ABOUT THE PROGRAM
Providing quality healthcare for employees can be a challenge
Our members tell us that healthcare is a top concern for their businesses. That’s why the Delaware County Chamber has partnered with the Small Association Leadership Alliance (SALA) to allow our members access to a comprehensive and cost-effective alternative to traditional insurance plans. The Chamber’s Healthcare program is proven insurance alternative for members to consider for their healthcare. The program has several components to choose from to customize their healthcare. When each component is brought together, the result is a comprehensive and affordable option for healthcare. The components include:
- Apex Preventative Care Plan that best fits your needs, family, and budget (2 Choices)
- Add-on a Sedera membership for medical cost sharing to be used for accidents, illness, and unforeseen medical needs. (5 IUAs to choose from)
- Take advantage of Teladoc telemedicine for increased savings and services (included with Sedera membership)
- The comfort of 2nd.MD to ensure you and your family receive the most up-to-date medical treatment available (included with Sedera membership)
Learn about the Healthcare Program Components
Choose an Apex Preventative Care Plan
Apex is the preventative care component of the SALA Healthcare Program. The Apex plans are not an insurance product, but a self‐funded plan sponsored by the Small Association Leadership Alliance (SALA). The Apex plans qualify as Minimum Essential Coverage (MEC) plans for preventative care coverage. A MEC plan must cover 100% of the Centers for Medicare & Medicaid (CMS) listed preventative and wellness benefits. The Apex plans are designed to meet your day-to-day healthcare needs.
Participants choose either the:
• Apex Basic MEC Plan (HDHP), or
• Apex Advantage Plan
Both plans comply with ACA mandated preventative services with 100% coverage for all 21 preventative services for adults, 26 services for women, and 27 services for children. (Click here to learn more about the ACA requirement)
Apex Advantage: Apex Advantage provides 100% coverage for preventive care, co-payments for small and medium cost medical expenses, and prescription coverage.
• This plan includes: 100% coverage for preventive care services
• Small co-pays for Specialists, Urgent Care, Lab, Imaging and Prescription Drugs.
• Prescription drug coverage managed by WellDyneRX
View Current Rate Sheets for Apex Advantage
Apex HDHP/Basic MEC: The Apex HDHP (High Deductible High Premium) Plan provides the Minimum Essential Coverage at a lower monthly cost but does not include a prescription plan or coverage for specialists. The Apex HDHP plan does allow for the addition of a Health Savings Account (HSA). This plan includes:
• 100% coverage for preventive care services
• The plan provides the required framework allowing members to setup and use a Health Savings Account (HSA) for qualified medical expenses
View Current Rate Sheets for Apex HDHP/Basic MEC
To learn more about the Apex options, we recommend reviewing the following:
• Current Rate Sheets – Advantage / Lvl 3
• Current Rate Sheets – HDHP / Lvl 1
• About Apex
• Apex Basic (MEC) & Advantage Plans
• Apex Basic (MEC) FAQ
• Apex Advantage FAQ
• Multi-Plan Provider Search Instructions
Add Sedera Medical Cost Sharing
The Sedera medical cost sharing model boldly challenges the insurance status quo. Through an innovative layering of healthcare services, we enable individuals and family’s access to high quality healthcare that is affordable, flexible and effective.
In addition to sharing medical expenses, Sedera provides access to valuable Counseling, Medical Bill Negotiation, Telemedicine, Expert Second Opinion, and Personal Member Advisor services to all members.
You can choose from 5 IUA’s (Initial Unshareable Amount) that range from $500 to $5000.
To learn more about Sedera we recommend reviewing the following:
• About Sedera
• Sedera Summary Info
• Sedera Membership Overview
• Sedera Membership Guidelines
• Sedera Key Terms
WARNING: SEDERA, INC. IS NOT AN INSURANCE COMPANY AND THE SEDERA MEDICAL COST SHARING MEMBERSHIP IS NOT ISSUED OR OFFERED BY AN INSURANCE COMPANY. WHILE EVERY EFFORT IS MADE TO MEET MEMBER’S MEDICAL NEEDS, SEDERA, INC. AND THE SEDERA MEDICAL COST SHARING COMMUNITY DO NOT GUARANTEE PAYMENT OF ANY MEDICAL EXPENSE.
Telemedicine through TelaDoc
Sedera members have 24/7/365 access to a board-certified physician through Teladoc telemedicine. This service provides on-call physicians available to help resolve routine medical issues by phone or video consultations. Members considering a trip to the Emergency Room, urgent care center, minute clinic or who just cannot wait to get scheduled for a doctor’s office visit can use Teladoc to access medical care, saving both time and money.
- On-demand care – talk to a doctor anytime, no matter where
- Prompt diagnosis for faster treatment
- No consultation time limits
- Treatment of children of any age
- Secure and portable health records
- Cost savings on expensive ER or urgent care visits
- Physicians can prescribe non-narcotic medication or refills when appropriate
- More info: Telemedicine FAQ
2nd.MD Medical Second Opinion
We’ve all hassled with doctor waitlists, gone back and forth to get a referral and searched the web for answers to medical issues. As a member of Sedera Health, you can bypass these frustrating steps through a program called 2nd.MD. This offering allows members to quickly and easily connect with some of the world’s best doctors for consultation via phone or webcam.
- Distinguished Network: 2nd.MD recommends the best medical specialist for your care.
- Virtual Consults: Schedule a video or phone consultation at a time that’s most convenient for you.
- Concierge Care: Provides you with a dedicated medical professional who handles your case from beginning to end.
- Follow-Up Notes: Once your consultation is complete, you will receive a written summary from your doctor.
- Local Referrals: 2nd.MD will help you find local doctors and institutions best equipped to carry out your treatment.
- More info: 2nd MD – Specialists
WHAT IS MEDICAL COST SHARING
Medical cost sharing is not insurance in which a premium is paid and the risk of major medical expenses are assumed by the insurance company. In medical cost sharing, the patient deals directly with the doctor or hospital without an insurance company actuary. The patient becomes a responsible and cost-conscious consumer rather than only being responsible for a co-pay and no concern about what is charged to the insurance company. Medical cost sharing plans are not for everyone, but they are a practical solution to managing healthcare costs.
The SALA Healthcare Program is offered as a benefit of membership in the Delaware County Chamber of Commerce. It is not a replacement for a traditional group insurance plan, but rather an option for those who currently do not have insurance or have an expensive individual plan. This program is an alternative solution to rising healthcare costs and features a choice of two preventive care plans–each coupled with a medical cost sharing program to cover unexpected or catastrophic events.
- Medical Cost Sharing is NOT insurance
- Available to member businesses and their employees
- Available to full-time, part-time, and seasonal staff.
- Enrollment period is rolling, allowing enrollment at any time.
- Lowers healthcare costs by as much as 60%
- Offers a choice of two high-quality, affordable healthcare options
- Includes a four-year “Rate Lock”, offering rate stability
HOW IT WORKS
- Be a Delaware County Chamber of Commerce member
- Attend an informational seminar
- Explore the programs and plans. Use the links below to explore plan details, coverage, key terms, and FAQs.
- Compare program costs and options using our Fee Estimator.
- Time to Join! Select the options that best suit your companies and your employees. Enroll here.
Medical Cost Sharing is not health insurance. It is critically important to understand the requirements and restrictions of the SALA Healthcare Program prior to applying. For example, most medical cost sharing organizations exclude or limit the amount eligible to share for pre-existing conditions. Medical cost sharing group plans are not appropriate for groups of 50 or more where employees with pre-existing conditions might not be covered and the employer could be subject to a tax penalty. There are exclusions for irresponsible behavior, including an accident or sickness related to drugs or alcohol. The website for each organization has the necessary detailed information to enable an informed decision.
The general information provided here has been taken from reliable resources. However, the Delaware County Chamber of Commerce does not provide insurance, legal or tax advice. We recommend that you seek competent legal advice for any questions on the forms and applications that you are required to sign to apply for membership to a medical cost-sharing organization.
The SALA Healthcare Program is not insurance and the Delaware County Chamber of Commerce is not an insurance agency or provider. This program is sponsored by the SALA (Small Association Leadership Alliance) with Minimum Essential Coverage (MEC) plans provided by Apex Management Group and a Medical Cost Sharing program provided by Sedera Health.
For more help and answers to your questions
Please contact the Small Association Leadership Alliance healthcare support center at email@example.com or call 888.994.4979.
NOTE: The SALA Healthcare Program is currently unavailable in Vermont and Alaska