Sedera Select Paired with Apex Group Products

By pairing the healthcare services offered by Apex Management Group and Sedera Health our objective is to help employers solve the dual problem of employee retention and providing affordable and comprehensive health care.  This “two component” Sedera Select/Apex solution delivers one of the industry’s best values available for a comprehensive health care offering.

  • Component One: for Day-to-Day Health Care Issues
  • Component Two: for Catastrophic or Unforeseen Health Care Needs

Compared to standard group health insurance plans, this alternative solution can provide health care cost reductions that can range from 30% to 50%, and at times even more.  Many employers will be drawn to this solution because of price.  More importantly though, employers should consider this health care solution because it offers tremendous quality of services and value to employees and their families.

Pairing Apex with Sedera Select requires a minimum group size of four (4) employees.

A webinar called "Medical Cost Sharing – The Proven Alternative" is also available under the Training tab. This presentation explains the benefits of pairing Sedera Select with Apex Management products to provide a comprehensive and cost effective strategy for group health care.

HDHP / 100% Preventive
Advantage Plan

Component 1) Apex HDHP/100% Preventive Care and Advantage Plan

HSA Compatible
HDHP / 100% PreventiveYes
Advantage PlanNot Applicable
Annual Deductible
HDHP / 100% Preventive$3,000 Ind / $6,000 Family
Advantage PlanNot Applicable
Coinsurance
HDHP / 100% Preventive80% of Negotiated Rate
Advantage PlanNot Applicable
Covered Medical Services (HDHP)
HDHP / 100% PreventivePhysician Office Visit (Primary Care), Laboratory Services, Urgent Care Only
Advantage PlanNot Applicable
Preventive Care Services
21 Preventive Services for Adults
HDHP / 100% Preventive100% Coverage, no Copay for Mandated Preventive Care Services
Advantage Plan100% Coverage, no Copay for Mandated Preventive Care Services
28 Preventive Services for Women
HDHP / 100% Preventive100% Coverage, no Copay for Mandated Preventive Care Services
Advantage Plan100% Coverage, no Copay for Mandated Preventive Care Services
31 Preventive Services for Children
HDHP / 100% Preventive100% Coverage, no Copay for Mandated Preventive Care Services
Advantage Plan100% Coverage, no Copay for Mandated Preventive Care Services
PPO Network: PHCS
Primary Care Office Visit
HDHP / 100% PreventiveNot Covered
Advantage Plan$20 Copay
(Max 3 visits per calendar year)
Specialists Office Visit
HDHP / 100% PreventiveNot Covered
Advantage Plan$50 Copay
(Max 3 visits per calendar year)
Urgent Care
HDHP / 100% PreventiveNot Covered
Advantage Plan$50 Copay
(Max 3 visits per calendar year)
Diagnostic X-Ray & Laboratory Services
HDHP / 100% PreventiveNot Covered
Advantage Plan$50 Copay by Date of Service
(Max 5 visits per calendar year)
* CT Scan or ¹MRI
HDHP / 100% PreventiveNot Covered
Advantage Plan$200 Copay
(Max 1 MRI or CT Scan per calendar year)
* 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
Prescription Drug Benefits - WelldyneRx®
Tier 1 – Low Cost Generics
HDHP / 100% PreventiveNot Covered
Advantage Plan$1 Copay
Tier 2 - Generics
HDHP / 100% PreventiveNot Covered
Advantage Plan10% Coinsurance
Tier 3 - Preferred Brand
HDHP / 100% PreventiveNot Covered
Advantage Plan20% Coinsurance
Tier 4 – Non-Preferred Brand
HDHP / 100% PreventiveNot Covered
Advantage Plan40% Coinsurance
Tier 5 – Specialty, Generic and Preferred
HDHP / 100% PreventiveNot Covered
Advantage Plan50% Coinsurance
Tier 5 – Specialty, Generic and Preferred
HDHP / 100% PreventiveNot Covered
Advantage Plan10% Coinsurance
(Plan pays 90% up to a max of $150 per Rx)
Tier 6 – Non-Preferred Specialty
HDHP / 100% PreventiveNot Covered
Advantage Plan20% Coinsurance
(Plan pays 80% up to a max of $250 per Rx)
Membership/Contribution Fee
Member Only
HDHP / 100% Preventive$66.00
Advantage Plan$129.75
Member + Child(ren)
HDHP / 100% Preventive$66.00
Advantage Plan$201.24
Member + Spouse
HDHP / 100% Preventive$66.00
Advantage Plan$217.24
Member + Family
HDHP / 100% Preventive$66.00
Advantage Plan$297.30

 

 

Sedera Select Tier 1 Pricing
*Sedera Select Tier 3 Pricing

Component 2) Sedera Health - Medical Cost Sharing

Initial Unsharable Amount Options:
$500, $1,000 and $1,500
Needs over IUA Fully Sharable by Community:
Fully Shared by Community
Limiting Out-of-Pocket Costs:
Three (3) for Individual and five (5) where there are family members participating
Pre-existing Condition Limitation:
Year 1: No Sharing for that spcific condition
Pre-existing Condition Limitation:
Year 2: $15,000 Sharing for that spcific condition
Pre-existing Condition Limitation:
Year 3: $30,000 Sharing for that spcific condition
Pre-existing Condition Limitation:
Year 4 : Fully Sharable
Telemedicine - Teladoc:
Included
$500 IUA Tier 1 Pricing
Under 30 / 30 Plus
$500 IUA Tier 3 Pricing
Under 30 / 30 Plus
Employee Only
Tier 1 Pricing$189 / $238
Tier 3 Pricing$168 / $209
Employee + Child(ren)
Tier 1 Pricing$387 / $460
Tier 3 Pricing$341 / $402
Employee + Spouse
Tier 1 Pricing$448 / $511
Tier 3 Pricing$392 / $445
Employee + Family
Tier 1 Pricing$646 / $726
Tier 3 Pricing$646 / $726
$1,000 IUA Tier 1 Pricing
Under 30 / 30 Plus
$1,000 IUA Tier 3 Pricing
Under 30 / 30 Plus
Employee Only
Tier 1 Pricing$151 / $187
Tier 3 Pricing$137 / $167
Employee + Child(ren)
Tier 1 Pricing$306 / $359
Tier 3 Pricing$275 / $320
Employee + Spouse
Tier 1 Pricing$351 / $396
Tier 3 Pricing$313 / $352
Employee + Family
Tier 1 Pricing$508 / $564
Tier 3 Pricing$454 / $502
$1,500 IUA Tier 1 Pricing
Under 30 / 30 Plus
$1,500 IUA Tier 3 Pricing
Under 30 / 30 Plus
Employee Only
Tier 1 Pricing$136 / $166
Tier 3 Pricing$119 / $143
Employee + Child(ren)
Tier 1 Pricing$273 / $318
Tier 3 Pricing$236 / $272
Employee + Spouse
Tier 1 Pricing$311 / $349
Tier 3 Pricing$266 / $296
Employee + Family
Tier 1 Pricing$451 / $498
Tier 3 Pricing$386 / $424
*Sedera Select Tier 3 Pricing only applies when utilizing the Apex Advantage Plan
NOTE: For full details please review the Apex-Sedera Group Proposal
Documents
Employee Documents for Apex Management Group Products