3 Low-Cost Programs
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Partially Self-Directed Healthcare

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Partially Self Directed Healthcare

Partially Self-Directed Healthcare Program Designed For A "Cash-Pay" Patient Who Desires Full Preventive Care Services With Medical Cost Sharing As A Back-up For Large Expenses

This is the ONLY option that permits establishing a tax-advantaged health savings account (HSA). An HSA permits setting aside pre-tax dollars to pay for “qualified” medical expenses as defined by the IRS.

PARTIALLY SELF-DIRECTED HEALTHCARE

If your “Need” (i.e. a large medical expense) exceeds the Initial Unshareable Amount (similar to a deductible if this were insurance) you selected, Medical Cost Sharing takes over and will share the full amount at 100% unless your Need is subject to sharing limitations for conditions listed in Sections 8, 9 or the Appendix of the Access Membership Guidelines.

With Medical Cost Sharing you can to choose to receive services from any doctor or facility. There’s no network of providers (this is referred to as "open access"). Tell the provider you're a "cash-pay" patient and want their “best cash price." Providers will usually be happy to give you a large discount because they won’t have to deal with an insurance company or meet the company's oversight requirements and interference with the way they practice medicine.

Member and Concierge Services will help you research doctors, facilities and hospitals if you need access to care. They’ll assist you in selecting fair-priced, quality services, and your Sedera Member Advisor is available to help you, as well.

This is our featured program. We expect that most of those who join Health Excellence Plus will elect this option. All Affordable Care Act-mandated preventive services are provided at $0 cost by in-network PHCS participating providers.

This is the ONLY option structured to permit the establishment of a tax-advantaged health savings account (HSA). An HSA permits you to set aside money on a pre-tax ("qualified") basis to pay for qualified medical expenses as recognized under the Internal Revenue Code. Being able to present an HSA debit card facilitates providers in offering cash discounts to "cash-pay" patients.

PARTIALLY SELF-DIRECTED HEALTHCARE
HDHP / BASIC MEC PLAN
Medical Services—Must Utilize PHCS Network Providers For All Services
Preventive Care—Covers All Mandated Preventive Services Required By The ACA
All 18 Preventive Services for Adults 100% Coverage, no Copay for
Mandated Preventive Care Services
All 26 Preventive Services for Women 100% Coverage, no Copay for
Mandated Preventive Care Services
All 27 Preventive Services for Children 100% Coverage, no Copay for
Mandated Preventive Care Services
The Program Contains High Deductible Health Plan Features (You Probably Won’t Utilize These)
THAT MAKE YOU ELIGIBLE To Establish a Health Savings Account (HSA).
You Can Contribute The Following Amounts To An HSA In 2019 and 2020 Respectively
Maximum Contribution
(Single Member)
$3500/$3550
Maximum Contribution (Family) $7000/$$7100
“Catch-Up” Contributions
(One Member Must Be At Least Age 55)
$1,000
The Apex HDHP/Basic MEC Plan is a self-funded plan and accordingly is not fully insured.
Please see the Plan’s Summary Plan Description (SPD) for full details.

Designed for the Cash-Pay Patient who wants Full Preventive Care Services with Medical Cost Sharing as a Back-Up

Partially Self-Directed Program that combines all WellFit Wellness Services, Preventive Care using the PHCS Network, AND Medical Cost Sharing using an Open Access network of care providers. Includes the ability to establish a tax-advantaged Health Savings Account.

Features
Avoid

AVOID medical costs with education and a proactive and interactive wellness program (called WellFit Wellness) provided by My Academy of Health Excellence. You become a member of WellFit Wellness when you join the MPowering Benefits Association. As a member of the Association, you’re entitled to become a member of the Partially Self-Directed Healthcare Program.

  • Single Point of Access for Services
  • Fully Integrated Health and Wellness Program
  • Wellness Assessment Program
    (health risk assessment to inform you are your current health status)
  • QR For Life Code for Emergencies and Personal Medical Vault
  • WellFit Community (on-line forum for blogs and group interaction)
  • Twelve Habits of Highly Healthy People
  • Artificial Intelligence Manager*
    (functional medicine-based risk assessment, personalized recommendations, and coaching service)
  • HealthGenie Symptom Checker*
    (links symptoms to user-friendly disease information and the appropriate setting to seek care)
  • On-line Resource Center
    (webinars, podcasts, interviews with experts, newsletters and e-books)
  • Healthy Rewards Program
*Note: These wellness options can be added to the membership for a small monthly charge.
Prevent

PREVENT medical expenses using the Apex Management Group’s HDHP/Basic MEC program. All preventive services are provided at no cost through a PHCS provider. Provides all preventive services required by the Affordable Care Act.

Manage

The HDHP/Basic MEC program permits you to establish a tax-advantaged Health Savings Account.

Money Management: You can ALSO elect to establish a patented, proprietary Health Matching Account (HMA) provided through Health Matching Account Services, Inc. to help pay for expenses that are either unshareable or subject to high Individual Unshareable Amounts (IUA) under the Medical Cost Sharing portion of the program. Call us at 877-734-3884 to see how an HMA may benefit you.

Mitigate

Mitigate using My AHE Pharmacy Programs, My AHE Member and Concierge Services, TelaDoc™ (telemedicine), the Expert Second Opinion Program (2nd MD™), and Counseling services

Contain
  • Contain large medical expenses with Medical Cost Sharing powered by Sedera, Inc.*
  • Services included:
    Sedera Medical Advisor and Medical Bill Negotiation
Specifications
  • WELLFIT WELLNESS PLATFORM - Managed by My Academy of Health Excellence
  • PREVENTIVE CARE NETWORK AND SERVICES - Requires use of PHCS network for all services.
    No cost for preventive services mandated by the Affordable Care Act
  • SMALL MEDICAL EXPENSES - Mitigate using My AHE Pharmacy Programs, My AHE Member and Concierge Services, TelaDoc™ (telemedicine), the 2nd Opinion Program (2nd MD™), and Counseling services. Manage with a voluntary Health Savings Account
Large Medical Expenses
  • Contain With Medical Cost Sharing Powered By Sedera, Inc.
  • Medical Cost Sharing Network - Open Access network; can use any provider who accepts cash payment
  • Initial Unshared Amount (IUA) Options - Choice of $500, $1000, $1500, $2500, or $5000
  • Maximum Number Of IUA’s Annually - 3 per individual/5 per membership unit
  • Outpatient Prescription Drugs - maximum of 120 days for conditions diagnosed after the effective date of membership. No maximum for cancer drugs or sublingual immunotherapy medications and one year maximum for transplant medications
  • Pre-Existing Conditions - 36 month look-back: no coverage for 1st 12 months;
    $15K 2nd year; $30K 3rd year; unlimited thereafter
  • Maternity Benefits - $5K IUA for normal deliveries and $7.5K for non-emergency/elective C-sections; conception must have occurred after membership per section 9 of the Guidelines
  • Therapies And TMJ - range from $1.5K to $2.5K/Need under Section 8 of the Guidelines
  • Psychiatric And Behavioral Health - $5K inpatient maximum/Need;
    $1.5K outpatient/Need under Section 8 of the Guidelines
  • Tobacco Use - $75 surcharge per membership unit. If age 50 or over, $25K sharing restriction for cancer, stroke, heart conditions and COPD
  • Sharing Limits - No annual or lifetime limits unless restricted by Sections 8 or 9 of the Guidelines
Review the 3 types of programs
health excellence plus

SELF-MANAGED PROGRAM OPTIONS
Partially Self-Directed Healthcare
Partially Self-Directed Healthcare
Partially Self-Directed Program Combining Wellness Services, Preventive Care, An Optional Health Savings Account, AND Medical Cost Sharing For Large Expenses
LEARN MORE
PHYSICIAN-DIRECTED PLAN OPTIONS
DPC - Direct Primary Healthcare
DPC - Direct Primary Healthcare
Provider-Directed Program Supplementing Direct Primary Care With Wellness Services AND Medical Cost Sharing Plan For Large Expenses, Screening Colonoscopies And Mammograms, And Childhood Immunizations/Vaccinations
LEARN MORE
Provider-Directed Healthcare
Provider-Directed Healthcare
Provider-Directed Program Combining Wellness Services, Redirect Health for Preventive Care And Most Small Expenses, AND Medical Cost Sharing For Large Medical Expenses

LEARN MORE
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