What is the overall deductible?

In-network: $5,000 individual / $10,000 family per calendar year.

Out-of-network: $10,000 individual / $20,000family per calendar year.

Are there services covered before you meet your deductible?

Yes. Certain preventive care and those services listed below as "deductible does not apply" or as "No charge."

Are there other deductibles for specific services?No

What is the out-of-pocket limit for this plan?

In-network: $7,350 individual / $14,700 family per calendar year.

Out-of-network: $14,700 individual / $29,400 family per calendar year.

What is not included in the out-of-pocket limit?Premiums, balance-billing charges, and health care this plan doesn't cover.

Will you pay less if you use a network provider?Yes. See https://regence.com/go/OR/Preferred or call 1 (888) 367-2116 for a list of network providers.

Do you need a referral to see a specialist?

No. 

What is Sedera?

Sedera is a nonprofit Medical Cost Sharing Community that offers a non-insurance approach for managing large and unexpected medical expenses through direct Member-to-Member sharing. Sedera Members belong to a Community of individuals who are active and engaged participants in their healthcare decision-making, dedicated to a healthy lifestyle, and united by shared values.

Is Sedera available in all states?

While Sedera operates in most states, there are a few exceptions. Click here to learn more.

What kind of company is Sedera?

The Sedera Medical Cost Sharing Community is a nonprofit Medical Cost Sharing Community that offers a non-insurance approach for managing large and unexpected medical expenses and is focused on serving the engaged healthcare consumer. Sedera facilitates the direct sharing of medical costs among our participating Members (the Community).

What other features are included with a Sedera Medical Cost Sharing Community membership?
A Sedera membership includes access to additional tools including convenient telehealth services for basic healthcare needs, expert second opinions, a cash pay marketplace, and medical bill negotiation services when needed to ensure the Members are not overpaying for their healthcare costs.

Some Memberships may include add-ons and/or additional products that are not owned, operated, serviced, or maintained by Sedera. Sedera makes no warranty regarding the websites, resources, materials, products, transactions, and services provided by third parties. Sedera makes no representations or warranties that every or all Memberships include any add-on/additional product(s). Members can utilize the Member Portal for more information on what their Membership includes.

Is Sedera an Insurance Company?
No. Sedera is a nonprofit Medical Cost Sharing Community that offers a non-insurance approach for managing large and unexpected medical expenses through direct Member-to-Member sharing. Insurance arrangements are a contract whereby one party agrees to be legally responsible for and accept another party’s risk of loss in exchange for a payment — a premium. Medical cost sharing is an arrangement whereby members agree to share medical expenses through an act of voluntary giving. The Sedera MCS Community is not licensed or registered by any insurance board or department. The Sedera MCS Community does not assess applicants’ health risks, because the Sedera Medical Cost Sharing Community Members are assuming financial liability for any other Member’s risk.

Is Sedera a Health Care Sharing Ministry?
The Sedera Medical Cost Sharing Community meets the legal definition of a health care sharing ministry in a number of states that recognize HCSMs.

Does Sedera Community membership satisfy federal or state level individual mandates?
No. Membership in the Sedera Medical Cost Sharing Community is not minimum essential coverage (MEC) and does not make an individual compliant with the federal ACA mandate or any state-level individual mandate that requires individuals to purchase health insurance. Any and all applicable penalties still apply for individuals who are Sedera Members who do not otherwise meet federal and/or state coverage mandates.

Can I choose my own doctors and hospitals?Absolutely! Freedom of choice is fundamental to Sedera’s values. Sedera has no network restrictions which means Members are free to select their providers based on personal preference, value, cost, and convenience and there are no “out-of-network” penalties. Sedera’s Member Advisors are available to help Members locate cash pay friendly medical professionals and we go where Members go, worldwide.

Does Sedera use deductibles and co-insurance like traditional health insurance?
No. Because Sedera is not health insurance, Sedera’s process differs significantly from insurance practices. Health insurance deductibles are cumulative over the course of a plan year. Co-insurance is the portion of the medical expense owed by the patient. These insurance cost-shifting measures can amount to thousands of dollars in out-of-pocket costs to insurance policyholders annually. With Sedera, when Members incur an eligible medical expense that exceeds their Initial Unshareable Amount (IUA) for a specific eligible Need, any remaining balance relative to that specific Need is eligible for sharing with the Community, effectively reducing the Member’s portion to the selected IUA for any single Need.

Does Sedera charge monthly premiums?

No. Because a Sedera Medical Cost Sharing membership is not health insurance, there are no premiums. Sedera Members assist other Members with their medical expenses by contributing a predetermined amount each month; called a monthly “Medical Cost Sharing Amount” or “Share.” That Share is deposited directly into the Member’s individual FDIC-insured bank account specifically dedicated to Member-to-Member sharing.

What happens when a provider requires payment up front for services?

When a provider requires a Member to pay in advance for medical services, Sedera advises its Members to avoid paying more than their IUA toward the cost of any medical need so that Sedera can negotiate costs with medical providers if needed. In cases where Members pay more than their IUA, they can submit the amount that exceeds their IUA to the Sedera Community for sharing.

In certain limited circumstances, the Sedera MCS Community provides direct up-front payment to the Member for proposed services. The most common example of prepayment is with maternity cases. Sedera may prepay the Member for maternity needs, based on the provider’s cash pay rates, in advance of the baby’s delivery.

How does Sedera handle medical expenses submitted for sharing?

When Members incur medical expenses that exceed their IUA, they submit proof of their medical expenses to Sedera. The medical expenses are evaluated to make sure the Need qualifies for sharing under the applicable Member Guidelines. A Sedera medical bill negotiator may contact providers to discuss the appropriate payment for the services that were performed and determine if negotiations are necessary or available for the billed amounts. Because Members do not transfer risk to each other or to the Sedera Medical Cost Sharing Community, no request for sharing is ever guaranteed. Members always remain responsible for their medical expenses.

What is the process for paying my medical bills when I have a Need?

At the time of service, Members inform their medical providers (doctors, laboratories, clinics, hospitals, etc.) that they are “cash pay” patients. The providers will, in turn, bill the Member directly. Members organize their bills, log into their Member portal, complete the online Needs Submittal Process, and submit copies of all relevant medical bills and any proof of payments made towards their Initial Unshareable Amount (IUA). Sedera’s team of medical bill negotiators may contact the providers to discuss the appropriate payment for the services that were performed and determine if negotiations are necessary or available for the billed amounts. Sedera will review the Need and help administer a process whereby community funds are shared with the Member, less the Member’s IUA (as applicable), which the Member then uses to pay their medical provider. Because Members do not transfer risk to each other or to the Sedera Medical Cost Sharing Community, no request for sharing is ever guaranteed. Members always remain responsible for their medical expenses.

How long does it take Sedera to process a medical Need?

Sharing turnaround time normally ranges from 14-60 days from the receipt of bills and required information. Generally, after the Needs Submittal Process and the submission of required documentation is complete, and if there are no ongoing financial negotiations with a provider, a Need will be shared within 14-30 days after receipt. Please note that larger bills may take longer to negotiate.

Does the Sedera Community share medical costs that were incurred outside of the United States?
Yes. With Sedera there are no network restrictions. We go where our Members go, worldwide. Members’ eligible needs, wherever incurred, are eligible to be shared with the Sedera Community in the same fashion as medical expenses incurred in the U.S. If a Member has a Sharable Needs Case that occurs outside of the United States, the Member will be required to provide Sedera the itemized Medical Bill translated into English and the price converted into U.S. Dollars.Yes. With Sedera there are no network restrictions. We go where our Members go, worldwide. Members’ eligible needs, wherever incurred, are eligible to be shared with the Sedera Community in the same fashion as medical expenses incurred in the U.S. If a Member has a Sharable Needs Case that occurs outside of the United States, the Member will be required to provide Sedera the itemized Medical Bill translated into English and the price converted into U.S. Dollars.

What are Sedera’s Membership requirements?Sedera is inclusive and welcomes people from all walks of life who agree with and commit to the Ethical Beliefs and Principles of the Sedera Community. Sedera’s Member Guidelines include other details of Membership requirements.

Is there a lifetime or yearly maximum amount that is eligible for sharing for any one person or family?

There is no annual maximum dollar amount or lifetime maximum limits per Member, though certain dollar amounts and/or visit limits apply to specific types of medical care and therapies. Sharing is only limited by the amount available for sharing by the Community.

What happens if there are more medical Needs than available shares in a month?

Sedera’s Member Guidelines clearly state that payment is never guaranteed but is always based on the commitment of the Members to each other. For example, if there are only enough shares available for 90% of the Needs submitted for a particular month, only 90% of the Needs for that month will be shared. Sedera may overlap Needs from multiple months so that there are adequate shares for all Needs. However, if all Needs cannot be met, Sedera uses a prorating method to evenly distribute the burden. However, to date, Sedera has not had to prorate any sharing.

How can I be sure that Sedera really works?

The concept of Medical Cost Sharing has been highly successful in the context of faith-based groups for more than 25 years. More than one million members have shared over a billion dollars in medical expenses over that span of time, demonstrating a strong track record of success. We believe that a community of health-conscious people who care for one another can successfully participate in the sharing of each other’s medical burdens. However, it is important to note that past successes by faith-based sharing groups does not guarantee the future success of similar programs. There is no promise or contract by Sedera or the Members to contribute toward any Need a Member might have in the future. The only promise Sedera makes is to facilitate the distribution of shares given through the medical cost sharing process. Sedera distributes these monthly Shares on behalf of those Members with Needs.

Can my Membership be dropped if I have very high medical Needs?

No. Members cannot be dropped from the membership due to their medical Needs. Neither your membership nor your monthly share is affected by the amount of medical expenses you or any of your family members may have.

What kinds of Needs do Sedera Members share?In general, Needs for eligible illnesses or injuries resulting in visits to licensed medical providers, emergency rooms, diagnostic testing facilities, and laboratory or hospital charges are shared on a per person, per incident basis. See Sections 6-7 of the applicable Member Guidelines for details.

How can I know if a Need qualifies for sharing?The types of Needs that qualify for sharing can be found in the applicable Member Guidelines. Consult Sections 6-7 for the specific requirements for sharing certain types of Needs. If you have any questions, please call Member Services at 1-855-973-3372.

How does Sedera handle very large medical expenses?

There is no maximum limit to the amount that will be shared by the Community toward a specific medical Need. However, the Need must be within the scope of the Member Guidelines before it will be considered eligible for sharing. Sedera reserves the right to negotiate medical expenses with providers, and to prorate available shares, as necessary, in order to address all Member’s medical expenses. However, to date, Sedera has not had to prorate any sharing.

Are there any specific medical conditions that have an exclusion or waiting period?

Most medical expenses are eligible for sharing. However, some types of medical expenses are not eligible for sharing with the Sedera Community or are limited in the amounts that the Community shares. Details of the medical expenses that are not shareable and other limitations can be found in the Community’s applicable Membership Guidelines.

As Sedera is a Medical Cost Sharing Community that shares large and unexpected medical expenses, some expenses including those related to routine preventative care, prescriptions, cosmetic surgery, and dental care, are generally not shareable. Additionally, medical expenses resulting from using illegal drugs or participating in unlawful activities are not shareable.

How does the Sedera Community share expenses related to Pre-Existing Medical Conditions?

No prospective member is turned away for having Pre-Existing Medical Conditions, and Sedera does provide a path to sharing medical expenses associated with a Pre-Existing Medical Condition. The Sedera Community does have a look-back period of 36 months that applies to all Pre-Existing Medical Conditions for Sedera applicants. A Pre-Existing Medical Condition is any medical condition that existed prior to membership (diagnosed, suspected, or producing observable signs or symptoms). Needs that result from Pre-Existing Medical Conditions are subject to sharing limitations unless 36 months immediately prior to the membership effective date has passed without any signs or symptoms of the condition, without any treatment needed, without any medication prescribed or taken, and without any suspicion by the patient or doctors that the condition is resurfacing. This applies whether or not the cause of the symptoms is unknown or misdiagnosed. Pre-Existing Medical Conditions will become eligible for sharing based on the Member’s tenure with Sedera, as indicated by the applicable Membership Guidelines.

How do I manage routine healthcare costs while being a Member of Sedera?

Members are responsible for the costs of routine and preventative care costs other than the larger, high-cost routine diagnostic procedures of screening colonoscopy, screening mammogram, childhood immunizations to age 18, and annual flu vaccines subject to the applicable Membership Guidelines for age, membership period and/or monetary limits for certain preventative care. Many Sedera Members choose to also become members of Direct Primary Care (DPC) practices for routine healthcare. To find a DPC, visit our DPC Finder.

How do I pay for medical care that spans multiple calendar years?

There is no annual or lifetime sharing maximum on eligible Needs as outlined in the applicable Membership Guidelines. Community Members may share funds for eligible medical expenses that exceed a Member’s IUA, regardless of the duration of care for eligible Needs.

What is Recuro?

Recuro is an integrated digital health solutions company that takes a uniquely personalized and proactive approach to virtual care. Unlike other traditional virtual care solutions today, Recuro has created a Digital Medical Home to enable customized care that meets patients’ needs no matter their location or circumstance. Through its Digital Medical Home, Recuro provides a holistic suite of virtual care services and supplemental benefits that consumers can choose from to design a digital health solution. Recuro’s core virtual care offerings include primary care, behavioral health, and urgent care, with supplemental benefits spanning pharmacy, care management, advocacy, and physician locator. Recuro’s enterprise-ready SAAS platform seamlessly ties these digital solutions together enabling simple customization, white-labeling, and easy configuration. Recuro is committed to providing the tools to help you proactively manage your health and maintain well-being on an ongoing basis.

When is Recuro available?

Recuro is available 24 hours a day, 7 days a week, 365 days a year, even on holidays. Use Recuro anytime you have a non-emergency medical condition, are unable to see your primary care provider, or when you simply prefer a convenient, cost effective alternative to the emergency room, urgent care center, or clinic.

What are the most common conditions you treat?

Our doctors are able to treat a wide range of medical conditions. Some of the most commonly treated conditions for urgent care include: Allergies, Asthma, Bronchitis, Colds & Flus, Ear Aches, Fevers, Heartburn, Nausea, Rashes, Sinus Infections and Sore Throats.

Is Recuro appropriate for every medical condition?

No. Recuro is designed to treat non-emergency medical conditions. You should not use Recuro if you are experiencing a medical emergency. In case of a life threatening medical emergency, you should immediately dial 911.

Where are Recuro services available?

Recuro services are available nationwide. Consultations are subject to federal and state regulations and telephonic or video consultations may not be available in every state.

Who are the Recuro doctors?

Recuro utilizes a rigorous screening process to ensure you are consulting with the highest quality physicians. The initial selection involves a thorough review of their clinical experience, training, licensure and questionnaire. In addition, Recuro physicians are subjected to a NCQA/NPDB (National Committee for Quality Assurance/National Practitioner Data Bank) verification standard and background screen. Subsequently, each doctor is monitored through our industry leading Quality Assurance/Quality Improvement Process. When requesting a consultation, Recuro will connect you with a U.S. residing doctor licensed in your state.

Are Recuro's doctors able to prescribe medication?

Yes. Recuro doctors can prescribe medications which will be sent to a pharmacy of your choice. Prescriptions are subject to the discretion of the consulting physician and their clinical judgment in accordance with law limitations. Recuro doctors do not issue prescriptions for substances controlled by the DEA, non-therapeutic, and/or certain drugs which may be harmful because of their potential for abuse. Note: Non therapeutic drugs such as Viagra and Cialis are not prescribed by Recuro physicians.    View the current list of DEA controlled substances.

How are prescriptions sent to the pharmacy?When the Recuro doctor prescribes a medication, it is submitted electronically or by phone to the pharmacy of your choice. Recuro does not dispense prescription drugs.

How is Recuro able to provide a quality doctor visit at an affordable rate?

On average a doctor in a traditional office setting must charge $125-$150 to earn $20-$30. The difference between what’s charged and what the doctors earn per visit goes toward paying the overhead costs associated with running a doctor’s office such as rent, utilities, and administrative staff. Recuro uses technology and best business practices to eliminate these costs and pass the savings on to our customers.

Can a Member be turned down for a pre-existing condition?

Consultation requests are never denied due to pre-existing medical conditions.

Is Recuro safe and private?

Yes, Recuro is safe and private. Recuro is compliant with HIPAA (Health Insurance Portability and Accountability Act) and will only share your information with your selected physician and pharmacy.

How do I sign up for Recuro or activate my Recuro account?

You can easily sign up or activate your account by using one of the following methods:If you would like to sign up for Recuro, you can do so here.

If you would like to register your Recuro account, you can do so here.

OR, you can reach our Patient Care Team 24/7 at 1-855-6RECURO.

How much does it cost to use Recuro?

Depends on the plan. If you’re receiving Recuro as part of a group benefit, you may not be required to pay at all. Recuro accepts most major credit and debit cards.

Behavioral Health Questions

Do I have to schedule an appointment or can I just call and get the next available time?All Behavioral Health visits are scheduled. Recuro does not support an on-demand option at this time.

How long is the typical Behavioral Health visit?Our first time Behavioral Health visits average 45 minutes. Psychiatry visits vary in length based on the patient need.

Can I use the Behavioral Health service for an emergency?

This program is not intended to be used for emergency situations. Visit requests require an advance scheduling notification.

Are there Behavioral Health issues not treated by Recuro?

There are some prescriptions not provided by our service, but the licensed specialist will determine if you are best seen for an in-person visit for further evaluation.

What should I expect during my call?

After completing a quick intake assessment you will have a conversation with the Behavioral Health professional just as if you were in person.

Can I talk to the same specialist each time I request a visit?

Yes. A member can choose to see the same specialist or a different one. It’s your choice.

How secure is the communication line and who retains my medical records?

Confidentiality is very important to Recuro and we follow the same strict security protocols as we do for our core services. All medical records are kept in a secure environment and Recuro does not share the information with anyone outside of the patient’s specific request or as required by law.

How do I access this service?

Members can access the Behavioral Health service by logging into their account or by calling customer service.

What type of equipment do I need for a Behavioral Health visit?

You will need a telephone for telephonic visits. For video visits, you will need to have internet connectivity and webcam. Video visits are strongly encouraged by our specialists.

What if I need a medication?

Psychiatrists are able to prescribe from a limited formulary. If the Behavioral Health specialist determines a different/higher level medication is appropriate, they may refer you for an in-person visit.

Can I select my doctor based on preferences such as specialty, gender, language?

Our specialist profiles display information about each Recuro professional, including gender, language and specialty. This information will display when making your specialist selection online.

Will I be able to schedule recurring appointments?

If so, how far in advance can I schedule?

At the end of the visit, the provider will schedule a follow up if the individual specialist deems necessary. At this time, only the next visit can be scheduled.

Is there bilingual assistance provided when I contact Recuro for the visit?

Recuro does display a provider’s languages on the profile screen when making your selection.

Is there a time limit on how long I can speak with a specialist?

Our therapy visit is expected to be 45 minutes on average. Psychiatry visits vary based on patient need.

What type of Behavioral Health specialist does Recuro have?

Psychiatrist, Psychologist, Counselor, Clinical Social Workers, Therapist (Marriage and Family).

What types of specialists can prescribe medications?

Only psychiatrists can prescribe medications.

What can be shared with PCPs?

At this time Recuro does not include your Behavioral Health visit information in the medical record that is sent to your primary care provider.

Why do I have to fill our additional intake questions?

In order to make sure our specialist have the best information possible to assist members, we do require a short wellness assessment with specific questions about their Behavioral Health status.

What do I do if I feel I am in immediate danger of self-harm?

This is considered an emergency and the member should immediately dial 911 for assistance.

Are there limits to how many visits can be scheduled within a month?

Not at this time. However, Recuro is committed to evaluating this program to ensure compliance with patient safety standards.

Are there a maximum number of days a prescription can be issued?

At the discretion of the appropriate licensed specialist, prescriptions can be issued between 30-90 days.

Is my “Urgent Care 365” health insurance?

This is not health insurance and does not replace health insurance. No insurance will be billed, and your visit will not be counted toward any deductibles. This is a plan that allows you to have access to all Valley Immediate Care facilities, gain access to all of our services, and receive a 50% discount on those services. All Health Savings Account (HSA) plans can be used for the minimal facility fee as well as any urgent care services required.

Will my visit apply to my health insurance deductible?

No. This is not insurance and will not be billed to insurance or apply to any deductibles.

Can I have my family use this membership plan?Yes. My Urgent Care 365 membership is available to individuals and families. You can sign up and add up to 4 family members. A family plan allows for up to 5 visits per year.

When does my membership start?

Your membership starts the day you sign up for a one year period. You can renew every year and enjoy the benefits of the program.

How do I get billed?

Automatic monthly payments will be billed to the debit or credit card you provide at the time of sign-up. The automatic deduction occurs once a month and can be reviewed on your individual bank statement.

Can I cancel my membership?

Yes. If you use the membership program for a visit, you are responsible for payment of six months of service. You may continue to use the program for that six-month time period or simply pay the six months and discontinue the service. If you have never used the service, you may cancel any time and will not be billed for any additional monthly membership payments.

What is the “5-Day Promise?”

If you visit us for any reason, and within five days, you do not feel better, we welcome you back for a follow-up visit at no charge. The follow-up visit won’t even count against your membership plan! Any additional services will be charged, but you will receive the 50% discount on all services required.

Do I need a membership card?

No. You can simply show your identification at time of service and indicate that you are a My Urgent Care 365 member. We will have record of your sign-up, and you will be billed accordingly.

Do I save money with this membership program?

In most cases, this program saves you money and provides maximum flexibility. However, this largely depends on the type of insurance that you have and the annual deductible. Our staff will make sure to share your options.

May I cancel and sign up again later?

Yes, however, you are subject to our cancelation policy and a new application fee will apply.

What is a facility fee?

This is a nominal fee used to cover basic administrative costs associated with patient processing. This fee is charged for every visit to Valley Immediate Care. The exception is our 5-day Promise; follow-up visits do not incur this fee.

What is an application fee?

This is the one-time fee we charge to process your application for our membership program.

When should I to go to Urgent Care?

It's important to understand when you should go to an urgent care center. These facilities are not appropriate for life-threatening illnesses or injuries. If, for example, you have a cut that is extremely deep and will not stop bleeding, an emergency room may be a better option than the urgent care. Even if your injuries are listed as the most commonly treated, in more severe cases, you may be transported to a local emergency room. Urgent care facilities are a good option if, for example, you are unable to get to a primary care physician during their regular office hours.

Some examples of illnesses and injuries treated at urgent care facilities:

Fractures

Sprains or strains

Cuts and lacerations

Burns

Urinary tract infections

Yeast infections

Pink eye

Mono

Bronchitis

Colds

Flu

Ear Infections

Strep throat

Rashes

Minor abdominal pain

Nausea and/or diarrhea