Forms and Resources for Members

Continuity of Care (COC) lets members temporarily continue care with a provider who’s not part of the Sutter Health Plan network. Members may be eligible for COC if they’re:

• Existing Sutter Health Plan members whose provider leaves or is terminated from the Sutter Health Plan network
• New Sutter Health Plan individual and family plan (IFP) members whose prior coverage was terminated because their previous health plan withdrew from the market or discontinued their previous benefit plan
• New Sutter Health Plan small or large group members receiving active treatment with a treating provider who does not accept Sutter Health Plan

For additional COC eligibility criteria and more information, please review the Continuity of Care Request Form and Guidelines (PDF).

If you believe your health care coverage has been, or will be, improperly canceled, rescinded or not renewed, you have the right to file a grievance with the plan or the Department of Managed Health Care (DMHC).

You have 180 days from receiving Sutter Health Plan's Notice of Cancellation, Rescission or Nonrenewal to request a grievance.

To file a grievance with the DMHC, please complete the DMHC Grievance Form for Cancellations, Rescissions and Nonrenewals of an Enrollment or Subscription (PDF). For more information on your grievance rights and options, refer to the Right to Submit Grievance for Cancellation, Rescission or Nonrenewal of your Plan Enrollment Subscription or Contract (PDF) document.

If you have concerns with Sutter Health Plan or a Sutter Health Plan provider, we’re here to help. You have the right to file a complaint or grievance at any time. If you choose to file a grievance, you have 180 calendar days from the date of the issue that caused your dissatisfaction to submit it.

A grievance is when you share your concerns or dissatisfaction, either in writing or by speaking with us. Grievances include, but aren’t limited to:

• Benefit coverage decisions
• Cancellations, rescissions and nonrenewals of your healthcare coverage
• Quality of care concerns
• Requests for review of denied services

Sutter Health Plan handles all member information in a confidential manner. We don’t discriminate against any member who submits a grievance. There are multiple ways you can submit a grievance:

• Complete the Grievance Form (PDF). You can submit your completed Grievance Form by mail or fax (see page 2 for details).
• Call Customer Service from 8:00 am–7:00 pm, Monday through Friday, at 855-315-5800 or TTY 855-830-3500.
• Submit a grievance through your Member Portal.

Sutter Health Plan promotes excellence in transgender and gender-diverse healthcare. We follow the current version of the WPATH Standards of Care (SOC). Visit the WPATH website to access the Standards of Care (SOC) and materials that explain how they guide medical necessity determinations.