True Life Protect Medical Cost Sharing
Medical cost sharing is technically and legally not "insurance". But the mechanics work similarly. Members contribute a fixed amount per month to participate in the sharing community. When an individual has a medical need, the community steps in to ensure the need is met by taking funds from the sharing pool.
We are here for emergencies, accidents and unexpected illnesses. Routine health "maintenance" you pay cash for. Remember, you are saving an average of 60% on your monthly health care costs. For a family, this may be near $1,000 or more you are keeping...every month. You will use that money to pay for the occasional maintenance or preventative health care costs.
Remember the paradigm shift. In the past, families paid an average of $1500 per month ($18,000 per year). This would "cover" a wellness exam and a few other "benefits, giving them a sense of security and of having "good health care." But, it came at great cost and with most people experiencing frustration and confusion as to how their insurance worked and what it covered. Recently, the costs have escalated, while the "benefits" have eroded.
Our paradigm is that you pay a much lower monthly amount to share in the truly high dollar issues: accidents and unexpected illnesses. You then manage your own expenses for things like the yearly check-up, optical, dental, physical therapy, etc.
In the end, you may perceive spending more to be well, but you wind up spending MUCH less overall.
Most often, this will be a cost associated with an accident and the ER, or it will be a required surgical procedure, or it will be a significant medical diagnosis.
You will still have the "cash pay" mindset, but you will have the assurance that costs that exceed your IUA will be eligible for sharing with the Community. Therefore the billing party will still submit an invoice to you personally, and then you pay your IUA portion.
For sharing eligibility for any elective or non-emergency surgery, you must first contact our partner, "2nd.MD" (this does not apply to emergencies in the ER). They are a medical business that ensures that non-emergency surgery is the best course of treatment for the issue you are dealing with. For using 2nd.MD you will have $250 reduced from your IUA!
You will have access to a Member Adviser within a dedicated team at our partner Sedera Health who facilitates the sharing. They will walk with you through the negotiation process, how to achieve the best possible price, and how to submit your medical bills for sharing. Sedera has wonderful customer satisfaction in helping all of us through such difficult situations.
Any prior medical condition you have had in the past 36 months is considered "pre-existing." We define a prior condition as a medical issue where you have either received medical treatment, taken medications for, or exhibited observable symptoms. Any prior medical condition that has not exhibited symptoms during the 36 continuous months prior to membership effective date is considered cured and has no sharing restrictions.
If I do have a pre-existing condition and enroll, will it ever be shared?
Yes! Prior medical conditions will become eligible for sharing over time in this order:
- First 12 months: Not shareable
- Months 13 – 24: Shareable to $15,000
- Months 25 – 36: Shareable to $30,000
- Month 37 and after: Fully shareable
I have a pre-existing condition and am unsure if I should enroll right now. Help me decide?
Understand that any medical expenses you incur that are not related to your pre-existing condition are eligible for sharing if it complies with the Membership Guidelines. You need to gauge the chances of having an issue in regards to it in the next 12 months. In the previous question, you will see that in your second year of membership, you are eligible for sharing up to $15,000 (after your IUA).
Still unsure? Talk to us: email@example.com
In traditional insurance, you have an annual deductible that must be met before most of your coverage kicks in. The average for a family is $7,000, which is why, even with the high monthly premiums, you still end up paying so much out of pocket at retail prices.
With us, you have an IUA that applies per injury or illness. Lets say you choose the middle option of $1,500 (the majority choice). When you have an emergency, accident, or unexpected illness, and the cash price exceeds your selected IUA (e.g. $1,500) you pay your IUA first, and the rest of the costs are eligible for sharing with the Community.
This is how it works for up to three times each membership year for individual memberships, and up to five times each membership year per family membership.
If you have a fourth incident in the same membership year (rough year!), we waive your IUA, and the expenses are shareable starting at dollar one.
For a family, it is three times per any one individual, but is capped out at five for your total family; expenses that follow in the same membership year are fully shareable and not subject to the IUA.
Please note that, while the sharing process is the same (i.e. submitting the Need and going in to your provider as cash-pay), the maternity IUA is $5,000, regardless of the IUA you have selected.
A family is defined as two adults and any number of children.
Unmarried children under the age of 26 are eligible under their parents' membership if they are full-time students.
It is not. It is far better.
Let us compare it this way:
Traditional health insurance takes monthly premiums from members to create a pool of money to cover medical costs and are legally bound to do so. They profit from money they do not dole out to cover claims.
Medical Cost Sharing collects monthly shares from members to create a pool of money to cover medical costs and are not legally bound to do so.
We are ethically bound; and if we do not care for our members, they will discontinue and put us out of business!
We profit from administrative fees and are not allowed to accumulate an excess of money in the "pool." Thus, our motive is to take care of our members.
Here, however, is the legal disclaimer from our Medical Cost Sharing partner who facilitates the sharing of your medical expenses:
WARNING: SEDERA IS NOT AN INSURANCE COMPANY AND SEDERA’S MEMBERSHIP IS NOT ISSUED OR OFFERED BY AN INSURANCE COMPANY. WHETHER A MEMBER COMPANY CHOOSES TO SEND MONETARY ASSISTANCE TO YOU AND/OR YOUR FAMILY TO HELP WITH YOUR MEDICAL EXPENSES WILL BE TOTALLY VOLUNTARY, AND NEITHER YOU NOR SEDERA HAS ANY RIGHT TO COMPEL PAYMENT OF MEDICAL COST SHARING COSTS FROM ANY MEMBER. THE SEDERA MEMBERSHIP IS NOT AND SHOULD NEVER BE CONSIDERED TO BE OR TO BE LIKE A GROUP INSURANCE POLICY OR AN INDIVIDUAL INSURANCE POLICY. WHETHER YOU RECEIVE ANY MONEY FOR MEDICAL EXPENSES, OR WHETHER OR NOT THIS MEMBERSHIP CONTINUES TO OPERATE, YOU AS THE MEMBER WILL ALWAYS REMAIN LIABLE FOR YOUR UNPAID MEDICAL EXPENSES AND DO NOT HAVE ANY LEGAL RIGHT TO SEEK REIMBURSEMENT FOR ANY SUCH EXPENSES FROM SEDERA OR ANY OTHER MEMBER OR COMPANY. THIS IS NOT A LEGALLY BINDING AGREEMENT TO REIMBURSE YOU FOR THE MEDICAL EXPENSES YOU INCUR BUT IS AN OPPORTUNITY FOR YOU AND YOUR COMPANY TO ASSIST OTHER MEMBERS IN NEED, AND WHEN YOU ARE IN NEED, TO PRESENT YOUR MEDICAL BILLS TO OTHER MEMBERS AND MEMBER COMPANIES AS OUTLINED IN THESE GUIDELINES. THE FINANCIAL ASSISTANCE YOU MAY RECEIVE WILL COME FROM OTHER MEMBER COMPANIES, AND NOT FROM SEDERA.
Absolutely. Here is a PDF to review and download from Sedera Health who facilitates our Medical Cost Sharing. For clarity, Sedera only works through employer groups or associations like True Life Alliance: Sedera Guidelines
True Life Network
Facebook is an open network of people from everywhere. The True Life Network is made up of paying members who are all here for the same thing: to be and remain as well as possible. Their knowledge and experience is invaluable. We are gathering people from all walks of life who can chime in to all of our questions and inquiries, and you will have your own experiences to offer.
That is up to you. We do not share any person's direct location. However, every member is shown with their city and state, and you can inquire with people in your geographic area if you desire to ask about connecting face-to-face.
Yes, but we monitor it and endorse only those who apply and are authentically verified.
We are fans of business and commerce, and if someone can provide a relevant product or service to help you, we very much want to be conduits of it. We do, however, keep tabs on it.
If someone is selling more than serving, we reserve the right to discontinue their membership. So while there are not specific guidelines...serve more than sell, and you are all good!
Absolutely, we greatly encourage it!
Spouses and adult children are welcome. If you have a child under 18 whom you feel is mature and involved enough in their health and wellness to truly engage, just email us at firstname.lastname@example.org, and let us know.
We do believe you can get all you need from a perfect diet and from perfect food. Of course, that is just the issue - what is the perfect diet? And, where can we get that perfect food?
The fact is, there is never going to be any such thing as "the perfect diet."
Formulation, shelf life, and environment.
With formulation, think of home construction. Our co-founder, Kevin Miller, went from living in a modular home (southerners call it a "double wide!") to building a massive home with straw bale walls covered by thick stucco on both sides. This equates to 21" walls with a layer of concrete on both sides...it’s nearly impenetrable. The modular had 2x2 construction, and you could feel the wind coming through the electrical sockets inside (literally). You can live in both, but the construction significantly alters the quality of life inside.
Your supplements can be made of pure, natural, high value ingredients, or...junk. A milligram is a measure of space, not quality. You do not want empty milligrams.
Next is shelf life. The longer it exists, the less value it has. Simple.
Last is environment. Supplements like dry, cool, and darker environments. Humidity, heat, and light deteriorate supplement quality rapidly, with heat being the worst culprit.
People and companies have been found selling supplements online that have been sitting in hot, humid warehouses for months. There is one way to verify the security of your supplements, which we address in this next FAQ.
As we mentioned on the main page, no one can viably claim the title of being the absolute best. There are a small number of companies that are at the top of high-grade, professional, nutritional supplements. Then only two who have gone the furthest step to fully control their shipping, which guarantees two of the three key factors for quality: shelf life and environment.
There is no right answer for this. In today’s American diet (even the best), Dr. James’ experience is most people are in need of a 1) Multivitamin, 2) Probiotic, 3) Fish oil, and 4) Vitamin D. After that, it depends on your personal makeup and deficits.
Co-founder Kevin Miller struggles with cramps in his foot and uses a magnesium supplement to ward it off. He also struggles to keep his thyroid numbers in line and takes a thyroid supplement.
Dr. James will point out that supplements are just that...supplemental. If Kevin were leading a perfect life, he wouldn’t need those supplements. But, Kevin does not. Nobody is able to. So we supplement where needed.
Yes. We have a group devoted to just this subject, where you may ask questions. Supplements are also a frequent topic in our weekly member webcasts and podcasts.
At its core, Functional Medicine addresses root cause issues of pathology, whereas traditional medicine primarily manages illness and disease.
An example our co-founder, Randy James, MD, uses is this:
"Take high blood pressure, for instance. This is a serious problem and can ultimately lead to death. Traditional medicine comes in with an acute treatment, which is a pharmaceutical. This can be life changing and is the necessary use of pharmaceuticals. But to then go forward treating the issue every day with an acute treatment is like treating a broken leg every other week with a cast.
"At some point you will want to ask what is causing the leg to keep breaking, and you will eradicate the cause. In Functional Medicine, we do not believe someone has high blood pressure because their body has a deficiency of high blood pressure medication. They have it because they are giving their body something it does not want, or they are not giving their body something it desperately needs. Figuring that out is the detective hunt."
Great question. There are a lot of terminologies floating around out there. At the core, these are all entities trying to address root cause issues and help people become truly healthier, instead of merely managing symptoms.
In the marketplace, Functional Medicine has grown to the forefront of of these fields and practitioner degrees and licensure. That said, much of the value boils down to the individual practitioner, practice, and organization providing care or guidance.
To a degree, it is like real estate. Many can invest the time and money to get various certifications and licenses. It comes down to their overall knowledge and experience.
The Institute of Functional Medicine is the primary governing body for Functional Medicine and is a wealth of knowledge. This is where our cofounder, Randy James, M.D. received his Institute of Functional Medicine Certified Practitioner degree. Visit IFM online at www.ifm.org.