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Sedera

The Sedera Medical Cost Sharing Community, headquartered in Austin, Texas, has been serving its members under Sedera Inc., a Delaware corporation. Sedera was founded by British physician Dr. Tony Dale, who became interested in the American healthcare system after receiving surgery in the United States. Dale based the model for Sedera on the religious HealthShare ministries that already existed within the United States, but Sedera has no specific religious requirements for membership. Instead, members must agree to certain ethical beliefs set forth in the Principles of Membership. Such principles include a commitment to moral behavior and a healthy lifestyle. Although members do not need to adhere to any religious standards, Sedera has similar sharing exclusions for needs relating to abortions and health issues due to alcohol and other drug use.

Sedera’s most unique feature is its system for allocating funds toward member needs. Fifteen percent of member contributions are allocated to “very large Needs,” those over $150,000. These funds are saved in the Excess Needs Account for future use. All other needs, however, are allocated on a monthly basis. This means that each month, member contributions are collected and redistributed toward the member needs for that month. If the needs for that month are greater than the contributions received, Sedera will prorate the amount that is shared. This means that members might not have their medical costs shared at 100% depending on the other needs that month. Sedera does note that when there are more contributions than needs in a given month, the excess money will be shared with members whose needs were not completely shared the month before. Sedera does not state how frequently proration months occur, but they do note that the board of directors may vote to increase monthly contributions if prorating occurs in three out of six consecutive months.

Sedera seems to be more involved than many HealthShares in the medical treatment of their members. Although Sedera values medical freedom and has no network requirements, they do require that members allow them to negotiate medical costs and may penalize members who do not consult with their member advisors or take part in their Second Expert Opinion program. However, these two features do seem helpful, and Sedera is more than willing to negotiate prices for its members, which is beneficial for those who are not comfortable negotiating medical costs themselves. As long as members are willing to work with Sedera before receiving non-emergency medical care and don’t mind heavy involvement through the process, most members should not have a problem with these regulations.

Membership Requirements:

  • Members must agree to the Ethical Beliefs and Principles set forth in the guidelines

Key Considerations:

  • Sharing unavailable in Washington, New York, Illinois, and Vermont
  • No sharing from injuries resulting from the use of illegal drugs or participation in unlawful activities
  • Depending on proration, needs may not be shared at 100%
  • Sharing turnaround time between 14-60 days
  • Tobacco use allowed with additional contributions
  • Maternity IUA $5,000-$7,500
  • Sedera Member Advisors assist members through non-emergency needs

Pros:

  • No network requirements
  • Telemedicine available
  • Second Expert Opinion program can reduce the IUA for elective and non-emergency surgeries
  • Sharing for medical costs incurred outside the United States
  • No yearly or lifetime sharing cap
  • Maximum of 3 IUAs per calendar year (single members)
  • Maximum of 5 IUAs per calendar year (2 or more members)
  • 90.1% of monthly shares dedicated to assisting member needs

Cons:

  • Penalties for not using the Expert Second Opinion program
  • No single need may consume more than 1/3 of the total number of shares available in a given month
  • Limits on certain types of medical care such as ADHD and alcohol/drug abuse treatment
  • Membership terminates at 65
  • No sharing for pre-existing conditions in the first twelve months; partial sharing afterward
  • No sharing for fertility
  • Separate bank account and fees required
  • Required to join with an association, company or other grouped billing

Ideal Candidates:

  • Desire to join a HealthShare but do not meet the religious requirements of other sharing programs
  • Do not participate in illegal or reckless activities
  • Do not smoke or use tobacco products
  • Want a family membership with a legally married, domestic partner
Website sedera.com
Religious Requirements None
Need Processing Time 14-30 days
Caps No maximum dollar amount
Personal Responsibility Per Need IUA: Choose from $500, $1,000, $1,500, $2,500, or $5,000
Pre-existing Limitations One year waiting period. Up to $15,000 in second year; $30,000 in third year; 100% shareable thereafter
Pre-existing exception(s) None
Wellness Visit None
Preventive Immunizations Pediatric Only; Annual Flu Shot for all ages
Screening for Mammogram Yes
Screening for Colonoscopy Yes, conditional
Mental Health Up to $750 per need (after IUA)
Provider Network None
Need Processing Method Cost Sharing Account
Telemedicine Teladoc, $0 consultation
Startup Fee 30.00
Renewal Fee 0.00
Prescriptions Shared as part of eligible need or 120 days with new condition
Maternity 100% shareable after $5,000 IUA
Membership Size 20,000
Community Start Date 2014

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Sedera Options

Access+ (For Individuals & Families) Select+ (For Groups)
Annual Out of Pocket Max 3 x selected IUA (e.g. 3x$500 or 3x$2500) 3 x selected IUA (e.g. 3x$500 or 3x$2500)
Shareable Cost Per Need 100% after IUA 100% after IUA
Max Sharing Per Need None None
Extended Sharing N/A N/A
Doctor's Office Visits Only related to shareable needs Only related to shareable needs
Hospitalization 100% after IUA 100% after IUA
Emergency Care 100% after IUA 100% after IUA
Prescriptions Shareable as part of a need, or for 120 days with new condition Shareable as part of a need, or for 120 days with new condition
Maternity Shareable after $5000 Maternity IUA Shareable after $5000 Maternity IUA
Note Annual Flu Vaccine for all ages Annual Flu Vaccine for all ages

Limits on Tobacco Users: Sedera households with one or more tobacco users contribute an additional $75.00 per month. If the member who is a tobacco user is over the age of 50, then medical needs for that member are limited to $25,000 for each of the following four disease categories: Cancer, Heart conditions, COPD
and Stroke.

Maternity: Shareable after $5,000 maternity IUA ($7,500 IUA for planned C-section deliveries). Standard IUAs do not apply to maternity needs.

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