Preventative Care from Apex Management
with Sedera Medical Cost Sharing
This creative program is a proven insurance alternative for members to consider. When each component is brought together, the result is a customized, comprehensive, and affordable option for healthcare. The components include (and are detailed below):
- Apex Preventative Care Plan that best fits your needs, family, and budget (2 Choices)
- Add-on a Sedera membership for medical cost sharing to be used for accidents, illness, and unforeseen medical needs. (5 IUAs to choose from)
- Take advantage of Teladoc telemedicine for increased savings and services (included with Sedera membership)
- The comfort of 2nd.MD to ensure you and your family receive the most up-to-date medical treatment available (included with Sedera membership)
Reminder: Enroll by the 18th of each month to start on the 1st of the following month!
Learn about the SALA Healthcare Program Components:
Apex is the preventative care component of the SALA Healthcare Program. The Apex plans are not an insurance product, but a self‐funded plan sponsored by the Small Association Leadership Alliance (SALA). The Apex plans qualify as Minimum Essential Coverage (MEC) plans for preventative care coverage. A MEC plan must cover 100% of the Centers for Medicare & Medicaid (CMS) listed preventative and wellness benefits. The Apex plans are designed to meet your day-to-day healthcare needs.Participants choose either the:
- Apex Advantage Plan, or
- Apex Basic MEC Plan (HDHP)
Both plans comply with ACA mandated preventative services with 100% coverage for all 21 preventative services for adults, 28 services for women, and 31 services for children. (Click here to learn more about the ACA requirement)
Apex Advantage: Apex Advantage provides 100% coverage for preventive care, copayments for small and medium cost medical expenses, and prescription coverage.
- This plan includes: 100% coverage for preventive care services
- Small co-pays for Specialists, Urgent Care, Lab, Imaging and Prescription Drugs.
- Prescription drug coverage managed by CitizensRx
Apex HDHP/Basic MEC: The Apex HDHP (High Deductible High Premium) Plan provides the Minimum Essential Coverage at a lower monthly cost but does not include a prescription plan or coverage for specialists. The Apex HDHP plan does allow for the addition of a Health Savings Account (HSA). This plan includes:
- 100% coverage for preventive care services
- The plan provides the required framework allowing members to setup and use a Health Savings Account (HSA) for qualified medical expenses
PHCS Network Particpation: Before you enroll it is important to make sure your physician participates in the PHCS Network. There are slightly different networks depending on if you're in Apex HDHP Basic MEC or Apex Advantage. Use the PHCS Search Instructions to find in-network physicians and facilities. (Please note, preventive services performed at hospitals are not covered.)
To learn more about the Apex options, we recommend reviewing the following:
The Sedera medical cost sharing model boldly challenges the insurance status quo. Through an innovative layering of healthcare services, we enable individuals and families access to high quality healthcare that is affordable, flexible and effective.
In addition to sharing medical expenses, Sedera provides access to valuable
Counseling, Medical Bill Negotiation, Telemedicine, Expert Second Opinion,
and Personal Member Advisor services to all members.
You can choose from 5 IUA's (Initial Unshareable Amount) that range from $500 to $5000.
To learn more about Sedera we recommend reviewing the following:
WARNING: SEDERA, INC. IS NOT AN INSURANCE COMPANY AND THE SEDERA MEDICAL COST SHARING MEMBERSHIP IS NOT ISSUED OR OFFERED BY AN INSURANCE COMPANY. WHILE EVERY EFFORT IS MADE TO MEET MEMBER'S MEDICAL NEEDS, SEDERA, INC. AND THE SEDERA MEDICAL COST SHARING COMMUNITY DO NOT GUARANTEE PAYMENT OF ANY MEDICAL EXPENSE.
Sedera members have 24/7/365 access to a board-certified physician through Teladoc telemedicine. This service provides on-call physicians available to help resolve routine medical issues by phone or video consultations. Members considering a trip to the Emergency Room, urgent care center, minute clinic or who just cannot wait to get scheduled for a doctor’s office visit can use Teladoc to access medical care, saving both time and money.
- On-demand care – talk to a doctor anytime, no matter where
- Prompt diagnosis for faster treatment
- No consultation time limits
- Treatment of children of any age
- Secure and portable health records
- Cost savings on expensive ER or urgent care visits
- Physicians can prescribe non-narcotic medication or refills when appropriate
- More info: Telemedicine FAQ
This no-fee service provides up to 85% savings on medications. Members with expensive medications, including mental health
meds that might not be covered in other components of the healthcare program, are strongly encouraged to look up their prescriptions
and utilize the National Drug Card discount program. All you need to do is visit: https://ndcpro.net/sala/ to get started!
We’ve all hassled with doctor waitlists, gone back and forth to get a referral and searched the web for answers to medical issues. As a member of Sedera Health, you can bypass these frustrating steps through a program called 2nd.MD. This offering allows members to quickly and easily connect with some of the world’s best doctors for consultation via phone or webcam.
- Distinguished Network: 2nd.MD recommends the best medical specialist for your care.
- Virtual Consults: Schedule a video or phone consultation at a time that’s most convenient for you.
- Concierge Care: Provides you with a dedicated medical professional who handles your case from beginning to end.
- Follow-Up Notes: Once your consultation is complete, you will receive a written summary from your doctor.
- Local Referrals: 2nd.MD will help you find local doctors and institutions best equipped to carry out your treatment.
- More info: 2nd MD - Specialists
Regional Care, Inc. is a leading third-party administrator that is here to provide you with comprehensive dental coverage. Negotiated rates make the dental network Aetna Dental Administrators program, powered by the national Aetna Dental Access® network, very competitive. In most instances, savings range from 15-50 percent on services from general dentistry and cleanings to root canals and crowns.
View Program Brochure Here.
- Member Only - $42.33/mo
- Member + Spouse - $92.82/mo
- Member + Child(ren) - $90.78/mo
- Member + Family - $103.53/mo
NOTE: The SALA Healthcare Program is currently unavailable in VT, WA, NY, and IL
The SALA Healthcare Program is a member affinity program. Products are offered and serviced by Apex Management Group, Hawaii Mainland Administrators, Sedera, and Enrollment123 for the Small Association Leadership Alliance (SALA). The Small Association Leadership Alliance is not a licensed insurance entity and does not sell insurance. Medical cost sharing is not subject to the regulatory requirements or consumer protections of your particular State’s Insurance Code or Statutes.
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