Sidecar Health

Sidecar Health is a US health insurance company that sells ACA-compliant, employer-sponsored major medical coverage built around upfront price transparency rather than provider networks. For each covered service or prescription the plan defines a "Benefit Amount" equal to the average local cost of care in a given geography. Members look up the Benefit Amount in the Sidecar Health mobile app before receiving care, pay the provider directly at the time of service with a Sidecar Health Visa benefit card, and submit an itemized invoice as a claim. If the provider charges less than the Benefit Amount, the member keeps half of the savings, credited to their Sidecar Health account for future expenses or paid out by the employer after the plan year ends; if the provider charges more, the member pays the difference.

The plan design removes provider networks, prior authorizations, referrals, step therapy and restrictive formularies, so members can use any licensed provider that accepts Visa. Additional member-protection features include care search assistance to locate providers priced at or below the Benefit Amount, a care partner program for high-complexity episodic conditions such as cancer, and protection against additional charges beyond the deductible for unplanned events during planned care. The company previously sold an individual-only "Access Plan" that was a form of fixed indemnity coverage; it states that product has been discontinued and that all current plans are ACA-compliant major medical insurance.

According to June 2024 trade coverage, the company was founded in 2018, had reached unicorn valuation status roughly two years earlier, and served employers headquartered in Ohio and Georgia before announcing expansion into Florida.

Business model

Sidecar Health operates as a health insurance carrier selling employer-sponsored major medical plans. Internal records indicate both fully insured and self-funded administrative-services options for large employers. Revenue derives from insurance premiums/administrative fees for group coverage; the plan pays defined Benefit Amounts per service and splits savings with members when care is purchased below that amount.

Premiums and administrative fees from employer-sponsored group health plans; the company positions its coverage as roughly 20% more affordable than traditional plans.

Traction

Company statements cite unicorn valuation status as of about 2022, employer customers headquartered in Ohio and Georgia with expansion into Florida, a Koch Industries agreement to make coverage available to part of its workforce in 2025, and a claim that most claims processed between June 2024 and June 2025 resulted in money back to members. A named customer reference is Clark Grave Vault.

Latest developments

In June 2024 Sidecar Health announced a $165 million Series D led by Koch Disruptive Technologies, expansion into Florida beyond its existing Ohio and Georgia employer base, and an arrangement under which Koch Industries would offer Sidecar Health coverage to a segment of its workforce in 2025 while serving as design partner for jumbo-employer products.