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Frequently Asked Questions

What is Sedera?

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.

Definitions

There are terms that will be used throughout the website and this FAQ that are helpful to know. They are the following:

Need

A medical expense that exceeds the member’s Initial Unshareable Amount (IUA) caused by an injury or illness to an eligible Member or participating dependent.

Membership Guidelines

Our membership guidelines outline the expectations for all members participating in our Medical Cost Sharing Community and are used by Sedera, Inc. to determine medical expenses that are or are not shareable with other members of the Community.

Member Contribution

The amount that you contribute each billing cycle to participate in Sedera’s Medical Cost Sharing Community. It is determined by your age, your elected IUA and the number of household participants included in your membership.

Billing Cycle

Sedera’s billing cycle is monthly and contributions are made in advance. Your specific billing cycle is determined by your membership start date + 1 month. For example, enrolling for a membership start date of the 15th of a month will mean your billing cycle will be the 15th of one month through the 14th of the next month. Changes you make to your membership will be reflected at the start of your next billing cycle.

Initial Unshareable Amount (IUA)

The Initial Unshareable Amount is the financial portion ($500 - $5,000) that members pay their medical providers prior to any amount becoming eligible for sharing. After the IUA has been satisfied, a qualified Need, as determined by the Guidelines, becomes eligible for sharing consideration.
How long does the Need sharing process generally take?
Sedera prides itself on being a responsive and proactive medical cost sharing community. Once a Need is submitted using our simple to follow process, sharing generally occurs within a 14-30 day window. Members may experience variation in time caused by the size of the medical expense or the responsiveness of the individual Member or medical provider. Our experienced team of Need Coordinators is trained and equipped to help our Members each step of the way.
Does my Sedera Membership include Rx features?
Yes! The Sedera Community assists with the costs of prescription drugs in several ways.

Sedera Guidelines include provisions for sharing the cost of medications. Prescription medications for a shareable medical condition according to the guidelines are shareable for the customary cost for a period of 120 days. All medications, prescribed or not, administered during inpatient hospital stays will be shareable.

Sedera is committed to introducing providing cost saving tools to its Members. Maintenance drug costs represent a large expense that are not currently shareable according to Sedera Guidelines. To help with these unshareable expenses, Sedera Members have access to the Rx Marketplace, a free tool for Sedera Members that provides pricing from multiple pharmacies, including local retail pharmacies and mail-order options. Sedera Community Members can effectively shop for their prescription drugs on The Rx Marketplace.
Do Members of the Sedera Medical Cost Sharing Community qualify for a tax exemption?
Although the Sedera Medical Cost Sharing Community is a 501(c)3 nonprofit organization, monthly contributions are not tax deductible.

As a non-profit organization, the Sedera Community is solely focused on serving Members and carrying out our community-centric mission. Through this organization, the Community is able to better define and serve our membership and encourage Members to be active and engaged participants in their healthcare decision making. Sedera Members receive something of monetary value in return for their contribution. This legal nuance means joining the Sedera Community is not technically a charitable donation or medical expense.
Can I make changes to my chosen IUA after my membership has begun?
Members can make changes to their membership at any time during the year such as adding or removing members of their household and increasing their IUA. However, they may only lower their IUA during the 30 days prior to the anniversary of their enrollment.
Can I make changes to my membership?
Sedera Membership is renewed annually (Membership Year) at which time a Member can make changes to their dependents and/or Membership options. A Life Change Event (LCE) also allows a Member to make changes to their dependents and/or
Membership level during the Membership Year within 30 days of the LCE and will be made
effective at the start of the next billing cycle. An LCE includes:
     1. Changes in your household:
          a) A Member or spouse/domestic partner having a baby or adopting a child;
          b) A Member or dependent getting married or divorced;
          c) A Member or dependent dying;
         d) A dependent turning 26 years old.
     2. Changes in your employment status.

As a general rule, an LCE does not allow a Member to increase or decrease their IUA during their Membership Year.
Changes you make to your membership will be reflected at the start of your next billing cycle.
Can I cancel my Sedera membership at any time?
Yes
How do I cancel my Sedera Membership?
Members can cancel their memberships at any time using their member portal. Cancellation will take effect at the end of the billing cycle  within which it was requested.
How can I become a Sedera Member?
Sedera’s approach to medical cost sharing is inclusive. Our ethical principles allow Members with a shared faith in the power of community and desire to help one another to come together to access personal, affordable and flexible healthcare options.

The membership enrollment process includes affirmation of the Community’s Statement of Ethical Beliefs and Principles and Member Commitments.

Sedera looks at each community Member as a holistic-individual person. Our goal is for Sedera Members to commit to be active healthcare consumers, lead healthy lifestyles and work with the broader community in exchange for the cost savings associated with the medical cost sharing model.

If you are able to agree to the ethical beliefs and other commitments of membership, you can join here.
Does Sedera place caps on sharing?
There is no annual maximum dollar amount or lifetime maximum limit per Member, though certain dollar amounts and/or visit limits apply to specific types of medical care and therapies. Sharing is only limited by the amount available for sharing by the Community.
How does the Initial Unshareable Amount (IUA) work?
The Initial Unshareable Amount is the financial portion ($500 - $5,000) that members pay their medical providers prior to any amount becoming eligible for sharing. After the IUA has been satisfied, a qualified Need, as determined by the Guidelines, becomes eligible for sharing consideration. Sedera Memberships include multiple IUA options to allow Members to select a level that matches their preference and budget. The IUA selection occurs during the enrollment process.
How does the Sedera Community share expenses for Maternity Needs?
The Sedera Community loves welcoming new babies!

There are several ways that Sedera guidelines address the sharing of pregnancy and delivery expenses. For pregnancies that begin after the membership effective date, the Maternity Initial Unshareable Amount (Maternity IUA) is $5,000 (certain exceptions apply ). The Need is shared as any other Need for both the mother and delivery of the baby. All eligible expenses incurred by the baby post delivery are shareable if the baby is added to your membership within 30 days of birth*. Medical expenses for childbirth with an expected delivery date within the first 12 months of membership are not shareable.

*All eligible expenses incurred by the baby post delivery is treated as a separate and new Need that is generally shareable if the baby is added to the membership within 30 days of birth. Failure to add the newborn within 30 days will result in shareable expenses ONLY from the date Sedera is notified and on.
How does routine and preventative care work?
In general, the Sedera Medical Cost Sharing membership is designed to help our members with the costs associated with unexpected injury and illnesses. Expenses such as routine physicals, checkups, vaccinations other than Influenza (flu) vaccinations, 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.
Some exceptions exist for colonoscopies, mammograms, and childhood vaccinations as described throughout the Guidelines.
What about pre-existing conditions?
No prospective member is turned away for having Pre-Existing Medical Conditions, and Sedera does provide a path to sharing medical expenses associated with a Pre-Existing Medical Condition. The Sedera Community, however, does have a look-back period of 36 months that applies to all Pre-Existing Medical Conditions for Sedera applicants. A Pre-Existing Medical Condition is any medical condition that existed prior to membership (diagnosed, suspected, or producing observable signs or symptoms). Needs that result from Pre-Existing Medical Conditions are subject to sharing limitations unless 36 months immediately prior to membership effective 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. This applies whether or not the cause of the symptoms is unknown or misdiagnosed. Pre-Existing Medical Conditions will become eligible for sharing based on the Member’s tenure with Sedera, as indicated by the applicable Guidelines.
What do I need on hand to enroll?
Members will need their Social Security number, their bank account information (routing number and account number) and the health history for any members of their household they intend to enroll.

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7171 Southwest Parkway
Bldg 300, Suite 350
Austin, TX 78735

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Current Members:
memberservices@sedera.com
(855) 973-3372

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Prospective Members:
sales@sedera.com
(855) 400-9988

WARNING: THE SEDERA MEDICAL COST SHARING COMMUNITY AND/OR SEDERA, INC. ARENOTINSURANCE COMPANIES AND THE SEDERA MEDICAL COST SHARING MEMBERSHIP IS NOT ISSUED OR OFFERED BY AN INSURANCE COMPANY. WHETHER A MEMBER/HOUSEHOLD CHOOSES TO SEND MONETARY ASSISTANCE TO YOU AND/OR YOUR HOUSEHOLD TO HELP WITH YOUR MEDICAL EXPENSES WILL BE TOTALLY VOLUNTARY AND NEITHER YOU NOR THE SEDERA MEDICAL COST SHARING COMMUNITY AND/OR SEDERA, INC. HAS ANY RIGHT TO COMPEL PAYMENT OF MEDICAL COST SHARING COSTS FROM ANY MEMBER. THE SEDERA MEMBERSHIP IS NOT AND SHOULD NEVER BE CONSIDERED TO BE OR TO BE LIKE A GROUP INSURANCE POLICY OR AN INDIVIDUAL INSURANCE POLICY.

WHETHER YOU RECEIVE ANY MONEY FOR MEDICAL EXPENSES, OR WHETHER OR NOT THIS MEMBERSHIP CONTINUES TO OPERATE, YOU AS THE MEMBER WILL ALWAYS REMAIN LIABLE FOR YOUR UNPAID MEDICAL EXPENSES AND DO NOT HAVE ANY LEGAL RIGHT TO SEEK REIMBURSEMENT OR INDEMNIFICATION FOR ANY SUCH EXPENSES FROM THE SEDERA MEDICAL COST SHARING COMMUNITY AND/OR SEDERA, INC. OR ANY OTHER MEMBER OR HOUSEHOLD. THIS IS NOT A LEGALLY BINDING AGREEMENT TO REIMBURSE OR INDEMNIFY YOU FOR THE MEDICAL EXPENSES YOU INCUR, BUT IS AN OPPORTUNITY FOR YOU TO ASSIST OTHER MEMBERS IN NEED, AND WHEN YOU ARE IN NEED, TO PRESENT YOUR MEDICAL BILLS TO OTHER MEMBERS AND HOUSEHOLDS AS OUTLINED IN THESE GUIDELINES. THE FINANCIAL ASSISTANCE YOU MAY RECEIVE WILL COME FROM OTHER MEMBERS AND/OR HOUSEHOLDS, AND NOT FROM THE SEDERA MEDICAL COST SHARING COMMUNITY AND/OR SEDERA, INC.
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