What financial protections are in place to protect me from unexpected charges with the Sidecar Health employer plan?

The Sidecar Health employer plan takes additional measures to protect you and your family from unexpected charges when you can't shop for care. For example: 

Emergency room services:

The Sidecar Health employer plan complies with federal and state surprise billing laws, including the No Surprises Act. In an emergency, you will only be responsible for the deductible/MOOP (Maximum-out-of-Pocket). You will not be responsible for covered emergency charges that exceed the Benefit Amount. 

In these scenarios, employees should not pay at the visit. The provider should send the bill directly to Sidecar Health. 

Unplanned procedures during a planned service at the hospital:

In the unfortunate event where a covered unplanned service is required during a planned medical event due to an unexpected episode of illness or injury incidental to or contemporaneous with the planned medical event, we may pay up to billed charges for unplanned services you receive. Here's what you need to do:  

1. Ahead of your planned visit, request a pre-bill or other documentation needed for an itemized medical invoice from your provider, and submit it to your Member Care team.
2. Following your visit, submit your final medical invoice and we will take it from there.
3. We will work directly with your provider to cover charges for covered unplanned services that occur during a planned service, up to billed charges.

If you do not submit a provider’s pre-bill for the planned medical event or other required information for an itemized medical invoice prior to obtaining covered services for a planned medical event, we will pay the Benefit Amounts for the covered services, and you will be responsible for any expenses over the Benefit Amounts for the unplanned services.

Provider Location Assistance: 

Finally, when you search for, but cannot find, a provider in your area that charges equal to or less than the Benefit Amount, you may contact your Member Care team at [phone] for help locating a provider. Under the Provider Location Assitance program, Sidecar Health will further facilitate you accessing care at or below the Benefit Amount. 

For more details on how we protect you in any situation, please refer to your Sidecar Health Certificate of Coverage.  To find your Certificate of Coverage, go to your My coverage page in your account, click on the three-line menu, and select “Full benefits.”