Coverage and benefits
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...
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...
Are preventive 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.
What does the Total Policy Year Maximum mean in the Access Plan?
The Total Policy Year Maximum is the total amount your Access Plan will pay in Benefit Amounts for covered medical costs within one year. You can choose a Total Policy Year Maximum between $5,000 and $2 million for the base Access Plan....
How does the Access Plan work alongside traditional health insurance?
The Access Plan is a great supplement for traditional health insurance, especially if you have a High Deductible Health Plan (HDHP). The Access Plan can be used to cover or contribute to the costs of medically necessary services and drug...
Do I have any coverage for prescription drugs under the Access Plan?
It’s up to you. Prescription coverage is included with all the Access Plans, but you can choose to exclude it when you enroll in coverage. Similar to medical services, there is a fixed Benefit Amount for each drug, which you can look up ...
What happens if I become pregnant while on my Access Plan policy?
The base Access Plan does not offer maternity and newborn coverage, except for care arising due to complications of pregnancy. However, in some states, an optional Maternity Care Rider is available for purchase. For maternity coverage t...
What does medically necessary mean?
We cover services prescribed by a doctor for health reasons, but things like cosmetic and elective procedures may not be covered. Whether something is medically necessary is determined by Sidecar Health. Please refer to your policy for ...
What does a Sidecar Health Access plan NOT cover?
Your plan only covers medically necessary services, meaning things like cosmetic and elective procedures may not be covered by your plan. Please look at your policy for specific exclusions, limitations, and coverage details, which may v...
How long will my Access Plan coverage last?
All Access Plans last for a year, and in some states, you have the option to lock in your plan and premium for three years††. You can also cancel at any time.
What happens at the end of my Access Plan policy term?
The Access Plan is non-renewable, meaning you must re-apply for coverage near the end of your policy term.