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What is Medical Cost Sharing?

The best way to take control of your healthcare expenses is to become a Self-Pay Patient. At first blush, that seems scary with your potential financial exposure due to the rising cost of healthcare today. But, what if you could form a group of like-minded, health focused, Patriotic Americans, people just like you, that would agree to share any costs you incurred above an amount that you could comfortably handle. Maybe, then it’s not so scary.

With the rising costs of health insurance, businesses and individuals are looking for a cost-effective and efficient way to provide financially for their medical needs or for those of their employees that also complies with the Affordable Care Act (ACA). Whatever the goals and motivation behind the law, the net result has been neither “Affordable” nor improved access to “Care.” Through a combination of proactive wellness programs from My Academy of Health Excellence, preventive health insurance from ASi Benefits (that ensures that both employers, their employees and individuals comply with the Affordable Care Act), a health savings account from HSA Bank and an organized benevolence Sedera Health, we help those individuals or businesses to provide and control the medical expenses of their employees or themselves.

The best way to CONTROL YOUR Health Care Costs is a Health Strategy NOT Health Insurance – the strategy builds one component on top of the other – therefore to understand how the components function with each other start from the bottom of the image and work your way up.

My Academy of Health Excellence Plus is built upon the principles used by some of the Christian healthcare sharing groups. For the past 70 years, either the insurance model or the government has dominated the economic model of healthcare. However, in the late 1980’s and early ‘90’s, some modern day Christian groups began comparing the escalating costs of health care with the simple and effective manner in which older Christian groups (such as the Amish) handled their property and casualty needs. We have all heard of the proverbial Amish “Barn Raising.” There is no need to insure the “barn” because the community will come together for a “barn raising” if it should burn down.

These Christian groups decided to follow the Biblical mandate of “bearing one another’s burdens” by sharing healthcare costs in a similar fashion, members of the community literally share one another’s medical bills. This method of meeting needs proved effective as it withstood court challenges from its “outside the box” approach (which was, in reality, a reintroduction of the historical sharing approach modeled by the Amish!).

The Old Way / The Old-New Way

Now fast-forward to 2010 and the ACA. The impressive growth of the Christian health care sharing movement had, by now, led to hundreds of thousands of individuals and families not using an insurance model, but rather trusting to the sharing of needs as administered by these health care sharing groups. So the ACA, in recognizing the effectiveness of these groups and their sound legal history, enshrined their legitimacy in law by granting an exemption to the law’s penalties for those who were a part of these recognizable groups.

Although the exemption of the law only applies to a very limited number of qualified Christian health care sharing groups and their members, the model of health care sharing has proven legitimate and effective. As long as one can find other ways of fulfilling the law’s mandates, the health care sharing methodology can teach us much.

This is where Sedera Health was born as a concept. Businesses need a group health insurance solution that will fulfill the requirements of the Employer Mandate of the ACA. Employees need a plan that fulfills the Individual Mandate so they are not subject to the penalties individuals face if they do not have insurance. Both of these can be found within the Minimum Essential Coverage (MEC) as defined within the law.

Using this insurance model for handling preventative care needs, the minimum requirement of the law for both employer and employee are fulfilled. But what about actually handling the escalating costs of illness? This is where the health care sharing model, which is not insurance, can be applied. But now it is applied within the corporate context, not just for people of faith, but for groups of employers and employees who choose to share common health-related goals.

What is Health Sharing?

How Much Does It Cost? The My Academy of Health ExcellencePlus solution combines everything you’ll need to become a successful ‘Free-Market Patient’ who is MPowered with health cost sharing:

  • 1 Member $249 (Individual) w/ a $1000 0r $299. w/ a $500 Initial Unshared Amount
  • 2 Members $485 (Couple) w/ a $1000 or $599. w/ a $500 or Initial Unshared Amount
  • 2 Members $427. (Parent w/ Child) w/ a $1000. or $520 w/ a $500 Initial Unshared Amount
  • 3+ Members $638. (Family) w/a $1000 or $786. w/ a $500 Initial Unshared Amount

What is Covered?Yes – Preventative Care Included – At NO Cost to You!

  • Preventative Screening – Mammograms, Pap smears, PSA tests, Screening: Colonoscopies Limit: 1 every 2 years; 1/year over 50
  • Wellness – Babies 0-1 one year – well baby checkups including vaccinations. Adults – includes labs, x-rays (one per membership year)
  • What Else is Included? – Expenses Eligible for Sharing
    • Accidents – (accidents are investigated for other party liability)
    • Accidents Involving Recreational Vehicles
    • Ambulance Services
    • Diagnostic X-ray and Laboratory Services – Inpatient/Outpatient/Independent lab
    • Emergency Room Hospital And Physician Services – (Routine treatment excluded)
    • Home Health Care – Limit 30 days per Incident
    • Hospital Services – Inpatient: Daily Room and Board limited to the average semi-private room rate.
    • Maternity Care – Normal delivery (including physician charges, office visits, hospital charges and birthing centers) cesarean section and/or complications treated as new incident with new per incident limits
    • Physician Office Services – Per incident visit. All other physician office services included per incident. (Charges billed by a physician if performed in the physician’s office: injection, surgery, lab, x-ray, special diagnostic interpretation.)
    • Prescription Drugs – Per incident (charges must occur within 120 the days before or after any related medical incident)
    • Surgery – Surgeon, Assistant Surgeon, and Anesthesiologist Services. Inpatient/Outpatient services. Outpatient surgery facility
    • Therapy – Limit 20 visits /Year: (Combined with Speech, Respiratory, Physical, Occupational Therapy)
    • All Other Eligible Expenses – (Unless limited by the guidelines)

    Are Alternative Treatments Included? Yes – Treatment provided by a Naturopath or other practitioner of alternative treatments is eligible for sharing if such treatment meets the following criteria:

    • It treats a medically diagnosed condition.
    • It is less invasive than conventional medical treatment for the diagnosed condition.
    • It is less costly than conventional medical treatment and is expected to prevent more costly future conventional treatment.
    • It is presented for prior approval.

    Will My Doctor Take It? Yes – there is NO Network! It is a Total Open Access Program- Any Doctor that takes Cash or Credit Cards is available.

    If you are an Individual looking for Healthcare go here or

    If you are an Employer looking for your Employees go here.