Instead FORTEC4x4 offered HIPnation as an alternative for Health Care coverage to it’s employees.
What is HIPnation? We are a new delivery model that keeps you healthier. We are not insurance. We are a total healthcare solution developed by physicians for you.
See this pdf-presentation:
HIPNATION & SEDERA Fortec Employee.pdf
Note: IUA = Initial Unshareable Amount
which is a description of what HIPnation and Sedera are and how they work together** ➡️ ****
Fortec Roswell Employee Onboarding Guide[95].pdf
FAQ: Pre-existing Conditions.
Q: From: Axel Rost [email protected] Sent: Tuesday, February 15, 2022 12:54 PM To: Brian Hill [email protected] Subject: Re: FORTEC4x4 - Pre-existing Conditions.
Imagine everybody on our team is healthy, passing the underwriting process and finally signing up with HIPnation.
What happens if we want to hire a new employee and he or she has a pre-existing condition. Wouldn't this basically limit Fortec to offer Health Insurance to this employee?
A: On Tue, Feb 15, 2022 at 9:40 PM Brian Hill [email protected] wrote: We find that about 4-5% of the population has a pre-ex that doesn’t fit our solution. If this is the case with a new hire, then this is where we set them up on the Healthcare Marketplace for their care. We have done this with businesses on our solution in that uncommon instance where it is necessary. It goes back to our approach—individualize our healthcare solution so that people are getting the right healthcare product to meet their healthcare needs. We just don’t stick with a one-sized-fits-all approach. By being creative and personalizing options to meet people’s unique needs, we can make it so that companies save money. This excess capital can then be used to offset the cost of the Marketplace Plan while still leaving more left over to use for more beneficial items for the company and its employees. Brian E. Hill, MD, Founding Partner, President & CEO
FAQ: "securities" concern Q: From: Axel Rost <[email protected]> Sent: Thursday, February 10, 2022 5:25 PM To: Brian Hill <[email protected]> Subject: FORTEC4x4 - "securities" concern
Hello Brian, One of the team has a "securities" concern.
What happens if somebody gets a lot of bills in one year and HIPnation or Sedora decides that this person is too expensive and "all of the sudden" they don't pay the doctors or hospital bills anymore. Is there any kind of security / insurance in place for these extreme cases? Comparable to the securities you have in the banking industry with FDIC.
A: On Thu, Feb 10, 2022 at 10:18 PM Brian Hill <[email protected]> wrote: Axel, As for the security question, we have never had anyone’s medical care go unpaid (as long as their care met our Guidelines). Our fund’s dollars are owned by the community, and we follow the rules that guide our community. We have no shareholders or investors to respond to. And there are no arbitrary decisions to “kick someone out.” If this were ever done, then we would cease to exist. The uncertainty would destroy our solution. No one including me would ever participate in a product that did this. We don’t need an insurance commissioner or regulatory body governing us as our members in the community do. This is a totally different concept built by and around people. Brian E. Hill, MD, Founding Partner, President & CEO
FAQ: 3 initial Questions From: Axel Rost <[email protected]> Sent: Wednesday, February 2, 2022 6:49 PMTo: Brian Hill <[email protected]> Subject: FORTEC4x4 - 3 initial Questions
Hi Brian, Question 1) One question regarding the Cost of Care Below IUA came up. If an individual or family member has 3 health issues and sees the doctor for let's say $1,050.00 each, we understand that our own responsibility is to pay max 3 x $1,000.00 (Limited Out of Pocket Cost). How would this look like if there is another issue for $950.00 or even more single issues all for less than $1,000 each? Answer 1) from Brian: The employee would be responsible for these costs if they are unrelated to the previous 3 medical events. But this is not the reality of how the body works. First, it is rare that people have 3 completely unrelated medical issues in one year that broach $1,000. It is even more rare to then have additional multiple, unrelated medical issues that do not cross $1,000. Our bodies just do not work this way. It’s usually either something expensive/bad is going on and the chain of treatment is related, or it is a small, non-event. And as you can see in slides 14 and 15, it’s not like these events don’t carry cost in the insurance world. They do, and the costs of the monthly premiums and the cost of insurance purchased healthcare services is higher than with our solution.
Question 2) Or another extreme ... someone looks at 10 x smaller issues for $350.00 each? Answer 2) from Brian: The answer is similar as above. And I have never seen someone with 10 completely unrelated medical events costing $350 each occurring in a year. And again, the employees would still be paying 100% up to the $6,250 deductible on your current plan, and since they are paying for more expensive healthcare, they would spend more with the current plan than with our approach. And this does not take into account the higher monthly premiums.
Question 3) We still think traditional and the Max Out Of Pocket term is limiting the burden per year in case the worst happens. Answer 3) from Brian: One of the most difficult things we deal with is changing the status quo, not the evaluation of whether our approach is better. It is just hard sometimes to think differently. It’s why we talk about being intentionally different. The reality is that in a year where the worst case scenario happens, the financial burden is so much less with our IUA per medical event approach. We really do win. If this weren’t the case, I would not have my family on this solution.
The data points to the fact that 99.99% of people have one of three things happen medically, and I will tie this into your plan versus HIPnation.
They have a great year without any issues. We win here because our monthly costs are less, and all of our primary care comes without any additional cost. a. Compared to the high deductible plan, our solution is $1,884 less. b. Compared to the buy-up plan, our solution is $4,116 less.
They have a couple of small events, see a specialist or two, and/or get a CT or MRI. This is like slides 14 & 15 stopping at the first Total. a. With the high deductible plan, they pay 100% out of pocket until reaching $6,250 (and still pay 20% until reaching $8,5050). They buy these services at their higher insurance price. In this scenario, the employees will spend even more compared to our approach, and the savings with our solution become even more pronounced. b. With the buy-up plan, the office visit copays are cheaper than the direct payment approach that we use. The employee may save $100 for the specialist office visit. The cost of imaging is a wash. The savings may drop from the $4,116 a couple hundred dollars, but the total spending is still significantly less with us.
They have a bad event. This is slides 14 & 15 and includes the hospitalization and surgery costs. a. On the high deductible plan, they will reach the deductible and max of $8,550. With us, they would be responsible for the 1 $1,000. The employee is $7,550 ahead. When we add in the annual savings of $1,884 with us, the total cost difference is over $9,400. b. On the buy-up plan, they are out of pocket at least $3,000 with a max out of pocket of $7,750 still looming. They would’ve paid $1,000 with us. When we evaluate this out of pocket difference in addition to the extra monthly cost of the insurance plan ($4,116), the total cost difference is over $6,000.
The insurance companies will always win. They have designed a system where can make a significant profit to distribute to their shareholders, and they must do this on top of paying all of the tiers of people who work for them. They would not exist as a business if they did not turn this profit. I am not averse to profit, but I believe that profit can be made in a more efficient system. This is what we do.
Please let me know. I’d be happy to discuss this with you if the above doesn’t make sense. And I am happy to discuss anything. We are not a perfect solution, but there is no way the insurance system even gets close to what we can do.
FAQ: Is the premium pre or after tax? Q: From: Axel Rost <[email protected]> Sent: Monday, February 21, 2022 3:35 PM To: Brian Hill <[email protected]> Subject: Re: HIPnation for employees Hi Brian, And another question is, is the premium pre or after tax?
Answer 2) from Brian: This is post-tax.
Q: HIPnation Medical Questionnaire? A: This is a confidential questionnaire. Please complete this questionnaire in its entirety. Please complete one for each family member who will be participating on the company healthcare plan. Thanks. Brian E. Hill, MD Founding Partner, President & CEO
Q: HIPnation - legal jargon From: Axel Rost <[email protected]> Sent: Monday, February 28, 2022 10:10 AM To: Brian Hill <[email protected]>Subject: HIPnation - legal jargon
Hi Brian, While Alex is enrolling he read this on the Sedera enrollment portal ... see below. What do you suggest to respond to Alex ?
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 OR INDEMNIFICATION FOR ANY SUCH EXPENSES FROM THE SEDERA MEDICAL COST SHARING COMMUNITY AND/OR SEDERA, INC. OR ANY OTHER MEMBER OR HOUSEHOLD. THIS IS NOT A LEGALLY BINDING AGREEMENT TO REIMBURSE OR INDEMNIFY YOU FOR THE MEDICAL EXPENSES YOU INCUR, BUT IS AN OPPORTUNITY FOR YOU TO ASSIST OTHER MEMBERS IN NEED, AND WHEN YOU ARE IN NEED, TO PRESENT YOUR MEDICAL BILLS TO OTHER MEMBERS AND HOUSEHOLDS AS OUTLINED IN THESE GUIDELINES. THE FINANCIAL ASSISTANCE YOU MAY RECEIVE WILL COME FROM OTHER MEMBERS AND/OR HOUSEHOLDS, AND NOT FROM THE SEDERA MEDICAL COST SHARING COMMUNITY AND/OR SEDERA, INC.T
Answer From: Brian Hill <[email protected]> Date: Mon, Feb 28, 2022 at 11:58 To: Axel Rost <[email protected]>
Tell him that is legal jargon. There are so many things people don’t know about the insurance world. Every time we order a test or schedule surgery on an insurance patient, our staff goes through a process called prior authorization. The fine print at the bottom of the prior authorization states: “Prior authorization is not a guarantee of payment.” This of course means that while the insurance company says it’s ok to proceed, it doesn’t mean they will pay, and the responsibility falls on the patient. As for our solution, we have NEVER not paid a medical bill for our members (that of course met the pre-existing guidelines). I am on this myself. I would never put my family/home/life in jeopardy. I am a risk averse surgeon. In the end, it comes down to trust. Is there trust that an insurance company who’s focus is on revenue, profits, and shareholders has your best interests in mind? Or would you rather put your trust in a community of like-minded businesses and people whose rules are governed by the community to make sure that those in the community receive the care they need? I have chosen the latter, and businesses throughout the US are doing so as well.
Brian E. Hill, MD Founding Partner, President & CEO