Healthcare

eBenefits is the preventative care component of the SALA Healthcare Program. The eBenefits plans are not an insurance product, but a self‐funded plan sponsored by the Small Association Leadership Alliance (SALA). The eBenefits plans provide 100% coverage with a $0 copay for the preventive care services mandated by the Patient Protection Affordable Care Act, known mostly as the Affordable Care Act (ACA).

Participants choose either the:

• eBenefits HDHP/ Essential Plan, or
• eBenefits Summit Plan

Both plans comply with ACA mandated preventive 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)

Option One – eBenefits Essential: provides the 100% coverage for ACA mandated preventive care services at a lower monthly cost. This plan includes:

• 100% coverage for preventive care services
• the required framework allowing members to setup and use a Health Savings Account (HSA) for qualified medical expenses
• Virtual Primary Care (VPC): $0 copay, unlimited use
• Behavioral Health: $0 copay consults
• Recuro consumer health app

View:

• Current Rate Sheets for New eBenefits HDHP / Essential
• About the eBenefits HDHP / Essential Plan (Enrollment Guide)
• eBenefits Essential Statement of Benefits (SOB)

Option Two – eBenefits Summit: provides the 100% coverage for ACA mandated preventive care services, plus copayments for small and medium cost medical expenses, prescription coverage and more. This plan includes:.

• 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
• Virtual Primary Care (VPC): $0 copay, unlimited use
• Behavioral Health: $0 copay consults
• Recuro consumer health app

View:

• View Current Rate Sheets for eBenefits Summit
• About the eBenefits Summit Plan (Enrollment Guide)
• eBenefits Summit Statement of Benefits (SOB)

Recuro Telehealth Information:

• Virtual Urgent Care
• Virtual Primary Care
• Behavioral Health

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 eBenefits HDHP / Essential or eBenefits Summit. Use the PHCS Search Instructions to find in-network physicians and facilities. (Please note, preventive services performed at hospitals are not covered.)

• PHCS Network Search Instructions

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:

• About Sedera
• Sedera Membership Guidelines
• Sedera Select+ Pricing
• Member Testimonials

SALA members have 24/7/365 access to virtual care services, including primary care, behavioral health, and urgent care, as well as a suite of supplemental benefits, such as chronic care management, pharmacy, and care navigation.

Benefits include:

• • On-demand care – talk to a doctor anytime, no matter where
  • Primary care with dedicated physician
  • On-demand counseling
  • At-home lab testing
  • Condition management
  • Cost savings on expensive ER or urgent care visits
  • Physicians can prescribe non-narcotic medication or refills when appropriate
  • More info: Recuro Flyer
  • Recuro Webinar: Recuro Flyer

• • 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.
  • Recuro Webinar: Recuro Flyer

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.

Benefits include:

• • 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

The SALA Dental Plan is administered by ARM, Ltd. ARM is a leading third-party administrator that is here to provide you with comprehensive dental coverage. The great news, you can choose any dentist, anywhere. Complete freedom from networks. The plan will process and pay claims based on Usual, Customary and Reasonable (UCR) fees. Claims will be paid based upon a percentage of UCR, your plan is being established at the 90th percentile. This means that in most all cases the UCR payment will be accepted as payment in full, minus anything you are responsible for such as the deductible and coinsurance. If there are any issues or possible balance billing, please contact customer service.

View Program Brochure here.

Pricing

• • • Member Only – $42.33/mo
    • Member + Spouse – $92.82/mo
    • Member + Child(ren) – $90.78/mo
    • Member + Family – $103.53/mo