Healthcare after employer coverage ends in Dayton

Make a care decision, then choose your next step

SakeOf is a healthcare membership built around practical help with care decisions: everyday-care features when selected and active, freedom to choose an in-person provider, advocacy and fair-price review, and voluntary member-to-member community funding for eligible medical expenses. Your enrollment summary, effective dates, active features, eligibility, documentation, and member responsibilities determine how the program applies.

For a new concern, first consider what kind of care is appropriate and which active SakeOf features may help. Then decide whether virtual or in-person care fits. For planned care, ask the provider what services are proposed and what charges to expect. Your provider choice remains yours; SakeOf’s support does not guarantee a provider’s participation, a particular price, or an outcome.

Use the calculator or Savings Guide to explore options, the provider search to look for care, or Jordan to help plan a next step. Review membership options that fit the kind of support you want.

Use everyday-care features when they fit

If Zero Copay Telemedicine is selected and active, it may provide a convenient first step for a routine concern. A virtual visit can help you consider what care to seek next, but an exam, lab test, imaging, specialist visit, or follow-up may require a separate in-person service. Virtual Primary Care may support ongoing primary-care needs when selected and active.

For prescriptions, check the Rx and Prescription Benefits included with your active membership and confirm the terms for the specific medication with the pharmacy. A prescription may have a separate charge, and availability and price depend on the drug and applicable benefit terms. Vendor benefits may have coordination restrictions, so confirm current terms before assuming they can be combined with another arrangement.

Mental Health and Counseling may offer a counseling option when selected and active. Psychiatry, emergency psychiatric care, inpatient behavioral health, and medication costs are separate unless another active benefit or program expressly includes them. For urgent or emergency needs, seek an appropriate in-person service rather than relying on a routine virtual-care process.

Find local in-person care around Dayton

Kettering Health Dayton is located at 405 West Grand Avenue in Dayton. Its location page lists emergency care and on-site laboratory, imaging, and pharmacy services; contact the hospital to confirm current availability and expected charges for planned care. ^{www.summahealth.org} A location listing describes services at that site; it is not an individualized price quote.

Public Health – Dayton & Montgomery County lists area health centers and says listed federally funded centers provide routine care with sliding-scale fees. Ask a center directly about services, eligibility, fees, payment options, and appointments. The department’s public-health clinic has limited, appointment-based services and is distinct from primary care. ^{my.clevelandclinic.org}

The City of Dayton’s Community Paramedicine program describes scheduled home visits and connections to healthcare and community resources. The city lists 937-333-4509 and 937-333-4535; call to confirm current availability and eligibility. ^{www.summahealth.org} These are Dayton-area resources, not confirmation of a particular appointment, provider arrangement, or charge for an individual.

For planned hospital, specialty, lab, or imaging care, ask the provider what is planned and what it will cost before the service when possible. Participation and patient responsibility depend on the service, provider, and applicable arrangements.

Get help understanding a medical bill

Full Service advocacy can help members verify charges, review fair pricing, and seek negotiation support. If a bill is confusing, gather the itemized bill and submit it through the member process. It should include service dates and provider information, with CPT or HCPCS codes when available. SakeOf may request clinical notes, medical records, billing details, provider documentation, or a signed release to review eligibility, medical necessity, and fair pricing.

Submit complete documents within six months of the service date. Submit balance bills, denials, or payment demands within 10 days of receiving them. For planned higher-cost care, contact SakeOf in advance when reasonably possible so the proposed care and pricing can be reviewed before services take place. Keep your membership current and follow its documentation and member-responsibility requirements.

Know how support for larger eligible needs works

For larger eligible medical expenses, the Full Service pathway brings together advocacy, fair-price review, the applicable member commitment, and voluntary community funding. Funding is not automatic: eligibility, documentation, active membership, available community funds, and program rules matter. Check your enrollment summary and contact SakeOf before planned care when reasonably possible.

If considering pregnancy-related care, check whether the maternity feature is selected and review its terms before conception. Pregnancy must begin after the continuous 12-month maternity waiting period is complete; adding or restoring the feature after conception does not make that pregnancy eligible. Newborn needs after the initial discharge are separate from the mother’s maternity event, and the newborn should be added to membership within 30 days of birth.

Choose features that match your household

Dental and vision discounts may be available through participating providers when the feature is active. The member pays the provider directly at the applicable discounted rate; discounts vary and are not guaranteed at every provider. Routine dental and vision bills are not community-sharing expenses unless another written program term expressly says otherwise.

Chiropractic or acupuncture, PT/OT, and durable medical equipment may also be relevant depending on the program and active features. Check your membership summary before scheduling or purchasing so you understand what is selected and what terms apply.

• New concern: Check whether telemedicine is active, then choose the appropriate care setting.
• Ongoing care: Check Virtual Primary Care or contact a Dayton-area health center directly about services, appointments, and fees.
• Bill question: Gather the itemized bill and submit it promptly through the member process.
• Planned major event: Contact SakeOf in advance when reasonably possible and review active features, responsibilities, and any waiting periods.
• Ready to compare: Use the calculator, Savings Guide, provider search, or Jordan, then review membership options.