What is Earned Benefit Credit? – Sidecar Health Employer Plan

With Sidecar Health, you have the unique opportunity to earn credit when shopping for care. Earned Benefit is received by choosing care that costs less than your Benefit Amount. You can redeem this Earned Benefit throughout the year to pay for other covered medical expenses, and any remaining Earned Benefit will be paid out by your employer ~100 days after your accrual period (plan year/calendar year) resets.

For members on a family plan:

Earned Benefit can only be used for the specific member who earned the benefit. It cannot be transferred between members.
The plan’s primary member (the employee) will receive the payout for the entire family, and it will be taxed as wage income.

Starting in 2024, in the case the primary member's (employee’s) employment is terminated early, and/or your Sidecar Health coverage ends (job loss or change, transitioning to COBRA, etc.):

Sidecar Health will release your (and your whole family’s) remaining accrued Earned Benefit to your employer within a month of your termination of coverage date. Your employer will distribute these funds to you, according to their payout schedule.
Note: This accelerated payout for terminated coverage applies only if your employer started with Sidecar Health in 2024 or your plan has already been renewed in 2024.

How does it work?

Earning it:

Before your deductible has been met:

Scenario: Your doctor charges less than your plan’s Benefit Amount for a service. Your Benefit Amount is $100 and your doctor charges $80. You Paid $80 at time of care using our Sidecar Health VISA benefit card.

Outcome: Full $100 Benefit Amount is applied to your deductible. By shopping smart for care, you have met your deductible faster. Well done!

For covered services not subject to deductible, or after your deductible has been met:

Scenario: Your doctor charges less than your plan’s Benefit Amount for a service. Your Benefit Amount is $100 and your doctor charges $80. You paid $80 at the time of care using our Sidecar Health VISA benefit card.

Outcome: $20 Earned benefit credit. Received as:

Earned benefit credit to be used towards future healthcare costs through Sidecar Health. Not taxed.
A payout via your employer after your coverage ends. Taxed as wages.

Using it:

Throughout your plan year, you can use your Earned Benefit towards covered medical expenses.
You can check your credit balance easily on the main dashboard of the member portal
- Need a more detailed view? Main dashboard --> Account --> Billing --> View “credit” tab and “See all credit activity”

Cashing it out:

Active members (employees with active Sidecar Health coverage):

Earned Benefit is available approximately 100 days after the plan year.
Earned Benefit is paid to the plan's primary member (the employee) and is considered taxable income.
- On a family plan? The plan’s primary member (the employee) will receive the payout for the entire family, and it will be taxed as wage income.
Payouts will be distributed by your employer, according to their payout schedule.
In most cases, you will receive this money as added to one of your paychecks. If your employer allows other options, please speak to your Human Resources department to find out more.

Former members (former or current employees with inactive Sidecar Health coverage):

Accrued Earned Benefit is available within 30 days after the primary member's (employee’s) termination of coverage.
If a dependent on the family plan leaves the plan while it remains active, their earned benefit will follow the standard annual payout process outlined above.
Earned Benefit is paid to the plan's primary member (the employee) and is considered taxable wage income.
- On a family plan? The plan’s primary member (the employee) will receive the payout for the entire family, and it will be taxed as wage income.
Payouts will be distributed by your employer, according to their payout schedule.
In most cases, you will receive this money as added to one of your paychecks. If your employer allows other options, please speak to your Human Resources department to find out more.
You have a 90-day window following the end date of your coverage to submit expenses for the care you received during the coverage period. Even after the initial payout, you remain eligible to accrue Earned Benefit for these expenses. Although you won't be able to redeem this Earned Benefit as cash, you can still use it to offset and pay for covered medical expenses associated with other Sidecar Health claims.

Why is my employer involved in the payout?

It's all about taxes! Since your health insurance premiums are paid with pre-tax dollars, there are tax rules for Earned Benefit payouts. Sidecar Health sends your credit to your employer, who then distributes it to you as taxable wages.

How can I check my balances?

Balances and balance details can be found throughout the member portal:

Need a quick summary of available credit balances? Main dashboard --> view “available credit” section

Need to understand more about credits or how they’ve been earned and spent? Main dashboard --> Account --> Billing --> View “credit” tab --> “See all credit activity” (for full breakdown)