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Frequently Asked Questions

MEMBERSHIP

Who Is Scoop Health?

Scoop Health is a company focused on providing new, innovative solutions to individuals, families, and small businesses across America. At the core of all of this is our member’s participation in the Sedera medical cost sharing community. When you become a Scoop Health member, you are joining a community of like-minded individuals who are committed to leading a healthy lifestyle and want to be active and engaged participants in their health care decision making.

What Are The Advantages of Membership?

A few of the perks of membership include:

24/7 Access to Telemedicine – Sinus infections, strep throat, the flu…these are just some of the conditions that telemedicine can help treat. When you start to feel crummy, give them a call and get moving back in the right direction.

Expert Second Opinion Service – Picture this: Your doctor says they’re going to have to put you under the knife and perform surgery. We don’t know about you but getting a second opinion is one of the first things we’d be asking for. This service is provided at no charge to members and allows them to have a virtual 2nd opinion consult with board certified, leading doctors from around the country.

Personal Member Advisors – Advisors work with members every day. From finding the best dentist for their children to getting the best possible price on medications, their job is to ensure each Member has a wonderful experience and gets the best results possible from Sedera.

Who Is Sedera?

Sedera was founded by Dr. Tony Dale. A former physician from Great Britain, Dr. Dale’s interest in the American medical system began in the mid 1990s when he had to have surgery in the United States. Through this experience, Dr. Dale saw the tremendous inconsistencies and staggering costs built into the American health insurance system. He knew there had to be a better way.

Recognizing the unmet needs in the traditional health insurance industry, Sedera was founded in 2014 as an alternative solution.

That alternative was a Medical Cost Sharing organization. While the concept is not yet widely known, the philosophy has a 30-year legacy of success. Healthcare cost sharing is non-insurance where all Members share funds for medical care. Sedera was founded on the principle that people should share one another’s burdens. Today, Sedera has Members throughout the United States.

To date, there have been over $28M in medical bills processed through the community and an average of 53% in cost savings through negotiations.

Is There A Penalty For Not Having Insurance?

Starting with the 2019 plan year, the Shared Responsibility Payment (i.e. the “fine” or “penalty”) no longer applies on a federal level. Read more here.

Note: Some states have their own individual health insurance mandate, requiring you to have qualifying health coverage or pay a fee with your state taxes for the 2019 plan year. It is the responsibility of members to understand their state level requirements and any associated penalties and make the decision that is right for their situation.

Do I have to sign up for a whole year and is there a penalty for cancelling early?

This is one of the best parts about medical cost sharing – flexibility! There is no minimum time frame needed for membership. And there’s no penalty for canceling either. 

Some folks are excited to have found their permanent solution that fits with their lifestyle, beliefs, and budget. Others sign up temporarily until they find a new career opportunity that offers them benefits – although, we end up finding that many of these folks find it hard to go back to traditional insurance after experiencing Sedera’s membership.

How will I know there will be enough money for my medical Needs?

While medical cost sharing is a non-insurance solution, our community has been very stable throughout our history and has put a number of measures into place to maintain that stability. Here are a few important points:

The first thing to note is that in the last six years, we’ve only changed our monthly rates once.

Second is that as a community, we’ve never had an eligible member medical needs that we were unable to share.

Lastly, we take 15% of member’s monthly shares and put them into an Excess Needs Fund. We can tap into this for large needs over $150,000. This helps to maintain the financial stability of the community in the face of very large medical Needs.

 

GETTING STARTED

How Much Does Scoop Health Cost?

Membership options start as low as $114 per month. We find that most people save on average 30-60% when compared to traditional health insurance. Check out our Calculator to see how much you can save!

How Does The Sign-Up Process Work?

The sign-up process is all completed online, it takes about 5-10 minutes and couldn’t be simpler. You’ll simply do the following: Select your IUA, enter in your contact info and add your dependents (if any), agree to abide by the membership principles and guidelines, list any pre-existing conditions, input your payment information, hit submit and you’re done!

To get started, just click here – we’d love to have you become part of our community!

Is There A Long Term Contract

The long and short of it is no! We don’t believe that anyone should be tied down in long term contracts. If you ever need to leave our membership for any reason, just give us a shout. We only ask that you let us know that you need to cancel with 5 business days left in the month so that we have enough time to get everything processed in our system and generate a refund if needed.

What Is An IUA?

IUA stands for Initial Unsharable Amount. This is the amount of money that members are required to carry on their own prior to any amount that may be eligible for sharing.

Think of it this way, would you ask your friends to come help you move and then just sit on the couch the whole time and let them do all the lifting? Of course not! It’s the same idea here, the IUA is simply you doing your portion of the ‘lifting’ before asking your medical cost sharing community to help you out.

Members that experience multiple Needs within their 12-month membership year are required to pay the first three IUAs at the selected amount. If there is a fourth Need during the same membership year, no IUA would apply. The fourth Need, and any subsequent Need(s), would be eligible for immediate sharing; subject to any stated restrictions or limitations in the Guidelines.

For households with multiple members (2 or more), a maximum of five IUAs apply per 12-month membership year. Beginning with the sixth Need during the same membership year, medical expenses would be eligible for immediate sharing; subject to any restrictions.

What Is A Need?

A Need is simply a medical expense that exceeds the member’s Initial Unshareable Amount (IUA) caused by a single injury or illness to an eligible Member or participating dependent.

Our membership guidelines outline how Needs are shared, read more here.

MEDICAL COST SHARING

What Is Medical Cost Sharing

The Sedera Medical Cost Sharing Community is a membership-based non-insurance community of like-minded individuals established for the purpose of sharing legitimate healthcare expenses between members.

Instead of paying monthly premiums to an insurance company, Members share a given amount on a monthly basis and draw from Community funds as medical Needs arise. Monthly shares are generally lower than typical insurance premiums. Through Sedera’s Medical Cost Sharing model, Members save between 30 – 50% of the costs that are typically incurred with health insurance plans.

So How Does Medical Cost Sharing Actually Work?

When members join, they select their Initial Unshareable Amount ($500, $1500, $2500, or $5000) which determines how much they contribute in shares each month. The monthly contribution goes into the community fund for the sharing of member medical Needs. The IUA comes into play when we have an unexpected illness or injury, it’s the amount that members are responsible to bear prior to any sharing. 

For example: Let’s say a member picked the $500 Initial Unsharable Amount (IUA) and the monthly contribution that goes along with it. Each month, this member contributes their monthly share, which goes into the Community funds. Then say for example that this member has an accident and needs surgery to repair a broken arm. The estimated costs associated with this injury total $7,500. Let’s take a look at how the process would be broken down:

1: As these costs were due to an unexpected injury, this member would ‘open a Needs case’ and submit their bills to Sedera to be shared.

2: If needed, the billss will first go through bill negotiation, reducing the total cost from $7,500 to about $3,500 (we average right around a 53% reduction costs through negotiation).

3: The member would be responsible to pay their chosen IUA ($500 in this example).

4: The member receives a check for the difference, in this case $3,000 from the Community to cover the remaining medical bills from their Need. 

The medical Need is resolved with the member paying a total of $500 vs the original 7,500 estimated cost. Great, right?

Is The Concept of Medical Cost Sharing New?

It’s not – the concept of medical cost sharing has been in practice for over 30 years. It started in faith-based communities and we model our medical cost sharing community after those successes, we’ve simply removed the religious rules and restrictions. Today there are over a million members participating in medical cost sharing which represents over a billion dollars shared.

To date, there have been over $28M in medical bills processed through the community and an average of 53% in cost savings through negotiations.

Why Is Medical Cost Sharing A Better Approach?

First things first, members typically save 30-60% when compared to traditional health insurance. And when a large medical need does arise, you have a large community of people there to support you.

On top of that, members are back in the drivers seat of their own healthcare decisions. There’s no network restrictions so members are free to seek out the care that they need from whoever they think is best.

We combine all of this with a high-quality membership experience – what’s not to love?

What Expenses Are Shared?

In general, Needs for unexpected illnesses or injuries resulting in visits to licensed medical providers, emergency rooms, testing facilities, or hospitals are sharable on a per person, per incident basis.

* Some limitations may apply, refer to the membership guidelines for more specifics.

What Expenses Are Not Shared?

Routine medical care such as general wellness, preventative care, and maintenance meds are generally not shared.

There are a couple exceptions to this: Colonoscopies and mammograms. These two items are sharable without the IUA if the screening is performed as a well-patient procedure (i.e. not to evaluate signs/symptoms of a potential new illness). The third exception is for routine childhood immunizations which are also sharable.

When operating as a self-pay patient for routine medical care, you’d likely be surprised to see how affordable health care really can be. In addition to in-person visits with your primary care doctor, there are a number of virtual resources you can utilize as well. Take a look at all of the resources on our Member Resources page and see how easy it is to save money on your health care.

Is There Any Maximum On How Much Can Be Shared?

There is no specific annual maximum dollar amount or lifetime maximum limits per member, though certain dollar amounts and/or visit limits apply to specific types of medical care and therapies. Sharing is only limited to the cumulative contributions received from participating members in any given month. There is, however, no limit on the number of Needs that an individual member or household may have.

Is There Any Fine Print I Should Read?

Our commitment to complete transparency is something we strongly pride ourselves on. We highly recommend that everyone read through the membership guidelines prior to becoming a member. You can view the Sedera membership guidelines here to get a more in-depth look at how and what we share as a community.

MEDICAL NEEDS

What About Pre-Existing Conditions?

Pre-existing health conditions will have limitations on sharing for the first few years but do not make anyone ineligible to join our community. We define pre-existing conditions as: Any medical condition that existed during the immediate 36 months prior to membership (diagnosed, suspected or producing observable signs or symptoms). You can read more specifics in the membership guidelines

The sharing limitations for pre-existing conditions are:

Months 1-12 – Not eligible for sharing

Months 13-24 – Sharing up to $15,000

Months 25-36 – Sharing up to $30,000

Months 37 and after – Fully sharable

*If you would like to discuss your personal pre-existing condition sharing options, please contact our Membership and Enrollment Team.

Are Maternity Needs Sharable?

Maternity expenses incurred after 12 months of membership are generally shareable. This includes expenses for prenatal care, delivery, postnatal care, and miscarriage.

Medical expenses for child birth that have an expected delivery date within the first 12 months of membership are not shareable.

Normal vaginal deliveries and emergency Cesarean section deliveries have a total Initial Unsharable Amount (IUA) of $5,000. Non emergency/elective Cesarean section deliveries have a total IUA of $7,500. The standard IUA levels of $500 – $5,000 do not apply for Maternity Needs. Members who wish to reduce their IUA’s may seek alternative delivery methods may be eligible for reductions in their IUAs.

You can read additional information about Maternity Needs in that section of the membership guidelines, starting on page 37.

Can I Be Dropped For Having An Expensive Medical Need?

Members cannot be dropped due to their medical needs. Neither your membership nor your monthly share is affected by the amount of medical expenses you or any family members may have.

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