Members

Choosing a health plan is a big decision.
We understand.
If you're looking for caring coverage that is connected, convenient,
and designed to fit your needs, we may be the right plan for you.
We are an HMO plan, which means you choose a primary care
physician, also called a PCP, who gets to know you and coordinates most
aspects of your care, including referrals to specialists when needed.
This personalized approach helps ensure you receive the right care
at the right time.
With access to a network of award-winning providers,
including many Sutter Health doctors, care centers and hospitals,
you'll have coverage for the every day and everything in between.
Our plans include comprehensive coverage for preventive care, mental health,
pharmacy benefits and more, and also digital tools to support your well-being.
We know life gets busy.
That's why we offer flexible care options to fit your schedule, like same day care
and virtual or in-person visits
for everyday health needs, when and where you need it.
Managing your coverage is easy with our member portal.
You can easily check your benefits, view claims, estimate
costs, request an ID card, and even change your PCP.
Stay connected to your care wherever you are.
With My Health Online, Sutter’s secure patient portal, you can book appointments,
message your care team, view test results, pay bills and more at your fingertips.
We also provide
support for your wellness journey with personalized tools and resources,
including a digital health assessment, action plan, modules, and a health
coaching program to help you set goals and make lasting changes.
If you have questions about your coverage options, our customer service
team is here to help.
Call 855-315-5800.
Monday through Friday, 8 a.m. to 7 p.m.
include holidays.
You can also reach us by email at shpcustomerservice@sutterhealth.org

Choosing the right health plan for you
begins with understanding your options.
Let's explore what an HMO is
and the different types of plans available
to help you find the best fit for your health care needs.
With an HMO like Sutter Health Plan, you choose your primary care physician
who manages most of your care
and refers you to specialists and other services as needed.
These plans typically have lower premiums
and out-of-pocket costs compared to PPO plans,
but they are limited to a specific network of providers.
When choosing a health plan,
it's smart to understand how each plan works.
Traditional plans typically offer set copays for many covered services, and
may have a co-insurance for some benefits where you pay a percentage of the cost.
These plans may also have a deductible, which is the amount
you pay for covered services until the deductible is met.
Once you've met the deductible, you'll pay cost shares
for all covered services until you reach the out-of-pocket maximum.
High Deductible Health Plans, or HDHP, work a bit differently with these plans,
you'll pay the full cost of all covered services until you meet your deductible.
Once you reach it, you'll only pay cost shares
for covered services until your out-of-pocket maximum is met.
The good news no matter which type of plan you choose, preventive services
are covered at no cost-share.
Before you pick a health plan, think about the care
you and your family may need in the coming years
and how much you can afford on monthly premiums and out-of-pocket costs.
A traditional plan may be a good fit if you see your doctors or specialists
often, have a high level of medical needs, or are planning
a life change like expanding your family or an upcoming surgery.
These plans usually have higher monthly premiums,
but lower out-of-pocket costs when you receive care.
If you only see your doctor for routine checkups and minor illnesses,
an HDHP may be the better option.
HDHPs typically have lower monthly premiums
but higher out-of-pocket costs until you meet your deductible.
Some people prefer lower monthly payments and are willing to pay more
when they need care.
Others choose higher premiums to reduce costs, such as co-pays and deductibles.
To find the right balance, compare
each plan's deductible, coinsurance, and out-of-pocket maximum.
Understanding these differences can help
you choose a plan that fits both your health needs and your budget.
If you have questions about your coverage options, our customer service team
is here to help.
Call 855-315-5800 Monday through Friday, 8 a.m. to 7 p.m. including holidays.
You can also reach us by email at shpcustomerservice@sutterhealth.org.

Are you considering a high deductible health plan,
also known as an HDHP, but you're not quite sure how it works?
This video explains deductibles and out-of-pocket expenses,
as well as the differences between HDHPs and traditional plans
to help you understand potential costs and determine
if an HDHP is the right plan for you.
HDHPs are different from traditional HMO plans.
With an HDHP, you pay the full cost for covered services
until you meet your deductible,
except for preventive care, which is always covered at no cost to you.
Once you meet your deductible, you'll only pay cost shares,
such as a copay or coinsurance for covered services
until you reach your out-of-pocket maximum.
It's important to know that this is different from your monthly premium,
which is the amount you pay for health care coverage.
Your premium doesn't count towards your deductible or your out-of-pocket maximum.
HDHPs also come with a unique benefit.
They’re the only type of plan that lets you contribute to a health savings account
or HSA.
This account allows you to save money tax-free for qualified
medical expenses, HDHPs typically have lower monthly
premiums and higher out-of-pocket costs until your deductible is met.
An HDHP may be a good fit if you're generally healthy
and only visit the doctor for routine checkups or minor illnesses.
There are different deductibles for an HDHP.
Let's review them.
The first one is an Individual or Self-Only Deductible.
This applies if you enroll in a plan for yourself only,
and you pay 100% of out-of-pocket costs until the deductible is met,
except for preventive care.
The second type is an Individual Family Member Deductible.
If you're part of a family plan, each person has their own deductible to meet.
That means each family member pays the full cost of their care
until they meet their individual deductible,
or the family deductible is met, whichever comes first.
Lastly, there's the Family Deductible.
This applies to all members within a family.
The deductible is met when any one family members or combination
of family members costs for covered services reach the family deductible.
Once it's met, no one in the family pays toward the deductible
any more, even if they haven't met their individual amount.
Understanding which deductible applies to you is important because it can help
you choose the right plan that fits your health care needs and budget.
Let's see what this might look like.
Here's an example of a family of four.
Robert, Grace, Tyler, and Eva.
They're enrolled in an MDP with an individual family member
deductible of $3,400, and a family deductible of $5,000.
In March, Robert paid $400 for diagnostic services.
Tyler paid $300 for labs and Ava paid $200 for physician fees.
Grace spent $3,400 on her hand surgery, and has met
the individual family member deductible of $3,400 combined.
The family paid $4,300 on health care services,
but they still have to spend $700 on covered services
until they meet their family deductible of $5,000.
In November, both Grace and Robert were hospitalized due to pneumonia.
Since Grace has already met her individual deductible,
she's only responsible for the applicable cost shares,
such as co-pays or coinsurance for her hospitalization.
On the other hand,
since the family deductible hasn't been met and Robert hasn't met
his individual deductible, he must pay for 100% of his hospitalization
until the remaining $700 of the $5,000 family deductible is met.
Even after both deductibles are met, Robert will still be responsible
for cost shares like copays or coinsurance for any covered services
until the plan's out of pocket maximum is reached.
The family deductible is met when the family collectively spends
$5,000 on covered health care services.
As a member, you can easily check your deductible and out-of-pocket
spending in the Balanced Summary section of your member portal
and see what you've paid, such as copays,
coinsurance, and other costs excluding your monthly premium.
If you have any questions about your coverage options,
our customer service team is here to help.
Call 855-315-5800.
Monday through Friday, 8 a.m. to 7 p.m.
include holidays.
You can also reach us by email at shpcustomerservice@sutterhealth.org

At Sutter Health Plan, we partnered
with CVS Caremark to make getting your prescriptions easy and convenient.
Whether you prefer picking them up at your local pharmacy or having them
delivered to your door, you have options that fit your needs.
No need to add an extra stop to your busy day.
Fill your prescriptions at many independent and chain pharmacies,
likely the same places you already shop.
And with the CVS Caremark Retail-90 program,
you can get up to a 100 day supply of your maintenance medications
for the cost of just two retail copays at select pharmacies, including CVS.
Save even more time with CVS Caremark Mail Service Pharmacy,
where you can get up to a 100 day supply of your maintenance prescriptions
for the cost of two 30 day copays and with free standard shipping.
If you take specialty medications, they'll need to be filled through CVS
Specialty and will be shipped directly to your home at no extra cost.
Before your new health
plan coverage begins, check if you have any prescription refills left.
If you do, fill them through your current plan
so you have enough until you can get established with your new doctor.
If not, contact your previous doctor to get a refill or a new prescription.
Once your coverage starts, you can transfer prescriptions to a CVS
Caremark network pharmacy or bring in a new prescription to fill.
And for prescriptions you take regularly, consider
the Retail-90 program or mail order to save time and money.
For more information, visit the CVS Caremark guest website
info.caremark.com/oe/sutterhealthplan to check drug costs,
find a pharmacy, view the formulary and learn more about mail order options.
If you have questions about your coverage options, our customer service
team is here to help.
Call 855-315-5800.
Monday through Friday, 8 a.m. to 7 p.m.
include holidays.
You can also reach us by email at shpcustomerservice@sutterhealth.org