Sidecar Health Forms

You can find forms here related to coverage through Sidecar Health.

HIPAA Authorization Form – Manual submission (Español)

HIPAA Authorization Form – Manual submission

Specialty SRXMASTER (without EES) Drug List – June 2025

Dependent Disability Form

Appeal request form for fully insured plans sponsored by Florida employers

Appeal request form for fully insured plans sponsored by Ohio employers

Appeal request form for fully insured plans sponsored by Georgia employers

Appeal request form for Self-Insured employer plans

Appeal request form for Access plans

Coordination of Benefits (COB) Form

SiriusPoint America Insurance Company Name Change Endorsement

HIPAA Authorization Form – Digital submission

HIPAA Authorization Form – Digital submission (Español)

Expense form