Who is eligible to join? Anyone who can benefit from regular exercise and is under the age of 65 can join.
Can my family members participate? Yes, spouses and dependent children up to age 26 are welcome.
When will I get my membership or insurance card? This is not insurance and there is no need for a card. You select your own physicians and let them know you are a cash pay patient and want to be billed directly.
Who is SHMI? SHMI is a facilitator for individuals and their physicians seeking the best way to manage healthcare. For 40 years, SHMI has been assisting its clients to improve healthcare services and reduce costs.
When can I enroll (or cancel)? Members can enroll or cancel at any time; all changes must be made prior to the 20th of the month and become effective on the 1st of the following month.
Is this compliant with the Affordable Care Act (ACA) so that I will not incur the individual mandate penalty? Yes, although the healthcare mandate has changed, HSW is compliant with all ACA and state mandates for healthcare.
This all sounds too good to be true! Does this really work? Absolutely! The medical cost Sharing model has existed for over 30 years and today serves over a million members.
Can I choose my own doctors and hospitals? Yes! There are no “preferred providers”, or network restrictions. We know continuity of care and a trusting physician-patient relationship are crucial to better healthcare.
How are my bills reimbursed? Preventive services are reimbursed, up to 130% of the national rate. Checks are issued to members within 30 days of receiving the itemized invoice and paid receipt.
Medical bills for treatment, over the IUA, are shared through Sedera. Consult the Sedera guidelines for full details.
What do I tell my medical provider? Let the doctor know that you are a member of a medical cost sharing community and that you will be paying for the visit at the time of service. Ask for a “prompt pay” discount. Many practices are happy to offer one since they will not have to file claims with insurance companies and wait for payment.
How often can I go for a well visit? One well visit per twelve month period for adults.
Are required school/camp/work, etc. physicals considered preventive care? There is one standard preventive care visit in the ACA compliance. That visit may suffice for other physicals as well.
Is Birth Control included in preventative care? Yes.
Is the Blood work of a Preventive care visit included? Routine blood work is included. Do not pay the bill in advance! Send us the bill and we will send you payment.
Is preventative vision screening covered? Yes, but only for children.
Is preventative dental work covered? No, regular dentistry (cleanings, x-rays and fillings) are not covered under the ACA.
Annual Recertification Once a year, we ask you to reconfirm your adherence to the Community Standards that are part of the Sedera guidelines to be a member in good standing.
What are STATS and HealthShare.Fit? All members of HealthShare Works are also enrolled in the STATS. The organization promotes good health through exercise. You can report your general results and be paid for doing so. HealthShare.Fit is our exercise association; there is no added cost to join. Members report their STATS monthly and are paid for doing so.
What are the STATS? The basic statistics: weight, height, resting pulse, high pulse, and the number of thirty minutes or more exercise sessions you did last month. For example, a session can be a walk, yoga, cycling, weightlifting, etc.
How do members submit STATS? They can download the SHMI STATS app from Google Play or submit directly on our website on the STATS tab. How much does SHMI pay for STATS? SHMI pays $10 for each month a member submits their statistics. STATS payments are sent quarterly. Members must submit STATS at least two out of the three months to be eligible for payment.
Why do you want my STATS? Your STATS are part of a national study on the importance of exercise.
Can my STATS results affect my membership? No, STATS are not used to adjust contributions or end membership.
Will I lose my membership if I do not submit STATS? No, submitting STATS is voluntary.
Who do I call for help? In all matters of HealthShare Works, call us.For Sharing (including Second Opinions), and telemedicine, Call Sedera 855-973-3372 or check their website -memberservices@Sedera.comClinical questions about medical treatment that are not preventive care, speak to your Sedera Counselor.
My physician has never heard of HealthShare Works There is no need to submit a “claim” to get paid.The patient pays up to the IUA and larger bills just need a bill to the patient.
What do I say when they ask, “Your insurance card please?” If it is the first time you are seeing this provider, show them the Letter to Physicians. Better, email it to them in advance. Or you can say “I am a member of a Sharing community. I pay at the time of visit if the bill is not excessive.” Never pay more than the basic IUA of $500.
A Preventive visit has turned into treatment for a diagnosed condition Then proceed as for any treatment. It is never a Preventive care until the physician completes his exam and says it is.
How do I get reimbursed for Preventive Care? For reimbursement of preventive care, HealthShare Works will accept an itemized “Paid” receipt from your physician up to $500.00 as proof of payment.
Do I use up my Sharing benefits? No. There is no lifetime limit on medical bills.