Presents Apex Management Group s Affordable Health Care Solutions MEC Plan MEC Plan HDHP/ 100% Preventive Care Plan with HSA Options HDHP/ 100% Preventive Care Plan with HSA and The Advantage Plan The Advantage Plan PLUS Medical Cost Sharing & Supplemental Insurance Plans
Telemedicine Bill Reduction Negotiator Prescription Card MailMyPrescriptions.com Dental Hearing About National Consumers Benefits Association The National Consumers Benefits Association (NCBA) is a non-profit organization serving the goals and needs of consumers from across the nation. Since its inception in 2000 NCBA has been dedicated to providing benefits and resources to help its members with professional, lifestyle and health-related benefits, as well as advocacy opportunities so they can have a voice on issues to positively impact their lives. Despite changes to the economy and the health care landscape that have made an uncertain future, NCBA is focused on assisting its members in any way possible and growing into a leader for the everyday citizen. Below is a highlight of what types of benefits you receive as a member. Health Services Labs Imaging Diabetic Supplies Durable Medical Equipment Emergency Medical Info Card Vitamins Consumer Services Travel Services Business Services Everyday Savings Grocery Coupon Discounts Child ID Card Legal LifeLock Identity Theft Protection Floral Service Discounts Magazine Discounts Moving Discounts Truecar Discounts 24 HR Emergency Roadside Assistance Travel Assistance Plan Hotel/Motel Discounts Car Rental Discounts Cruise Discounts Travel Package Discounts CitbVisas (Expedited Passports) Office Depot Discounts UPS Discounts Constant Contact Discounts ADP Payroll Processing Credit Card Processing Hewlett Packard Discounts Wireless Traveler VOIP/Internet Discounts Custom Website Discounts For full details on NCBA Benefits, please refer to: https://www.ncbamembers.com/benefits.php
Costs have Skyrocketed Total premiums have increased by 55% Employees portions have increased 70% Wages have only increased by 19% The Unsustainable Squeeze
Membership in NCBA provides eligibility to enroll in Affordable e Health Care Solutions We all know that Health Care has become Unaffordable, Complicated and Limited in Options Apex Management Group s Suite of Healthcare Solutions provide simple to understand, affordable options and addresses Skyrocketing Health Care Costs As your Healthcare Solutions Partner We simplify what has become so complex Provide Better Benefits with lower out of pocket costs Premium Savings often 50% of a Marketplace Plan Four (4) Year Rate Lock on Apex Products Options for catastrophic, comprehensive benefits Four (4) Year Rate Lock Increase in plan years 2 through 4 cannot exceed 3% on an accumulative basis over 4 year period NOTE: The Rate Lock applies to the Apex Plans, Not Sedera ACA Compliance Plans exceed the requirements of the Affordable Care Act
The Apex Plans, What are they? Initially, the Apex Plans were Minimum Essential Coverage (MEC) Plans. MEC plans were implemented at the start of the Affordable Care Act (ACA). An employer Group of 50 or more had to have a plan in place that provided Minimum Essential Coverage to satisfy Employer Penalty A. On an Individual side, you had to be enrolled in a MEC Plan through your employer or be forced to pay the Individual Mandate Penalty. That was its core purpose at that time. To meet the Minimum Essential Coverage requirements a MEC Plan must provide the preventive care services mandated by ACA. Today, the mandated preventive care services encompass 80 preventive care services, inclusive of 21 preventive care services for adults, 28 for women and 31 for children. To see a complete list of covered preventive care services, please visit: www.healthcare.gov/coverage/preventive care benefits/ The Apex plans however go much further. The Advantage Plan provides great access to care to address the bulk of an Individual s or Families day to day health care expenses. Providing benefits for Primary Care, Specialists, Urgent Care, Lab, Imaging and Prescription Drug coverage all with a small copay and 100% coverage through a National Network of physicians and facilities. The HDHP/Basic MEC again provides the preventive care services in addition the framework to make it an HSA eligible plan. The Health Savings Account is included in the plan but it is unfunded. Should the member choose to fund the HSA, the contribution too the HSA is tax deductible and can be utilized for all out of pocket medical, dental and vision expenses. Both Plans, the Advantage Plan or the HDHP/Basic MEC Plan when combined with an HSA provide a great solution to address the lower cost health care needs, but what about high cost, unforeseen needs For the unforeseen medical care, Hospital Inpatient or Outpatient, Emergency Room, Surgery, a critical illness such as cancer, heart attack, etc. we have a solution partner delivering a Medical Cost Sharing plan. More to follow.
Apex Management Group s Suite of Health Care Products AFFORDABLE HEALTH CARE SOLUTIONS No Pre Existing Conditions No Deductible to Meet Great Rates 4 Year Rate Lock Easy Enrollment Platform COMPREHENSIVE BENEFIT PLANS NEW Preventative Care Plan with $1 Rx Co Pay Preventative Care Primary Care Visits Specialists Care Urgent Care Laboratory Services Imaging or X Ray Services Prescription Drugs Can be sold standalone or packaged with other products NEW High Deductible Plan Option with a FREE Health Savings Account with:
Apex s Suite of Affordable Healthcare Solutions for Employer Groups Membership Benefits of NCBA HDHP / 100% Preventive Included Advantage Plan Included HSA Compatible Yes Not Applicable HSA Account Included Not Applicable Annual Deductible $3,000 Ind / $6,000 Family Not Applicable Coinsurance 80% of Negotiated Rate Not Applicable Annual Out of Pocket maximum $6,650 Ind / $13,300 Family Not Applicable Covered Medical Services (HDHP) Physician Office Visit (Primary Care), Laboratory Services, Urgent Care Only Not Applicable Preventive Benefits Covers all mandated Preventive benefits required by PPACA For a complete list of covered preventive care services, please visit: www.healthcare.gov/center/regulations/prevention.html All 21 Preventive Services for Adults All 28 Preventive Services for Women All 31 Preventive Services for Children PPO Network: PHCS Primary Care Office Visit Specialists Office Visit Urgent Care Diagnostic X Ray & Laboratory Services 100% Coverage, no Copay for Mandated Preventive Care Services Not Covered Not Covered Not Covered Not Covered 100% Coverage, no Copay for Mandated Preventive Care Services $20 Copay (Max 3 visits per calendar year) $50 Copay (Max 3 visits per calendar year) $50 Copay (Max 3 visits per calendar year) $50 Copay by Date of Service (Max of 5 Services per calendar year) * CT Scan or ¹MRI Not Covered $200 Copay (Max 1 MRI or CT Scan per calendar year)
Apex s Suite of Affordable Healthcare Solutions for Employer Groups HDHP / Basic MEC Plan Advantage Plan Tier 1 Low Cost Generics Prescription Drug Benefits WelldyneRx Not Covered $1 Copay Tier 2 Generics Not Covered 10% Coinsurance Tier 3 Preferred Brand Not Covered 20% Coinsurance Tier 4 Non Preferred Brand Tier 5 Specialty, Generic and Preferred Tier 6 Non Preferred Specialty Not Covered Not Covered Not Covered 40% Coinsurance 10% Coinsurance (Plan pays 90% up to a max of $150 per Rx) 20 % Coinsurance (Plan pays 80% up to a max of $250 per Rx) Membership/Contribution Fee Member Only $95.31 $166.53 Member + Spouse $125.92 $252.74 Member + Child(ren) $125.92 $236.42 Member + Family $125.92 $329.33 * 3D MRIs are not covered. Enhanced imaging services, the use of a contrast material to enhance the MRI or CT Scan is not a covered service. The base MRI or CT Scan only are covered. Apex s Suite of Affordable Healthcare Solutions are not fully insured, but self funded plans
Medical Cost Sharing, What is it? Let s start off with what it isn t. It is not a health insurance plan. Forget what you know about high deductibles, out-of-pocket costs, pre-authorization, networks and unaffordable insurance premiums. To be clear, this is not a cheap insurance plan or health care alternative, it is something completely different. Medical Cost Sharing is an affordable way to plan for unforeseen medical expenses. Medical Cost Sharing is Health Care through Community verses Health Care through an Insurance Company. A community of like-minded people whom agree to strive for a healthy lifestyle and share one another s health care expenses. In a medical Cost Sharing Community, funds are contributed by many thousands of members and shared when there is a medical need. A need is that unforeseen medical expense, an accident, hospitalization, trip to the emergency room, surgery or diagnosis of a serious health care condition such as cancer or cardiac care. When care is rendered, you advise the provider that you are a self-pay patient. As a member of a Medical Cost Sharing community, you will be responsible for an initial unsharable amount or IUA. All expenses above the IUA are then shared by the community. All bills for medical care will be sent to you as a self-pay patient. You however, are not left alone to negotiate large medical bills. They will be negotiated on your behalf, often at a 50% or more discount. As an example, you are presented a bill for $25,000 for health care services. Typically, that amount would be negotiated down to $12,500. In this example, we will assume that you were responsible for the first $1,000, your initial unsharable amount. All bills above your IUA will be paid in full and there in no maximum limit to what will be paid. Since this is not insurance, the provider cannot be paid directly. You will be sent a check to cover the expenses and it will be your personal responsibility to pay the provider. No more rules apply, no network requirements, you can go to any doctor or facility you want. All care and treatment decisions are made by you and your doctor. Sound refreshing? Many times, Medical Cost Sharing, a solution to the high cost of insurance plans delivers savings of 50% or more, at the same time providing a more comprehensive plan with lower out-of-pocket costs. It is however, not for everyone. Pre-existing conditions will be limited in benefits. No coverage is provided the first year, $15,000 second year and $30,000 the third year before those pre-existing conditions are fully shared by the community. Overall, an Apex MEC solution paired with Medical Cost Sharing delivers a trusted and affordable health care option. Our Medical Cost Sharing partner, Sedera Health
The perfect compliment to Apex Management Group Suite of Affordable Healthcare Solutions Medical Cost Sharing (MCS) membership is a community of health conscious people who voluntarily share one another s medical expenses. MCS is not insurance and should never be construed to be like an insurance policy. Sedera Health facilitates the sharing of healthcare costs based on an established set of Guidelines that all participating members have agreed to abide by. Some sharing restrictions apply. Interested persons should carefully read and understand the Sedera Membership Guidelines before applying for membership. See Sedera Select Guidelines at: www.sedera.com
Medical Cost Sharing A Proven Alternative Big Savings Over Health Insurance Promotes Healthy Lifestyles Sharing Begins at your IUA (Initial Unshareable Amount) on a per need basis Health Care through Community vs Health Care through Insurance Industry Wide Estimate: $1 Billion in Sharing 1 million Members Freedom From Networks Medical Cost Sharing by Sedera Health is not insurance and is specific to the Sedera Health membership community. To participate, one must be a member of an authorized association/sponsoring organization or Employer and agree to abide by the Sedera Principles of Membership. Sedera is NOT a Health Care Sharing Ministry (HCSM) and its members do not qualify for exemption from the Individual Shared Responsibility provision of the Affordable Care Act through the Sedera Membership. Members may meet the Aca s Minimum Essential Coverage (MEC) requirement by enrolling in an Apex Plan. *Industry wide statistic source: www.healthcaresharing.org
Medical Cost Sharing addresses Large Costs (Needs) Defining a Need and how it works A Need is one or more medical expenses caused by a SINGLE accident or illness Initial Unshareable Amount (IUA) What a member pay before Sharing begins for the need Needs over the IUA ($500, $1,000, $1,500. $2,500 or $5,000) Fully Shared with community Limiting your out of pocket costs Three (3) for Individual and five (5) when there are family members participating. Everything is fully sharable after that point
Do pre existing conditions apply Yes * Standard sharing restrictions apply when joining the community for genetic defects and/or hereditary diseases. There are also restrictions on existing pregnancies when joining the community. Please see the Sedera Select Membership Guidelines for more information.
Contributions Sedera Health Medical Cost Sharing NOTE: Sedera households with one or more tobacco users contribute and extra $75.00 Per month for both Level 1 and Level 3 Pricing Non smoking (There will be a $75.00 Surcharge for Tobacco use) SEDERA ACCESS Level 1 Pricing Association / Membership Solution 500 IUA 18 29 30 39 40 49 50 59 60 64 MO 191.84 219.39 245.92 300.00 542.85 MS 364.28 418.36 472.45 580.61 1,066.32 MC 352.04 403.06 454.08 557.14 1,018.36 MF 528.57 607.14 685.71 841.83 1,546.93 1,000 IUA 18 29 30 39 40 49 50 59 60 64 MO 183.67 210.20 219.39 264.28 480.61 MS 345.92 400.00 418.36 508.16 939.79 MC 334.69 385.71 301.02 488.77 898.97 MF 503.06 580.61 607.14 737.75 1,364.27 1,500 IUA 18 29 30 39 40 49 50 59 60 64 MO 165.30 191.84 201.02 245.92 453.06 MS 310.20 364.28 382.65 472.45 886.73 MC 300.00 352.04 368.36 454.08 847.95 MF 450.00 528.57 555.10 685.71 1,285.70 2,500 IUA 18 29 30 39 40 49 50 59 60 64 MO 146.94 160.20 177.55 222.45 412.24 MS 274.49 298.98 335.71 425.51 803.05 MC 266.32 289.79 324.49 410.20 769.38 MF 397.96 434.69 486.73 617.34 1,165.30 5,000 IUA 18 29 30 39 40 49 50 59 60 64 MO 111.22 138.77 154.08 177.55 334.69 MS 202.04 256.12 288.77 335.71 648.97 MC 197.96 248.98 279.59 324.49 621.42 MF 293.88 372.45 419.38 486.73 940.81
Contributions Sedera Health Medical Cost Sharing SEDERA ACCESS Level 3 Preferred Pricing When paired with Apex Advantage Plan Non Smoking (There will be a $75.00 Surcharge for Tobacco use) SEDERA ACCESS Level 3 Pricing Association / Membership Solution 500 IUA 18 29 30 39 40 49 50 59 60 64 MO 167.35 189.79 212.24 258.16 462.24 MS 318.36 364.28 409.18 500.00 908.16 MC 308.16 351.02 394.89 480.61 868.36 MF 465.30 530.61 596.93 728.57 1,320.40 1,000 IUA 18 29 30 39 40 49 50 59 60 64 MO 160.20 183.67 190.81 229.59 413.26 MS 306.12 352.04 367.34 443.87 811.22 MC 295.92 339.79 354.08 426.53 775.50 MF 446.94 513.26 535.71 645.91 1,178.56 1,500 IUA 18 29 30 39 40 49 50 59 60 64 MO 144.90 168.37 175.51 214.28 389.79 MS 275.51 321.43 336.73 413.26 765.30 MC 267.34 310.20 325.51 397.96 732.65 MF 402.04 468.36 490.81 602.04 1,112.24 2,500 IUA 18 29 30 39 40 49 50 59 60 64 MO 129.59 140.82 156.12 193.88 355.10 MS 244.90 266.32 296.94 373.47 694.89 MC 237.75 258.16 287.75 360.20 665.30 MF 358.16 388.77 433.67 543.87 1,010.20 5,000 IUA 18 29 30 39 40 49 50 59 60 64 MO 97.96 120.41 133.67 153.06 282.65 MS 181.63 225.51 354.08 290.81 550.00 MC 177.55 220.41 244.90 281.63 527.55 MF 266.32 330.61 369.38 425.51 799.99
Sedera Health Member Services 24/7/365 Telemedicine (Teladoc) Nation s Top Doctors (2nd.MD) Counseling Service AMemberAdvisor(Coach)whowill help with... Medical Record Transfer Physician and Hospital Search Appointment Scheduling Prescription Cost Search Health Cost Estimate Elder Care Services Surgery Cost Saver Pre-Negotiation Medical Bill Negotiation NOTE: Even in Year 1 Sedera s member Services Team is available to assist our member s in locating cost effective providers or alternative services, AND to negotiate their medical bills that exceed $500
How does Sedera Health, Medical Cost Sharing work? You are a self pay patient. That is what you advise medical facility or doctors at time of need. Step 1 You have a need that exceeds your Initial Unsaharble Amount all bills will come to you as a selfpay patient Step 3 Sedera Health will then utilize their parent company, The Karis Group to negotiate the bills on your behalf. The average discount negotiated is 53% Step 5 It is your personal responsibility for your Initial Unsharable Amount and to utilize that check you received to submit it to the providers whom have already agreed to accept it as payment in full. Step 2 You will then utilize the Sedera App to take a picture and send the bills to Sedera Health. They can be emailed as well Step 4 After negotiation, Sedera Health will send you a check as payment in full minus your Initial Unsharable Amount.
Voluntary Benefit offerings from AccidentAdvance CriticalAssistance SM Advance TransDI Plus Short Term disability CancerSelect Plus SM Trans Select 20 Group Term Life Ins. TransElite Universal Life Insurance
The perfect compliment to Apex Management Group s Suite of Affordable Health Care Solutions Our Valued Partners www.sedera.com www.hmatpa.com www.multiplan.com www.welldynerx.com Your Healthcare Community Who we are: Sedera Health is a community of health conscious and like minded people that are inspired by the modern sharing economy. Our non insurance community approach is centered on a commitment of striving for a healthy lifestyle and in collectively sharing the cost of one another s medical care. In doing so, we facilitate open access to affordable health care for our members and their families. While we re built on Christian principles, our members do not have to be affiliated with any religious group people of all faiths are welcome to participate. Third Party Administrative Services THE HMA Difference HMA provides the ability to offer all services from one company. Offer fully developed, integrated and certified compliant health plans or fully customized plan options. Superior technology makes it work. This allows HMA to compete in any setting. It allows for superior customer service to be achieved because the technology ensures maximum efficiency. What is the network? Multiplan/PHCS has 900,000 plus healthcare Providers under contract, an estimated 68 million consumers accessing our network products and 40 million claims reduced through our network and non network solutions each year. Multiplan/PHCS has more experience and resources that healthcare payers in commercial healthcare, government, worker s comp and auto market needs, to face today s unprecedented cost and competitive pressures The Prescription Drug Benefits WelldyneRx is an innovative, full service prescription drug manager. Servicing health plan members through a retail network of over 65,000 pharmacies nationwide. Our full service mail order facilities, fill more than 1 million prescriptions per year Transamerica Employee Benefits Transamerica has been helping families Transform Tomorrow for over 100 years. For more than half a century we ve provided voluntary benefits. Transamerica Voluntary Benefits offers comprehensive portfolio of supplemental health, life and disability products underwritten by Transamerica Life Insurance Company and Transamerica Financial Life Insurance Company, It s our way of helping people create better financial futures.
Summary Great Benefits Great Rates Online Enrollment and Premium Collection Choice of Options Shopping Cart experience for members One ACH for all plans elected Apex/Sedera Health combined products lower healthcare costs by 50+% For additional Information, please contact: Broker Name: Agency: Address: Ph: E: