Sidecar Health pays the average local cost for care, and members can see any provider they choose. If the provider charges less than the Benefit Amount (the amount Sidecar Health pays for care), the member keeps a portion of the savings. If the provider charges more than the Benefit Amount, the member pays the difference. There are no networks, prior authorizations, referrals, or step therapy requirements.

Members use the Sidecar Health app to look up how much the average local price for the service they need. That’s how much the plan will pay — we call this the Benefit Amount. Members compare this amount to what their provider charges. Members pay for care using the Sidecar Health Visa card, upload an itemized invoice, and submit a claim. If the provider’s charge is lower than the Benefit Amount, the member keeps part of the difference. If it’s higher, the member pays the difference. Most claims result in money back*.

*Based on claims processed from 6/2024-6/2025. Money back refers to earned benefit. See Certificate of Coverage for details.

Sidecar Health lowers costs by combining price transparency with financial incentives. Members can see how much the plan pays for care in advance and are rewarded when they choose lower-cost options. The model eliminates administrative waste and barriers to care. Making it easier to see a doctor or get a test when you need leads to fewer expensive hospital visits. All of this helps reduce overall healthcare spending and keeps premiums lower for employers and their employees.

A Benefit Amount is the amount Sidecar Health pays for a covered service or prescription. It’s based on the average local cost for care in a specific geography. If the provider charges less, the member keeps a portion of the savings. If the provider charges more, the member pays the difference. In most cases, the difference is still less than a legacy plan copay. While doctors tend to charge near the local average, hospital services, surgeries, and imaging typically see wide price ranges and members often earn meaningful money back on those types of services.

When a member chooses care that costs less than the Benefit Amount, a portion of the savings is credited back to their Sidecar Health account. These earnings can be used for future expenses or paid out by their employer after the plan year ends.

Because the Sidecar Health model works differently than the legacy plans members and providers are used to, it’s important that members know how to talk about it with their providers. When visiting a provider, members should say something along the lines of: “I’ll pay upfront with a Visa card and will need an itemized invoice that I’ll submit to my insurance company.” They can also ask if the provider offers a discount for upfront payment. It’s common for providers to offer discounts to patients paying in full at the time of service since it saves administrative time.

No. Sidecar Health does not have a provider network, so members can go to any doctor who accepts Visa (which is virtually every doctor in America). Benefit Amounts are set at the average local provider price, and most providers charge near what the plan pays. If they charge less, the member keeps part of the savings. If a provider charges more, the member pays the difference.

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