For the Essential Plan, it is very important to understand that the federally defined preventive care services are covered, but nothing else.  Any other visits or appointments would be out-of-pocket for you and not covered.  On the Summit Plan there are co-pays for ongoing care ($20 for your primary, $50 for a specialist, $50 for lab work, $50 for Urgent Care - capped at 3 visits per person per year) and prescription drug coverage is also included.  For prescription drugs we can verify that the drug is included with CitizensRX; the Pharmacy Benefit Manager.  Just let us know the medication, dosage, and frequency, and we can look it up for you.  Both plans also include virtual primary and urgent care, as well as behavioral health through Recuro with no additional, no copays, and unlimited use!

Here is a brief summary for the eBenefits Preventative Care Plans.  Two choices to best fit your needs, family, and budget:

• Essential – The eBenefits Essential/HDHP (High Deductible High Premium) Plan provides the Minimum Essential Coverage at a lower monthly cost but does not include a prescription plan or coverage for specialists. The eBenefits HDHP plan does allow for the addition of a Health Savings Account (HSA).  Limited to the 80 federally defined preventive services.

• Summit – eBenefits Summit provides 100% coverage for preventive care, copayments for small and medium cost medical expenses, and prescription coverage.

In order to have a program that would include the larger, unforeseen medical expenses (hospitalization, surgery, diagnostic imaging, ER visits, etc.) you would need to add a Sedera Membership.  For Sedera, they do not use any network so you do not receive a card from them.  When you use your Sedera membership, you present yourself as a self-pay patient and asked to be billed.  Sedera is Medical Cost Sharing and not insurance.  There are a series of great videos that you can review for Sedera, each is just a minute or two - https://vimeo.com/showcase/5450309.  

For Sedera, there are 5 IUAs to choose from:

• 5 IUAs to choose from - $500, $1,000, $1,500, $2,500 & $5,000

• The IUA you select is what you are agreeing to be financially responsible for if you have a shareable need.  For example, if you break your leg and the total costs are $10,000 and you have the $1,000 IUA, you are responsible for paying the first $1,000 and the balance is shared through the community.

• NOTE: There are restrictions on pre-existing conditions, please contact us to review as these conditions may not be shareable.

If you do need to use your Sedera membership, you would call them in advance if possible or soon after if it is a medical emergency.  They can be reached at 855-973-3372 or memberservices@sedera.com.  When you speak to them you would tell them what has happened and that you need to submit a Need for sharing.  There is a great video on this process as well - https://vimeo.com/419015848.

Also, with your Sedera membership, the following are also included:

• Rx Marketplace:

• Sedera Members enjoy multiple ways to purchase medications and save! Discount Cards Use at Pharmacy of your choice. Over 67,000 in our network. International Pharmacy You can purchase the same quality medications from Canada and other countries. We have vetted the best vendors, providing safe and secure delivery.

• 2nd.MD to ensure you and your family receive the most up-to-date medical treatment available

• We’ve all hassled with doctor waitlists, gone back and forth to get a referral and searched the web for answers to medical issues. As a member of Sedera Health, you can bypass these frustrating steps through a program called 2nd.MD.

Lastly, we also now offer RCI Dental through Aetna

• RCI is a leading third-party administrator that is here to provide you with comprehensive dental coverage. Negotiated rates make the dental network Aetna Dental Administrators program, powered by the national Aetna Dental Access® network, very competitive. In most instances, savings range from 15-50 percent on services from general dentistry and cleanings to root canals and crowns.

A simple rate calculator can be found here: https://www.salahealthcare.org/pricing-calculator.  Enter the following:

• Type of coverage (Individual, Family, etc.)

• The age range of the oldest member

• The eBenefits plan you prefer (Basic or Advantage)

• The Sedera IUA

As always, if you have any questions please let us know.

For more information, please contact SALA:

• Email: hpsupport@smallassociations.org

• Phone: 888-994-4979