Benefits Summary
Sidecar Health Employer (0/3000)
Sidecar Health Employer (0/4000)
The Core Details Deductible (Individual / Family)
$3,000 / $6,000
$4,000 / $8,000
$3,000 / $6,000
$4,000 / $8,000
Maximum Out-of-Pocket (Individual / Family) Balance Billing Protection on medical services Co-insurance Prescription drugs included HSA-compatible high deductible health plan Deductible Option
Included
Included
0%
0%
Yes
Yes
No
No
Embedded
Embedded
Sidecar Health Employer (0/3000)
Sidecar Health Employer (0/4000)
Additional coverage details
Prescription Drugs
$0/$0/$0
$0/$0/$0
Prescriptions (Generic/Brand Name/Specialty)
Professional Services
$0 after deductible $0 $0 $0
$0
Primary Care Physician (PCP) Specialist (including mental health therapy visits) Preventive care exam Diagnostic x-ray and lab Complex diagnosis (MRI / CT Scan) Urgent Care
$0 after deductible $0 $0
$0 after deductible
$0 after deductible
$0 after deductible
$0 after deductible
Hospital Services
$0 after deductible
$0 after deductible
Inpatient Outpatient surgery Emergency Room
$0 after deductible
$0 after deductible
$0 after deductible
$0 after deductible
This is a high-level benefit summary. See Certificate of Coverage for details. $0 means no deductible or other cost-sharing up to the Benefit Amount. If a provider charges above the Benefit Amount, the member is responsible for the difference between the Benefit Amount and provider charge up to the Balance
Sidecar Health Insurance Company, Inc (NAIC #17104) underwrites this large group major medical insurance for employers (with 51 or more employees). Sidecar Health Insurance Solutions, LLC markets and administers this product.
This proposal and the proposed rates are subject to final underwriting approval and are subject to change in the event of changes in benefits, plan design selected, participation, or changes in the risk factors upon which this proposal is based. Sidecar Health Insurance Company may decline to offer coverage if any of information provided in the application or during the underwriting process is inaccurate, incomplete, or changes prior to the proposed Coverage Period. This proposal is valid for sixty (60) days from the date of proposal.
For convenience, the proposed rates are inclusive of broker service fees identified above, which are not part of your premium, but are fees agreed to between group and its broker for services rendered on behalf of group that Sidecar Health bills on behalf of your broker.
While enrolled with Sidecar Health, employees may generate cash back when they receive certain services at a price below what the plan pays. These amounts accumulate throughout the plan year and unused amounts are distributed to the group 120 days of the end of the plan year (or 30 days of an employee termination). We believe the IRS is likely to treat these amounts as employee compensation and that groups should treat these as wages, paid out and taxed accordingly in the year they are distributed to the group. As the employer, the group is responsible for any employer payroll taxes. We encourage you to consult with tax and payroll advisors on how to manage these payments to employees. Monthly premiums will be calculated based on the following methodology: For new employee enrollments: (i) Employees enrolled on the 1st-14th day of the month are charged a full month of premiums; (ii) Employees enrolled on the 15th or after are charged a half month of premiums. For employee terminations: (i) Employees who are enrolled and terminate within 1 day of coverage or less are treated as having no effective coverage ($0 premium charged); (ii) Employees who terminate coverage on the 1st-15th of the month are charged a half month of premiums; (iii) Employees who terminate coverage after the 15th are charged a full month of premiums. For mid-month change in policy : (i) Change in policy that occurs on the 1st-14th incurs a charge of the full monthly premium of the new policy; (iii) Change in policy that occurs on the 15th or after incurs a charge of a half month of the previous policy and a half month of the new policy.
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