Formulary

The definition of Formulary, and how it fits into the Zenefits Health Insurance Marketplace

What is a formulary?

A list of prescription drugs covered by the health plan, often structured in tiers that subsidize low cost generics at a higher percentage than more expensive brand-name or specialty drugs

How does a formulary work?

With a formulary, covered individuals can better understand their level of commitment when it comes to purchasing either generic or brand name prescription medications.

All insurance quotes provided to you through Zenefits (which are based on information provided to us by you and information provided and general assumptions made by the insurance companies) are made available to you for pricing comparison and quotation estimate purposes only and the actual final rates and details of your policy may vary. Many factors may cause estimated rates, details and availability to differ from actual. These may include changes in employee numbers, ages or other characteristics, selection of optional benefits, insurance company underwriting guidelines, selected locations as well as rate and plan changes implemented by insurance companies, which may occur at any time – particularly at calendar year end.

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"Sidecar Health", "Sidecar Health insurance", "Sidecar Health coverage" and "Sidecar Health plans", collectively, refer to the fixed indemnity insurance product marketed and administered by Sidecar Health Insurance Solutions, LLC. and underwritten by the insurance carriers described below. This is only a brief description of the insurance coverage available. The Policy contains reductions, limitations, exclusions, and termination provisions. Full details of the coverage are contained in the Policy. If there are any conflicts between this document and the Policy, the Policy shall govern in all cases. Insurance plans in Alabama, Florida, Georgia, Indiana, Maryland, North Carolina, Oklahoma, South Carolina, Tennessee and Texas are underwritten by United States Fire Insurance Company, 5 Christopher Way, 2nd Floor, Eatontown, NJ 07724. Insurance plans in Arkansas, Kentucky, Mississippi and Ohio are underwritten by Sirius America Insurance Company, 140 Broadway, 32nd Floor, New York, NY 10005. Coverage under these plans is unavailable to applicants age 65 years or older.

Fixed indemnity insurance plans do not provide ACA-qualified Essential Health Benefits or Minimum Essential Coverage. You cannot receive a subsidy (premium tax credit and/or cost-sharing reduction) under the ACA in connection with your purchase of such a fixed indemnity insurance plan. Also, the termination or loss of this policy does not entitle you to a special enrollment period to purchase a health benefit plan that qualifies as minimum essential coverage outside of an open enrollment period.

† Savings estimate based on a study of more than 1 billion claims comparing self-pay prices for a frequency-weighted market basket of procedures to insurer-negotiated rates for the same. Claims were collected between July 2017 and July 2019. R. Lawrence Van Horn, Arthur Laffer, Robert L. Metcalf. 2019. The Transformative Potential for Price Transparency in healthcare: Benefits for Consumers and Providers. Health Management Policy and Innovation, Volume 4, Issue 3. https://hmpi.org/2019/12/09/the-transformative-potential-for-price-transparency-in-healthcare-benefits-for-consumers-and-providers/