Healthcare

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 Basic MEC Plan (HDHP), or
• Apex Advantage Plan

Both plans comply with ACA mandated preventative services with 100% coverage for all 21 preventative services for adults, 26 services for women, and 27 services for children. (Click here to learn more about the ACA requirement)

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

View Current Rate Sheets for Apex HDHP/Basic MEC

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 WellDyneRX

View Current Rate Sheets for Apex Advantage

To learn more about the Apex options, we recommend reviewing the following:

• Current Rate Sheets – Advantage / Lvl 3
• Current Rate Sheets – HDHP / Lvl 1
• About Apex
• Apex Basic (MEC) & Advantage Plans
• Apex Basic (MEC) FAQ
• Apex Advantage FAQ
• Multi-Plan Provider Search Instructions Apex is an “in network” program. The network is PHCS, one of the largest provider networks in the country.

The Sedera medical cost sharing model boldly challenges the insurance status quo. Through an innovative layering of healthcare services, we enable individuals and family’s 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 Five (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 Summary Info
• Sedera Membership Overview
• Sedera Membership Guidelines
• Sedera Key Terms

​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.

Benefits include:

• 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

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