note: Sedera members do not share the cost of prescriptions for maintenance of chronic or recurring conditions (e.g. diabetes, eczema, blood pressure control) beyond the initial 120-day period. Subsequent sharing of a prescription for maintenance of the same condition will occur only when there is a new need. Sedera members do not share expenses for psychotropic medications for chemical imbalances that cannot be verified by laboratory tests. 

Is Counseling or Inpatient psychiatric care shareable?

Counseling is Not shareable outside of Sedera’s ancillary services network, however Membership includes access to professional counseling services (up-to 3 hours) per member per year. 


Shareable as follows: Inpatient psychiatric care due to involuntary commitment, and the treatment for injuries and detectable organic agents causing cognitive disabilities are shareable up to $5,000 per condition. 


Psychotropic medication to treat chemical imbalances not demonstrable by lab tests is not shareable except as a part of an involuntary commitment. 


Other types of psychiatric care or services are shareable to a maximum of $1,500 per separate need. 

Are Medical Equipment and Supplies Eligible?

Shareable if prescribed by a licensed medical provider. 


a. First month rental—As with all the sharing Guidelines, cost efficiency for the membership is desired in paying for medical equipment. With that in mind, the first month’s rental of prescribed, qualifying medical equipment (see paragraph c.) will be shared up to a maximum amount of the cost of purchasing the item. 


b. Rentals after the first month, and all purchases—Rental of equipment after one month, or any purchase of equipment, requires written preapproval to be shareable. 

c. Qualifying equipment—The equipment:
i. Must be a customary or necessary part of directly treating the condition (such as oxygen 

tanks and devices/respirators, special shoes, orthotics, crutches, compression socks, etc.). 


This would not include hospital beds; or
ii. Purchase or rental must result in an overall savings in cost (for example, hospital bed 

allowing for earlier release from the hospital).
d. Maintenance/Repair/Replacement—The cost of maintaining, repairing, or replacing 

equipment is not shareable. 

Registering as an individual - Easy as 1-2-3!

Memberships begin the first of any month - There are no enrollment fees, nor renewal frees!

Please note that enrollment/ registration needs to be completed and method of payment received and satisfied by the administration of Friends in Health Association prior to commencing membership the first of any subsequent month.

Step 1. Enroll/ Register with Sedera

Your first step is completing an online registration and medical history questionnaire form. 


Your payment method will be entered here.


Please use a mobile/ cell number when enrolling as you will be sent a text with information that you will need to set up your online account with Sedera.

Step 1 - Enroll/ Register with Sedera

Step 2. - Set up your online account

The next step is to set up your online account with Sedera. 


You will receive a text during the enrollment process. You will be entering that information during this next step.

Step 2 - Set up your online account

Optional Step 3 - Join a DPC membership for Preferred Pricing

Being a member of a Direct Care Practice has significant advantages. 


If a potential member does not wish to join a brick and mortar direct primary care practice it is recommended that they consider joining the virtual direct care practice MedLion.com


MedLion Membership costs $10 per adult with children's memberships are free. This DPC practice satisfies Sedera's requirement for DPC participation to access the preferred pricing and it,  most often, pays for itself and more.


Please compare Sedera's Standard Pricing vs. Preferred Pricing with a DPC membership.


After 

Step 3 (optional) Join MedLion - a virtual DPC - for preferred pricing

Or - Join a local DPC practice for Preferred Pricing

You will be transferred to DPC Frontier's website to use their mapper tool.

Please note that you may need to zoom in/ out to find a practice near you.

Find a DPC Practice near me

Confirm DPC membership

Email receipt of DPC payment/proof of participation to: TheHealthShareLady@icloud.com