Program Guidelines
Concise overview of how SakeOf works. This is not insurance. Final terms are in the full Program Guide.
What’s included (examples)
- Provider visits & hospital services (medically necessary)
- Urgent & emergency care
- Diagnostics, labs, and imaging
- Ambulance transport
- Prescription medications (plan limits may apply)
- Maternity on eligible plans (waiting periods may apply)
- Therapies when prescribed (PT/OT/Speech/Respiratory)
Eligibility and maximums vary by plan and options selected.
Plans & options (at a glance)
- Base plan selected for an individual or household.
- Visit bundle (e.g., number of visits per year).
- MRA (Member Responsibility Amount) you pay before plan benefits apply.
- Labs option and other configurable categories.
- Maternity option on eligible plans (waiting period may apply).
- Add-ons: counseling, Rx savings, vision, dental (as available).
- Annual pricing discount may apply when selected.
Not included
- Cosmetic or elective procedures
- Services not medically necessary
- Items outside published limits or maximums
- Pre-existing conditions during waiting periods
- Fraudulent, illegal, or non-covered items
Waiting periods & limits
- General eligibility begins after your initial waiting period.
- Maternity is available on select plans after the waiting period.
- Some categories may include annual or per-incident caps.
- Availability and rules may vary by state.
Member responsibilities
- Pay your plan’s MRA/initial responsibility as applicable.
- Provide complete, accurate documents for review.
- Submit bills promptly after receiving care.
- Use benefits in good faith; report changes that affect eligibility.
How your plan works
- 1Pay your monthly price and select your options.
- 2Bring your membership card to any licensed provider (no networks).
- 3By default, providers bill using your membership details; if they offer a discounted immediate payment, you can pay on the spot with your SakeOf Visa card.
- 4Upload bills/receipts as needed — we review for eligibility and process payment or reimbursement per your plan.
Final eligibility, limits, and any waiting periods are defined in the full Program Guide (coming soon).