---
title: "COVID-19 Coverage and Cost at Sutter Health Plan"
description: "Sutter Health Plan covers medically necessary COVID-19 screening and testing at zero cost to members."
url: "https://www.sutterhealthplan.org/about-us/covid-19"
---
1. [Home](https://www.sutterhealthplan.org/) /
2. [About Sutter Health Plan](https://www.sutterhealthplan.org/about-us) /
3. Information About COVID-19 Coverage Cost and Access to Care
# Information About COVID-19 Coverage, Cost and Access to Care
**Section menu**
- [About Sutter Health Plan](https://www.sutterhealthplan.org/about-us "About Sutter Health Plan")
- [Sales team](https://www.sutterhealthplan.org/about-us/our-team "Sales team")
- [Products and Plans](https://www.sutterhealthplan.org/about-us/products-plans "Products and Plans")
- [Individual and Family Plans](https://www.sutterhealthplan.org/about-us/products-plans/individual-family-plans "Individual and Family Plans")
- [Large Group Plans](https://www.sutterhealthplan.org/about-us/products-plans/large-group-plans "Large Group Plans")
- [Small Group Plans](https://www.sutterhealthplan.org/about-us/products-plans/small-group-plans "Small Group Plans")
- [Information About COVID-19 Coverage Cost and Access to Care](https://www.sutterhealthplan.org/about-us/covid-19 "Information About COVID-19 Coverage Cost and Access to Care")
- [Carelon Behavioral Health of California, Inc. (Carelon)](https://www.sutterhealthplan.org/about-us/carelon "Carelon Behavioral Health of California, Inc. (Carelon)")
- [Sutter Walk-In Care](https://www.sutterhealthplan.org/about-us/walk-in-care "Sutter Walk-In Care")
- [Service Area](https://www.sutterhealthplan.org/about-us/service-area "Service Area")
- [About Sutter Health Plan](https://www.sutterhealthplan.org/about-us "About Sutter Health Plan")
- [Sales team](https://www.sutterhealthplan.org/about-us/our-team "Sales team")
- [Products and Plans](https://www.sutterhealthplan.org/about-us/products-plans "Products and Plans")
- [Individual and Family Plans](https://www.sutterhealthplan.org/about-us/products-plans/individual-family-plans "Individual and Family Plans")
- [Large Group Plans](https://www.sutterhealthplan.org/about-us/products-plans/large-group-plans "Large Group Plans")
- [Small Group Plans](https://www.sutterhealthplan.org/about-us/products-plans/small-group-plans "Small Group Plans")
- [Information About COVID-19 Coverage Cost and Access to Care](https://www.sutterhealthplan.org/about-us/covid-19 "Information About COVID-19 Coverage Cost and Access to Care")
- [Carelon Behavioral Health of California, Inc. (Carelon)](https://www.sutterhealthplan.org/about-us/carelon "Carelon Behavioral Health of California, Inc. (Carelon)")
- [Sutter Walk-In Care](https://www.sutterhealthplan.org/about-us/walk-in-care "Sutter Walk-In Care")
- [Service Area](https://www.sutterhealthplan.org/about-us/service-area "Service Area")
Beginning Jan. 1, 2025, there are changes to coverage and cost share requirements for certain COVID-19 items and services as new members join Sutter Health Plan or existing members renew their plans. The coverage and cost share changes will only apply to members on a high-deductible health plan (HDHP).
## Frequently Asked Questions
We understand that you may have more questions about vaccines, coverage, cost and access to care due to COVID-19.
The FAQs below are provided to help answer some of your questions.
### Vaccines
**Will Sutter Health Plan cover my COVID-19 vaccine?**
Yes. Sutter Health Plan covers COVID-19 vaccines administered by in-network and out-of-network providers, in accordance with state requirements.
**How do I know if I am up to date with my COVID-19 vaccine?**
The Centers for Disease Control and Prevention (CDC) vaccine recommendations vary based on age, medical condition and vaccine type. The [CDC website](https://www.cdc.gov/covid/vaccines/stay-up-to-date.html) provides detailed information about how to tell if you are up to date with your vaccine, including any necessary booster shots or additional primary doses.
**Where can I get a COVID-19 vaccine?**
Members can find more information about COVID-19 vaccine appointments from the following resources:
- Your local pharmacy
- The [My Turn](https://myturn.ca.gov/) website hosted by the California Department of Public Health
**What will I pay for a COVID-19 vaccine?**
There is no member cost share for COVID-19 vaccines. This includes any vaccines requiring more than one injection.
**What should I do if a provider charges me at the time of service or I later get a bill for my COVID-19 vaccine?**
You can call Sutter Health Plan Customer Service at [855-315-5800](tel:855-315-5800) or by TTY at [855-830-3500](tel:855-830-3500). Customer Service is available 8:00 am – 7:00 pm, Monday through Friday.
**Where can I find more COVID-19 vaccines?**
You can view more information on the [CDC website](https://www.cdc.gov/covid/vaccines/).
### Coverage and Cost
**Does Sutter Health Plan cover items and services related to COVID-19? What is my cost share for the covered items?**
Coverage and cost share requirements for items and services related to COVID-19 depend on the item or service.
Beginning Jan. 1, 2025, there are changes to coverage and cost share requirements for certain items and services as new members join Sutter Health Plan or existing members renew their plans. The coverage and cost share changes will only apply to members on a high deductible health plan (HDHP).
Refer to the following table for more information.
| COVID-19 Item or Service | Coverage Requirements and Limitations | In-Network | Out-of-Network |
| --- | --- | --- | --- |
| **Vaccines** | We cover COVID-19 vaccines administered by in-network and out-of-network providers, in accordance with state and federal requirements. | No cost share. | No cost share. |
| **Screening and testing** | We cover COVID-19 screening when ordered by a treating provider as part of an individual medical assessment. Coverage includes any screening-related services, such as visits to a primary care physician (PCP), urgent care or emergency department, as well as lab tests. | No cost share.
For HDHPs only: For new members or members renewing on or after Jan. 1, 2025, COVID-19 diagnostic and screening tests are covered at no cost share after the annual plan deductible has been met. | The standard benefit cost share applies based on place of service. |
| **Treatment for confirmed COVID-19 diagnosis** | We cover COVID-19 treatment when ordered by a treating provider as part of an individual medical assessment. Coverage includes any treatment- related services, such as visits to a PCP, urgent care and emergency department, as well as lab tests.
Beginning Jan. 1, 2024, we only cover out-of-network treatment related to a confirmed diagnosis of COVID-19 treatment when services are provided as part of urgent care or emergency care. | Standard benefit cost share applies based on place of service. | The standard urgent care or emergency services cost share applies based on place of service. |
| **Over-the-counter (OTC) tests –**
**No prescription** | We limit coverage to eight OTC tests per member, per month. No individual medical assessment is required for coverage.
Members are responsible for the full cost of additional OTC tests exceeding this limit. | Members must submit a completed Member Claim Form to be reimbursed the amount they paid for the tests.
For HDHPs only: For new members or members renewing on or after Jan. 1, 2025, Sutter Health Plan will reimburse the cost of the OTC tests after the annual deductible has been met. | Members must submit a completed Member Claim Form to be reimbursed up to $12 per test.
For HDHPs only: For new members or members renewing on or after Jan. 1, 2025, Sutter Health Plan will reimburse the cost of the OTC tests after the annual deductible has been met. |
| **OTC tests –**
**With prescription** | We do not limit coverage for OTC tests when prescribed by a treating provider as part of an individual medical assessment. | No cost share when obtained at a pharmacy and processed through the outpatient pharmacy benefit with CVS Caremark® .
For HDHPs only: For new members or members renewing on or after Jan. 1, 2025, COVID-19 OTC tests are covered at no cost share after the annual plan deductible has been met. | No cost share when obtained at a pharmacy and processed through the outpatient pharmacy benefit with CVS Caremark®.
For HDHPs only: For new members or members renewing on or after Jan. 1, 2025, COVID-19 OTC tests are covered at no cost share after the annual plan deductible has been met. |
| **Prescription drugs and other therapeutics** | We cover COVID-19 prescription drugs and other therapeutics when ordered by a treating provider as part of an individual medical assessment. | No cost share.
For HDHPs only: For new members or members renewing on or after Jan. 1, 2025, COVID-19 therapeutics are covered at no cost share after the annual plan deductible has been met. | No cost share.
For HDHPs only: For new members or members renewing on or after Jan. 1, 2025, COVID-19 therapeutics are covered at no cost share after the annual plan deductible has been met. |
**Do I need to get prior authorization for items or services related to COVID-19?**
Sutter Health Plan does not require prior authorization for medically necessary items or services related to COVID-19.
**What should I do if I am uncertain about a cost share applied to an item or service related to COVID-19?**
You can call Sutter Health Plan Customer Service at [855-315-5800](tel:855-315-5800) or by TTY at [855-830-3500](tel:855-830-3500). Customer Service is available 8:00 am – 7:00 pm, Monday through Friday.
### Access
**Where can I get information on COVID-19 testing locations?**
We recommend contacting your PCP to ask if COVID-19 screening or testing is needed based on your personal circumstances. If your PCP recommends COVID-19 screening or testing, they will be able to help direct you to a location that can provide you services. Working with your PCP to get testing at an in-network location helps your doctor manage your care more effectively.
If you need more help, you can call Sutter Health Plan Customer Service at [855-315-5800](tel:855-315-5800) or by TTY at [855-830-3500](tel:855-830-3500). Customer Service is available 8:00 am – 7:00 pm, Monday through Friday.
**Where can I get at-home OTC COVID-19 tests?**
You can purchase at-home OTC COVID-19 tests from local retail pharmacies; retail stores such as Target, Walmart or Costco; grocery stores; and online vendors. You do not need a prescription or clinical assessment by a provider. The tests must be authorized for use by the FDA.
**What if I have a clinical concern about COVID-19 or if I experience related symptoms?**
You should call your PCP or our 24-Hour Nurse Advice Line for help with clinical questions. You can call the 24-Hour Nurse Advice Line at [855-836-3500](tel:855-836-3500).
You also have access to [video visits](https://www.sutterhealth.org/video-visits) with licensed providers for treatment and advice. Video visits are available 11:00 am-7:00 pm every day from a smartphone, tablet or computer.
### General
**Where can Sutter Health Plan members find additional information about COVID-19?**
You can view more information on the [CDC website](https://www.cdc.gov/coronavirus/2019-ncov/index.html).
We’re Here to Help
Customer Service can help answer your questions about health plans, benefits, enrollment, portal access and more.
### Message Us
Submit a secure message and we’ll contact you within five business days.
[Complete the Form](https://feedback.sutterhealth.org/f/136895/8368 "Complete the Form")
### Call Us
Call 855-315-5800 or TTY 855-830-3500, weekdays: 8:00 am – 7:00 pm.
Call [855-315-5800](tel:+18553155800)
### Email Us
Email shpserviceteam@sutterhealth.org with details about how we can help you.
[Email Now](mailto:shpserviceteam@sutterhealth.org)
```json
{"@context":"https://schema.org","@type":"WebPage","name":"COVID-19 Coverage and Cost at Sutter Health Plan","description":"Sutter Health Plan covers medically necessary COVID-19 screening and testing at zero cost to members.","url":"https://www.sutterhealthplan.org/about-us/covid-19","breadcrumb":{"@id":"https://www.sutterhealthplan.org/about-us/covid-19#breadcrumblist"}}
```
```json
{"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealthplan.org/about-us/covid-19#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealthplan.org/"},{"@type":"ListItem","position":2,"name":"About Sutter Health Plan","item":"https://www.sutterhealthplan.org/about-us"},{"@type":"ListItem","position":3,"name":"Information About COVID-19 Coverage Cost and Access to Care"}]}
```