Coverage and benefits
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What is a Benefit Amount?
A Benefit Amount is the fixed amount Sidecar Health plans pay for a covered, medically necessary service. The Benefit Amount for each covered, medically necessary service is approximately equal to the amount an average health care pr...
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How do employer plans with first dollar coverage work?
How it works: The first step is to identify which type of coverage you have. Open the member portal and navigate to your digital member id card. If your plan has “(0/)” preceding the deductible amount like the image below, your plan prov...
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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 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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Where can I find details about my coverage?
You can find coverage details, plan information and your 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.”
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Are preventive services covered?
Absolutely. Preventive services are covered the same way as other health care services that you may receive, and you don't need to pay your deductible before receiving the benefit.
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What are my preventive care benefits?
Preventive care is routine treatment that prevents illnesses, diseases, or other health problems.With the Sidecar Health Employer plans, preventive care services are covered at your plan’s Benefit Amount regardless of whether your deduct...
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How does the Sidecar Health employer plan coverage work for high-cost procedures?
Navigating complex or costly care? Don’t stress. We have you covered. Request a pre-bill (good faith estimate) from your provider and upload it as a new expense to: Gain clarity around your benefits and coverage. Authorize the Sidecar H...
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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 feder...
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Does the Sidecar Health employer plan cover mental health benefits?
Yes, of course. For additional details, please see your 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.” Coverage is in...
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Does the Sidecar Health employer plan provide dental or vision coverage?
The Sidecar Health Employer Plan is not intended to be a substitute for a dental or vision insurance plan. However, dental and vision coverage is provided in limited circumstances. Dental coverage is provided for injury and repair of tee...
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What are my in-person COVID-19 test benefits?
Sidecar Health Employer plans cover COVID-19 lab tests, including rapid and PCR tests, administered by licensed medical providers (i.e. not at-home tests). Eligible COVID-19 lab tests are covered at cost (100% of the provider price) and ...
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What are my at-home COVID-19 test benefits?
The federal Public Health Emergency for COVID-19 has ended and over-the-counter COVID tests are not covered by your Sidecar Health plan. However, all preventive vaccines, including COVID-19, are covered at cost. In other words, your vacc...
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When I get a COVID-19 vaccination, what information should I share?
All preventive vaccines, including COVID-19, are covered at cost. In other words, your vaccine bypasses the deductible, and you will have no other cost. How it works: Get your COVID-19 vaccine or booster. Pay for care on the spot using...
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What do Sidecar Health employer 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 Certificate of Coverage. To find your Certificate of Coverage, go t...
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What is the Maximum Out-of-Pocket (MOOP) for my plan?
The Sidecar Health employer plan MOOP (Maximum-out-of-Pocket) 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 provid...
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Is there a Total Policy Maximum on the Sidecar Health employer plan?
No, there is not a total limit for your plan’s Benefit Amounts if your care is medically necessary and not excluded from coverage as outlined in your Sidecar Health Certificate of Coverage. To find your Certificate of Coverage, go to you...
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What happens if I can’t find a provider whose price is at or below the Benefit Amount?
Under the Sidecar Health employer plan, when you search for, but cannot find, a provider in their area that charges equal to or less than the Benefit Amount, you may contact your Member Care team at (855) 282-0822 for help locating a pro...
