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:
The specific Guidelines for maternity needs that are shareable can be found in Sections A, B and C
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Email receipt of DPC payment/proof of participation to: TheHealthShareLady@icloud.com
Copyright - Karen Torsoe -TheHealthShareLady.com 845-641-9123