Let’s face it, long gone are the glorious days of low deductibles, affordable premiums, and low-cost health care. While the price tag paid for traditional health insurance is dependent upon your age, health, lifestyle, and family dynamics, the truth is many Americans are searching for an alternative. Now are the days of needing a plan in place to aid in affording the costs associated with illness or injury. For some, that search has an answer: Medical Cost Sharing.
Medical Cost Sharing is an innovative, non-insurance solution to managing your larger healthcare costs. Unlike insurance it gives you the opportunity to take the lead in your healthcare choices without the sticker-shock of outrageous medical bills. To understand the benefits of a Medical Cost Sharing plan, you should have a grasp on how it works.
The first step is to enroll in a Medical Cost Sharing (or Health Share) program. Once enrolled, you will begin contributing monthly to the community as an active member. This amount is determined according to who has been included for coverage under your plan:
• Member
• Member plus Spouse
• Member plus Children
• Member plus Family
Once your Medical Cost Sharing (or Health Share) membership has been established, you are eligible for assistance should an eligible medical need arise. You are responsible for your Initial Unshareable Amount (IUA) or Member Responsibility Amount (MRA) at the time of service and will submit the remaining bill to the community. It is your responsibility to refer to your member guide for details on medical expense coverage, pre-existing condition considerations, and other details pertaining to the membership you have chosen.
There are a few interchangeable terms that will help familiarize you with the details of Medical Cost Sharing memberships in comparison to traditional health insurance.
Traditional Insurance: Deductible
Cost Sharing: Share Amount
Definition: The amount you are responsible for before an insurance company or Medical Cost Sharing community will make a payment towards your medical expenses.
Traditional Insurance: Premium
Cost Sharing: Monthly Share
Definition: With traditional insurance, this is the amount you pay each month for your insurance policy. With a Medical Cost Sharing plan, this is the amount you pay each month for your membership, a cost that is much less.
Traditional Insurance: Claim
Cost Sharing: Eligible Event
Definition: A formal request for compensation for a covered policy event. Once approved, payment is issued to the policy holder/member for proper dispersement to pay incurred medical expenses.
Examples of Large Medical Expenses Covered Depending on Membership:
(Related to a New Injury or Illness)
• Appendicitis
• Broken Bones
• Fractures
• Lacerations
• Cyst Removal
• Infectious Diseases
• Gastrointestinal Issues
• Liver Disease
• Cancer
• Stroke
• Heart Attacks
• Medically Necessary Surgery
At American Online Benefits Group, we have two different membership to choose from that qualify as Medical Cost Sharing benefits. Each selection is a voluntary health community for the sharing of medical expenses per the member guidelines and the program elected.
Sedera Medical Cost Sharing Process
1. Consult with Sedera Member Services for direction on medical care or assistance with Membership Guidelines.
2. You will then go to a recommended provider from health advisor and have the freedom to choose your own provider.
3. If your doctor is recommending non-emergency surgery, you must get a 2nd opinion before scheduling surgery.
4. Complete the necessary forms and submit your claim to Sedera along with supporting bills and itemized invoices.
5. If the bill is greater than $500, it may be negotiated down on your behalf.
6. Funds for qualified needs that exceed the IUA are sent directly to you.
7. You will pay each provider(s) as indicated on the explanation of Needs Shared.
ASH Community-Based Medical Expense Sharing Details
1. You must agree with and attest to the ASH Statement of Beliefs.
2. ShareValue includes the PHCS Practitioner & Ancillary Network while MultiPlan negotiates discounts for savings.
3. When scheduling an appointment, specify your accessibility to this network and confirm the providers participation.
4. You should present your ShareValue ID card upon arrival to your appointment.
5. Other value-added benefits include bill negotiation support, telemedicine, discount lab pricing, and high cost prescription discounts/assistance.
6. If you go out-of-network, sharing will be based upon Referenced Based Pricing and you may be asked for full payment at time of service.
7. To find participating doctors or facilities go to www.multiplan.com or call (877) 499-6111.
American Online Benefits Group offers Sedera Medical Cost Sharing and ASH Community-Based Medical Expense Sharing as an alternative to traditional insurance. Please contact our agent or member services to receive more information at 214-389-9072.
