Coverage and benefits
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How are inpatient benefits paid?
Sidecar Health pays a fixed Benefit Amount for covered, medically necessary services. In most cases, providers bill for specific medical codes to describe treatments and services (such as CPT codes) or diagnoses (such as ICD codes) and S...
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How are Sidecar Health Benefit Amounts set?
A Benefit Amount is the fixed amount Sidecar Health plans pay for a covered, medically necessary service. Sidecar Health calculates the cash price for all procedures, tests and drugs using multiple data points to determine how much proce...
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What is the Maximum Out-of-Pocket (MOOP) for my plan?
The Sidecar Health ACA Plan MOOP is the same as the deductible. Once you reach the deductible/MOOP, the plan pays 100% of the Benefit Amount at any provider or pharmacy. However, if you choose to see a provider that charges more than the...
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What happens if I can’t find a provider whose price is at or below the Benefit Amount?
When you search for, but cannot find, a provider in your area that charges equal or less than the Benefit Amount, you may contact Sidecar Health’s Member Care team at (877) 653-6440 for help locating a provider. Sidecar Health will furth...
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How do I know the date of service for my prescriptions?
For most prescriptions, the date of service is the date the pharmacy filled the prescription. For prescribed over-the-counter (“OTC”) drugs the date of service is the date the OTC drug was purchased. If you have any questions, please con...
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Are preventive care services covered?
Absolutely. Preventive services are covered by all plans from Sidecar Health. The application of deductibles to preventive services varies by plan so refer to your policy for details.
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What are my preventive care benefits?
Preventive care is routine treatment that prevents illnesses, diseases, or other health problems.With Sidecar Health ACA plans, preventive care services are covered at your plan’s Benefit Amount regardless of whether your deductible is m...
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Is there a Total Policy Maximum on the ACA Plan?
No, there is not a total limit for your plan’s Benefit Amounts as long as your care is medically necessary and not excluded from coverage as outlined in your policy.
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What does medically necessary mean?
We cover services prescribed by a doctor to treat or diagnose an injury or illness, which means things like cosmetic or elective procedures may not be covered. Whether something is medically necessary is determined by Sidecar Health. Pl...
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What do Sidecar Health ACA plans NOT cover?
Your plan covers medically necessary procedures, tests, and drugs. Exclusions and limitations include cosmetic and elective procedures. The full list can be found in the policy form.
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How long will my ACA coverage last?
Your 2022 ACA plan coverage will last until the end of the 2022 calendar year, December 31, 2022, as long as you pay your monthly premiums as outlined within the policy.
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What happens at the end of my ACA Plan policy term?
If you take no action, you will be automatically re-enrolled into the same plan for the following year. You can also pick a different metal tier for your plan during the Open Enrollment Period or, if you qualify, a Special Enrollment Per...
