Sedera, the medical cost sharing administrator, has announced that they will be updating the medical cost sharing Guidelines for both the Access and the Select programs effective as of September 1, 2019. Access is used for the Association program offered through the MPowering Benefits Association, whereas Select is used for the Group program that was formerly offered to individuals who became 1099 employees of MPowering Benefits.
The new Guidelines are scheduled to be published July 31. We’ll publish both sets of Guidelines in the September issue of this newsletter and will be updating the website at www.controlyourhealthcarecosts.com. The site will contain the new Guidelines, and the description of the Sedera portion of
Health Excellence
Plus
on the Plan Strategy page of the website will be modified to summarize some of the changes.
Sedera will be notifying members of these changes this week.
Please see this
analysis
that provides a description of the changes to the Guidelines. We encourage all members to read this material.
In general, the new guidelines clarify issues experienced with administering the present program.
Domestic partners will now be permitted to join, dependent on how a domestic partner is defined under applicable state law. Although Sedera does not consider the new Guidelines to be major changes, there ARE some changes, so members should read to see how they are affected.
The changes are intended to improve transparency so members are more fully informed. The new Guidelines provide more clarification on pre-existing conditions and also discuss methods Sedera will use to control costs when members go to providers who do not accept reasonable reimbursement for their services. Members who experience a new Need are encouraged to call Sedera within 3 days so Sedera Member Advisors can help them find providers and also better assist in bill negotiation.
