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Access Plan: Coverage and benefits

What do Sidecar Health Access plans 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 vary by state. 

Below is an illustrative list of exclusions and limitations to the Access Plan.

1. Services and drugs that are experimental or investigational.

2. Care provided in rest homes, health resorts, homes for the aged, halfway houses, college infirmaries or places used primarily for living, and extended care in treatment or substance abuse facilities.

3. Day care and foster care.

4. Personal comfort or beautification, cosmetic services and supplies.

5. Vision services and devices, including but not limited to, routine vision screenings and contact lenses.

6. Eye surgery when the primary purpose is to correct myopia (near-sightedness), hyperopia (far-sightedness), presbyopia (aging eye) or astigmatism (blurring).

7. Cosmetic procedures including but not limited to breast augmentation, liposuction, abdominoplasty and vaginal rejuvenation.

8. Any services rendered by an immediate family member, unless allowed per state law.

9. Treatment for obesity, including but not limited to prescription or over-the-counter medications, food, diet or exercise programs, surgery, weight management, or nutrition programs. (Prescription medication prescribed by a physician that is medically necessary to treat obesity will be covered under the Outpatient Prescription Drug benefit.)

10. Vitamins, food supplements and over-the-counter medicines.

11. Wellness benefits such as exercise classes, health club membership or smoking cessation products.

12. Diagnostic procedures and treatment related to infertility including, but not limited to, in vitro fertilization, artificial insemination and use of egg donor or surrogate.

13. Sterilization or sterilization reversal, including surgical procedures and devices.

14. Sexual reassignment surgery and related therapy, whether before or after surgery, including but not limited to treatment of gender dysphoria.

15. Body piercing, unless allowed per state law.

16. Dental services and devices, including but not limited to, routine dental services, new, or repair or replacement of dentures, bridges, dental implants, dental bands or braces or other dental appliances, crowns, caps, inlays or onlays, fillings or any other treatment of the teeth or gums.

17. Treatment of complications of procedures not covered under your policy.

18. Policyholder’s pregnancy or childbirth or the well-baby care of policyholder’s child after childbirth (except for complications of pregnancy). Exclusion does not apply to well-baby care of a child who has its own issued policy or if the policyholder has optional Maternity Care Rider available in some states.

19. Preexisting conditions that a policyholder didn’t disclose during enrollment and certain upcoming treatment, conditions, and procedures that you did disclose.

20. For elective treatment or elective surgery or complications arising therefrom.

21. As a result of committing or attempting to commit an assault or felony, or participation in a felony, riot, illegal occupation, insurrection or civil commotion.

22. For injury resulting from fighting, except in self-defense.

23. For any private duty nursing or skilled nursing services.

24. Prescription drugs (if you choose to not elect this coverage)

25. Therapy that exceeds the number of services specified in your policy for chiropractic services and behavioral health therapy

To see the most up-to-date list of exclusions and limitations, be sure to view your policy document.

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