Frequently Asked Questions

Everything needed for you and your loved ones
to have access to quality healthcare and control over the costs.

General

Are these products insurance?
Are these memberships compliant with the individual mandate of the Affordable Care Act?
How many providers are involved in delivery of your products?

All virtual healthcare services included in our Essential Care and Primary Care memberships are provided by Lyric Health, an industry leader in the delivery of virtual healthcare. The financial protection for major medical events is provided by Sedera, one of the originators of medical cost sharing outside of the faith based community.
Is there a contract required as part of the membership process?

Lyric Health requires no contractual agreement. Sedera requires execution of a “List Bill Agreement” which defines the terms of the relationship between Sedera, the Sedera cost sharing community and the member. Membership with either provider can be terminated at any time without cause.”
How do I pay for my membership?

Membership dues for Essential Care and Primary Care are processed on the first day of every month via credit/debit card or ACH. For legal compliance reasons, monies transferred between parties in the cost sharing community are done via special bank accounts set up for that purpose. With Group memberships, monies come from the company or organization on the first of each month and with self-pay memberships, monies come from the member.”
Is there an app for my smartphone to simplify the appointment and consultation process?
With your Primary Care Plan we get to consult with the same doctor and medical team every time we call but you say we can obtain services 24/365. How does that work?
Are there any co-pay’s or one-time charges associated with Essential Care or Primary Care consultation?

The exception to this are services like psychological and psychiatric counseling which are available on a pay-per-call basis. Less frequently used services like this are provided to members at no cost as a customer service. Neither Lyric Health nor Optimal teleHealth receives compensation for the use of these services.
Is there any limitation on how often we can consult with a doctor or how long we can be on any one consultation?
Doesn’t the doctor need to know something about my medical history to give me a treatment plan?

Yes they do, and that is part of your membership enrollment process with both Essential Care and Primary Care. Lyric Health retains your medical history in an electronic medical records file. During onboarding with Lyric Health, you will go through a Q&A process to provide initial health related information which is recorded in their electronic medical records system. These medical records are shared between your Urgent Care and Primary Care doctors. After each consultation, the records are updated.
Can I consult with a doctor to get a second opinion on a treatment plan recommended by another practitioner?

Absolutely, your primary care physician in both Essential Care and Primary Care will provide second opinions on most diagnosis. You can even send them copies of lab reports or other documents provided by medical practitioners you’ve already consulted. Regarding a major diagnosis with Optimal Care, you are required to use their second opinion services in non-emergency situations to assure accurate diagnosis and treatment.
What if I need see a specialist, or go to another provider for laboratory or imaging services?

Although as much as 90% of your primary care medical needs can be handled virtually, it’s certain that at some point you will need to seek services outside your primary providers. Since we do not have a provider network, you are free to use any provider you wish, but your objective should be to seek a provider that extends reduced rates for cash patients, and almost all of them do. If you need assistance or have questions, both Lyric Health and Sedera have Care Navigators available to provide support. Another source of support would be your Patient Advocacy service with Lyric Health.
Can I pay my membership dues on a quarterly, semi-annual, or annual basis?
Do I receive a refund on the unused portion of my membership dues if I cancel my membership?

Membership dues are processed in advance of the month services are provided. At the point membership is terminated, no further dues will be collected, and your membership will remain in effect for the remainder of the month that was previously paid. No refund will be made.
Are there any restrictions on joining such as certain pre-existing conditions or residency requirements?

There are no restrictions on joining either of our virtual healthcare plans, Essential Care and Primary Care. Anyone over the age of 18 can join regardless of their current medical condition, residency, or alien status. Children under the age of 18 can join as a family member in their parents’ membership, or as a primary member but they must have a parent or legal guardian present during every consultation. Membership in the Optimal Care plans requires you are in the United States legally. Membership is never refused due to pre-existing conditions but there are special conditions. Refer to the community guidelines for restrictions on pre-existing conditions.
Can I use the service when I travel?

You can consult with a board-certified doctor licensed to practice in the state or country from which you are calling if you’re within any of the 50 United States or Puerto Rico. When you call to request a consultation, simply advise member services where you are calling from. Services are not available for members traveling in foreign countries. With the Optimal Care cost sharing community, you can obtain services from any source you choose and receive reimbursement if the cost of services are reasonable. Your Sedera Care Navigator will assist in locating affordable services.
Are services available in other languages besides English?
Is a consultation more effective if I use voice or video conference?

It is up to you and what you are most comfortable with. Some members feel that seeing the doctors face creates a more intimate and effective experience, and video can become valuable if you want to show the doctor a rash or injury. Certain states require a video consultation, but most members consult by phone for convenience. Either technology is available in all consultations from any mobile devise or properly equipped computer.
Will a membership be of any value to me if I already have a medical insurance policy from my employer or one I purchased myself?

Family Plans

How many family members can be covered within a single membership?

An Essential Care or Primary Care Membership can include the primary member plus seven (7) additional family members and dependents living at the same address. Dependents do not have to be related, if they live at the same address, they are qualified. With the Optimal Care Plan, Sedera has no limit on the number of children that can be included in a member plus children or family membership.
Do the members in a family membership have to all be related to each other?

Our virtual healthcare memberships provided by Lyric Health, Essential Care and Primary Care, can include domestic partners, spouse, children, extended family and dependents, as long as they all reside at the same address. Parent plus child(ren) and family memberships in Optimal Care require members to be related through marriage, birth or adoption.

Group Plans

What is a Group Plan?

All three membership plans can be delivered to individuals and families (Self-Pay Memberships) or to companies or organizations for the benefit of their employees or members (Group Memberships). The primary distinction is the group or organization is responsible for paying the monthly dues for all members in the group. The employees’ portion of the monthly dues is normally collected via payroll deduction. There must be a minimum of three (3) memberships to qualify as a Group in Optimal Care. There are no minimums with Essential Care or Primary Care.
Do I have to provide all three plans to my employees?

No, you can provide any plan(s) you wish, but it’s to your advantage to make all plans available even though you may not want to contribute toward the cost of each plan. You have buying power as a group that gives employees access to these benefits at a lower rate than if they purchased them individually on the open market. Providing comprehensive medical benefits at a more affordable rate is itself a valuable benefit to employees.
Do employees have to be full-time workers to qualify?
What benefits do Group Plans provide compared to Individual and Family Plans?
What is the process for adding new employees and removing those who leave my company?

Optimal teleHealth provides each employer with an account dashboard which provides all the functionality necessary to add new employees and delete employees from Essential Care and Primary Care services. Cancelling memberships with Sedera will require a phone call or email to the provider.
How do I know what medical expenses are eligible for sharing with the Sedera Community?

General

Family Plans

Group Plans

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Employer (Group) Plans

Self-Pay Plans

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