---
title: "Member forms and resources | Sutter Health Plan"
description: "Access Sutter Health Plan's essential forms and resources for members. Download enrollment applications, claim forms, grievance documents and more."
url: "https://www.sutterhealthplan.org/members/forms-resources"
---

1.  [Home](https://www.sutterhealthplan.org/) /
2.  [Members](https://www.sutterhealthplan.org/members) /
3.  Forms and resources

# Forms and resources for members

Get all the essential member forms and resources you need. 

**Section menu**

-   [Members](https://www.sutterhealthplan.org/members "Members")
    -   [Member portal](https://www.sutterhealthplan.org/members/portal "Member portal")
        
    -   [Forms and resources](https://www.sutterhealthplan.org/members/forms-resources "Forms and resources")
        
    -   [Individual and Family Plan Coverage](https://www.sutterhealthplan.org/members/enroll "Individual and Family Plan Coverage")
        
    -   [Health and wellness](https://www.sutterhealthplan.org/members/health-wellness "Health and wellness")
        
    -   [Pharmacy benefits](https://www.sutterhealthplan.org/members/pharmacy-benefits "Pharmacy benefits")
        
    -   [Plan partners](https://www.sutterhealthplan.org/members/plan-partners "Plan partners")
        -   [Acupuncture and chiropractic benefits](https://www.sutterhealthplan.org/members/plan-partners/acupuncture-chiropractic "Acupuncture and chiropractic benefits")
            
        -   [Behavioral health benefits](https://www.sutterhealthplan.org/members/plan-partners/behavioral-health-benefits "Behavioral health benefits")
            
        -   [Dental benefits](https://www.sutterhealthplan.org/members/plan-partners/dental "Dental benefits")
            
        -   [Vision benefits](https://www.sutterhealthplan.org/members/plan-partners/vision "Vision benefits")
            

-   [Members](https://www.sutterhealthplan.org/members "Members")
    -   [Member portal](https://www.sutterhealthplan.org/members/portal "Member portal")
        
    -   [Forms and resources](https://www.sutterhealthplan.org/members/forms-resources "Forms and resources")
        
    -   [Individual and Family Plan Coverage](https://www.sutterhealthplan.org/members/enroll "Individual and Family Plan Coverage")
        
    -   [Health and wellness](https://www.sutterhealthplan.org/members/health-wellness "Health and wellness")
        
    -   [Pharmacy benefits](https://www.sutterhealthplan.org/members/pharmacy-benefits "Pharmacy benefits")
        
    -   [Plan partners](https://www.sutterhealthplan.org/members/plan-partners "Plan partners")
        -   [Acupuncture and chiropractic benefits](https://www.sutterhealthplan.org/members/plan-partners/acupuncture-chiropractic "Acupuncture and chiropractic benefits")
            
        -   [Behavioral health benefits](https://www.sutterhealthplan.org/members/plan-partners/behavioral-health-benefits "Behavioral health benefits")
            
        -   [Dental benefits](https://www.sutterhealthplan.org/members/plan-partners/dental "Dental benefits")
            
        -   [Vision benefits](https://www.sutterhealthplan.org/members/plan-partners/vision "Vision benefits")
            

Member forms

[2027 Individual and Family Plan Enrollment Form (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/2027-ifp-enrollment-form.pdf)

[2026 Individual and Family Plan Enrollment Form (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/m-mk-25-068r-2026-ifp-enrollment-form.pdf)

[2025 Individual and Family Plan Application and Enrollment Form (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/m-mk-24-149r-2025-ifp-enrollment-form.pdf)

[Authorization for Use and Disclosure of Protected Health Information (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/shp-authorization-use-disclosure-phi.pdf)

[Coordination of Benefits Form (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/shp-coordination-of-benefits.pdf)

[Continuity of Care Request Form and Guidelines (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/shp-continuity-of-care-request-form.pdf)

[Disabled Dependent Certification (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/disabled-dependent-form.pdf)

[DMHC Grievance Form for Cancellations, Rescissions and Nonrenewals (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/cancellation-review-DMHC-request-form.pdf)

[Termination Form for Cal COBRA and Individual and Family Plans (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/cal-cobra-or--individual-aand-family-plans-termination-form.pdf)

[Member Claim Form (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/shp-member-claim-form.pdf)

[Pharmacy Mail Order Form (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/cvs-caremark-mail-order-form.pdf)

[Prescription Drug Coupon Adjustment Request (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/prescription-drug-adjustment-request.pdf)

[Prescription Reimbursement Claim Form (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/rx-reimbursement-claim.pdf)

[Request for Confidential Communication Form (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/confidential-communications-request-form.pdf)

[Sutter Health Plan Grievance Form (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/shp-grievance-form.pdf)

Important forms information

**Continuity of Care**

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)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/shp-continuity-of-care-request-form.pdf).

**DMHC Grievance form for cancellations, rescissions and nonrenewals**

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)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/cancellation-review-DMHC-request-form.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)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/shp-right-to-submit-grievance.pdf).

**Sutter Health Plan grievance form**

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).](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/shp-grievance-form.pdf "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](tel:855-315-5800) or TTY 855-830-3500.
-   Submit a grievance through your [Member Portal](https://shplus.org/memberportal).

**World Professional Association for Transgender Health (WPATH)**

Sutter Health Plan promotes excellence in transgender and gender-diverse healthcare. We follow the current version of the [WPATH Standards of Care (SOC)](https://www.wpath.org/soc8). Visit the WPATH website to access the Standards of Care (SOC) and materials that explain how they guide medical necessity determinations.

## Nurse Advice Line

Enjoy 24/7 access to registered nurses who can answer your medical questions and help determine the level of care you may need.

[Call 855-836-3500](tel:+1-855-836-3500)

Member resources

[2027 Individual and Family Plan Rate Guide (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/2027-ifp-rate-guide.pdf)

[2026 Individual and Family Plan Rate Guide (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/pm-mk-25-019-q1-2026-ifp-rate-guide.pdf)

[2025 Individual and Family Plan Rate Guide (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/2025-ifp-rate-guide.pdf)

[COVID-19 Coverage and Cost Information](https://www.sutterhealthplan.org/about-us/covid-19)

[Glossary of Terms](https://www.sutterhealthplan.org/members/glossary)

[Member Rights and Responsibilities (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/shp-member-rights-and-responsibilities.pdf)

[Opt-Out of Covered CA Sharing (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/m-cc-24-155r_opt_out_of_covered_ca_sharing_form.pdf)

[Premium Payment Options (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/shp-premium-payment-options.pdf)

[Rights and Protections Against Surprise Medical Bills (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealth/Files/billing-insurance/costs-and-charges/no-surprises-act/protections-against-surprise-medical-bills.pdf)

[Right to Submit a Grievance, Rescission or Nonrenewal of Your Plan Enrollment, Subscription or Contract (PDF)](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/PDF/shp-right-to-submit-grievance.pdf)

[Timely Access Standards](https://www.sutterhealthplan.org/about-us/timely-access-standards)

![couple-laughing-in-kitchen-cutting-vegetables](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/Images/couple-laughing-in-kitchen-cutting-vegetables.jpg?h=600&iar=0&w=800)

## Health and Wellness

Explore resources to support your health and wellness, from expert insights to tools that help you stay on track.

[Explore wellness resources](https://www.sutterhealthplan.org/members/health-wellness)

![couple-laughing-in-kitchen-cutting-vegetables](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealthPlan/Images/couple-laughing-in-kitchen-cutting-vegetables.jpg?h=600&iar=0&w=800)

We’re here to help

Customer Service can help answer your questions about benefits, enrollment, billing, 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 shpcustomerservice@sutterhealth.org with details about how we can help you.

[Email now](mailto:shpcustomerservice@sutterhealth.org)

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