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health excellence plus
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HEALTH EXCELLENCE PLUS

Who Benefits Most From The Program?

The program uses a variety of funding and delivery mechanisms that differ from insurance. The person who obtains the most value from this program (1) is not eligible for significant subsidies under the Affordable Care Act, (2) is healthy or health-focused, (3) has no significant pre-existing conditions, (4) has a different mindset from the person who purchases health insurance, and (5) is a non-smoker.

No one is denied membership because of health status, although medical conditions that existed prior to membership may be limited or excluded from sharing for a period of up to three years.

A prior medical condition that has not exhibited symptoms during the 36 continuous months prior to the membership effective date (note: cancer relating to a type a member had prior to becoming a member is permanently excluded) is considered cured and will have no sharing restrictions other than as stated in Sections 8, 9, or the Appendix of the Sharing Guidelines.

The program promotes open access to healthcare and gives members the freedom to choose their medical providers. There is no provider network. Instead, Sedera, Inc., the entity that services the Community, works with members to seek cost savings, help obtain more transparency from medical professionals, and provides caring customer service.

The goal is to provide exceptional service to members, reduce their healthcare costs and empower them to lead healthier lives.

The prospective member takes personal responsibility in actively managing his or her health and exercises freedom of choice in selecting healthcare providers and maintaining health and wellness. The program promotes freedom of choice, promotes and supports members’ ability to choose their own doctors and health care facilities, enables members freedom to choose their personal strategy in dealing with their medical issues, and to collectively share medical costs with one another.

Members can achieve SIGNIFICANT cost savings (often between 30 and 90%, depending on the members’ age, choice of program, and selection of Individual Unshareable Amount) over insurance.

IMPORTANT: the medical cost sharing calculator link in the last paragraph on the Plan Strategy page links to a calculator that does not include smoking and is NOT the same calculator that is on the Program Calculator in the 3 Programs page part of the site. This needs to be corrected. The Program Calculator on the 3 Programs page includes smoking and has made the other changes. Has your engineer checked to make sure that the calculator on the 3 Programs Page calculates EXACTLY the same as it formerly did, except the Self-Directed and Co-Pay Network Healthcare options have now been taken off?

Who's Eligible To Join?

You're eligible to enroll in Health Excellence Plus if you become a member of the MPowering Benefits Association. Association membership provides access to the WellFit Wellness Program and all the associated tools for living a healthy lifestyle, and enables you to enroll in one of three different medical cost sharing programs.

The program utilizes the Access Membership Guidelines. You should become familiar with these Guidelines, as they are the official description of how Sedera Medical Cost Sharing works and control in the case of any differences between what is described in this website and the Guidelines.

Note: Health Excellence Plus is also available to employers with at least 5 employees. Please call us at 877-734-3884 for details if you are an employer and interested in offering this type of group program for your employees. Employer Group programs utilize the Select Membership Guidelines instead of the Access Membership Guidelines and can be significantly less expensive than traditional group plans.

Cash-Pay Patients

The best way to take control of and reduce healthcare expenses is to become a cash-pay patient (this is someone who chooses to pay for his or her treatment directly and typically receives significant discounts for services s/he receives from providers).

By joining Health Excellence Plus he or she also elects to become a member of a group of like-minded, health-focused people [the Sedera Medical Cost Sharing (MCS) Community] who agree to share any costs they incur above an amount they can comfortably handle.

Sedera (the entity that services the Community) attempts to negotiate further discounts on bills of $500 or more. You should never pay more than your Initial Unshareable Amount (abbreviated as "IUA") up-front to your provider so that Sedera’s ability to negotiate additional discounts for you will not be affected.

Sedera pays you directly and you pay the provider (you’re a true “cash-pay” patient). You can choose between five different IUA's: $500; $1,000; $1,500; $2,500; and $5,000.

Cash-pay patients often save 1/3 to 1/2 or more on their healthcare expenses and pay less in monthly share contributions as compared to insurance. (If this were insurance, you’d probably refer to these as “premiums,” although these are NOT premiums since there are differences between a “monthly share contribution” and a “premium” as explained in the Guidelines.)

How Much Does It Cost (How Much Are Monthly Share Contributions)?

There's an initial enrollment (administration and set-up) fee of $125 and an annual enrollment fee of $25 starting with the second year of membership.

In addition, you pay monthly share contributions. These contributions vary depending on which optional program you choose and are age-banded (18-29; 30-39; 40-49; 50-59 and 60-64) based on the age of the oldest adult member and the size of your membership unit: member only, member and spouse/domestic partner, member and child(ren), and entire family.

Unmarried children through age 25 are eligible for membership in their parents’ program. (Married children must apply for membership on their own.)

Smokers pay an extra $75 per month per membership unit.

While all three program options utilize medical cost sharing to pay for large Needs (see below under CONTAIN), individual members might have different requirements and may want to consider using different delivery models for their smaller Needs. That's why we've introduced three different options into our program choices.

We offered only the Partially Self-Directed Healthcare program when we first introduced Health Excellence Plus, but we've added two other program choices that use new and emerging delivery models to deliver services (DPC-Direct Primary Care and Provider-Directed Care) that prospective members are choosing as the concepts and delivery methods used in these models grow, become more widely known, and are available in their local communities. These models are explained in the 3 Programs section of this website.

See this comparison chart to see the major differences between the different program options.

Monthly contributions vary based on which of the three program options you choose (as well as the age of the oldest member, the size of your membership unit, and your choice of Individual Unshareable Amount). You can determine the amount of your monthly share contribution by accessing the Price Calculator for each option. Click Learn More under the picture of the option you're interested in. This will take you to a more complete description of that program, which includes a description of Features and Specifications. You can also access the medical cost sharing calculator for the three options. Using the Calculator, you can determine your monthly share contribution for each option.

Please call us at 877-734-3884 for help in choosing one of the three options and for enrolling in the option you choose.


Our Strategy For Controlling and Reducing The Cost of Healthcare

Please click on the appropriate link below to learn more about each of the elements of what we refer to as “the healthy care strategy”.

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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