How Everyday Care Works on SakeOf

What Everyday Care Means on SakeOf

Everyday Care on SakeOf refers to direct access healthcare services available through optional membership features. These services include telemedicine consultations, virtual primary care, counseling, and select medications. SakeOf is not an insurance provider, and these services operate through vendor partnerships, not through the community sharing process.

Services Included in Everyday Care

When members activate the relevant optional features, Everyday Care provides:

• 24/7 telemedicine consultations with board certified physicians licensed for the member's state
• Virtual primary care with a dedicated physician relationship, including annual wellness visits, health risk assessments, chronic care follow up, and medication management support
• Approximately 70 acute medications at participating pharmacy locations (67,000+ locations)
• Unlimited telephonic counseling and up to 3 face to face counseling consultations per incident when arranged and available

Telemedicine is designed for common illnesses and symptoms appropriate for remote care. Provider availability, technology, state law, and clinical appropriateness determine what can be handled through telemedicine. The current service partner does not impose a program limit on consultation frequency or duration.

How to Access These Services

Members access Everyday Care services through the SakeOf platform after enrolling and activating the applicable optional features. Members may use any appropriately licensed provider for other care needs. SakeOf can help identify fair price options for planned care.

Cost Structure for Everyday Care Features

Default Full Service enrollment currently includes these optional features:

• Zero Copay Telemedicine: +8 dollars per month
• Mental Health and Counseling: +6 dollars per month
• Rx and Prescription Benefits: +10 dollars per month

Members can turn features on or off. When a feature is active, the associated services are available. When turned off, those services are no longer included. Turning a feature back on later does not create retroactive eligibility for services, symptoms, conditions, or expenses from the inactive period.

What Everyday Care Does Not Cover

Telemedicine consultations do not automatically make other services eligible. Emergency care, specialty care, procedures, imaging, labs, and in person follow up are not included merely because telemedicine recommends them. Prescriptions may be issued when clinically appropriate and legally permitted, but prescription costs follow the active Rx program rules.

Everyday Care services do not guarantee payment or savings. Eligibility for services is not guaranteed and depends on program rules, documentation, and clinical review.

How This Differs from Community Sharing

Everyday Care provides direct access to specific services through vendor partnerships. For other medical needs, SakeOf operates through a community sharing model where members receive or plan care, SakeOf reviews eligibility and documentation, reviews or negotiates prices when applicable, applies the standard event commitment or member responsibility, and remaining eligible amounts may be matched to voluntary community funds subject to program limits and available funds.

Potentially eligible categories through community sharing include medically necessary illness or injury care, emergency and urgent care, diagnostics, labs, imaging, hospitalization, surgery, and medically necessary ambulance.

Enrollment and Eligibility

To access Everyday Care services, individuals must enroll as SakeOf members and activate the relevant optional features. Features apply prospectively from their effective date. Newly added features do not create retroactive eligibility for earlier events, symptoms, conditions, pregnancies, services, prescriptions, or expenses.

Pre existing condition rules apply to community sharing eligibility. An illness, injury, symptom, diagnosis, or treatment that existed, was known, or for which medical advice, diagnosis, or care was recommended or received during the 24 months before membership began may be treated as pre existing. A symptom can count during pre existing condition review even without a formal diagnosis. Final eligibility determinations depend on documentation, clinical review, and the Program Guide.

Frequently Asked Questions

• What is included in Everyday Care on SakeOf? Everyday Care includes 24/7 telemedicine, virtual primary care, approximately 70 acute medications at participating pharmacies, and counseling services when the applicable optional features are active.
• Are there costs associated with Everyday Care on SakeOf? Yes. Optional features that provide Everyday Care services add to the monthly membership amount. Zero Copay Telemedicine adds 8 dollars per month, Mental Health and Counseling adds 6 dollars per month, and Rx and Prescription Benefits adds 10 dollars per month.
• Can I use Everyday Care services for my family members? Family members can access Everyday Care services if they are enrolled as SakeOf members with the applicable features activated.
• Is there a limit to the number of telemedicine visits? The current service partner does not impose a program limit on consultation frequency or duration, though provider availability, technology, state law, and clinical appropriateness still apply.
• What happens if I turn off an Everyday Care feature? Once the feature is inactive, the services, discounts, or direct service access tied to that feature are no longer included. Turning it back on later does not make the inactive period retroactively eligible.