Members

No. Sutter Health Plan has a service area in which we offer healthcare coverage. Not all Sutter hospitals, physician organizations and other healthcare services are part of the Sutter Health Plan service area or network. Use the Find a Provider or Find a Location tool to search for participating providers in your area.

If enrolling in an individual and family plan, you must live or reside in the Sutter Health Plan service area to be eligible for coverage. If enrolling through your employer, you must live, reside or physically work in the Sutter Health Plan service area to qualify for coverage.

Yes, but only with a referral or prior authorization from your medical group.

Yes, all new members must select a PCP who coordinates their care and helps with everyday health needs. If you don’t choose one, we’ll assign one to you.

Yes, you can keep your current PCP as long as they’re in the Sutter Health Plan network and part of your medical group. Use the Provider Locator to find out if they’re in-network.

Yes, you can keep your current specialist if they’re part of the Sutter Health Plan network and are in the same medical group as your PCP. If you need specialty care and have a specific Sutter Health Plan specialist in mind, you’ll need to select a PCP in the same medical group as the specialist. You’ll also need to ask your new PCP for a referral to the specialist.

Use the Provider Locator to verify your specialist’s medical group. In some cases, your PCP may refer you to a specialist within the Sutter Health Plan network who’s outside your medical group.

You can find a PCP by using the Provider Locator.

Sutter Health Plan providers can typically access electronic health records (EHRs) from Kaiser Permanente, UC Davis Medical Group, UC San Francisco Health or Stanford Health. A fee may apply if you request these records for personal use.

If your previous medical group was Sutter Independent Physicians, Brown & Toland Physicians or another group, you must submit a Medical Records Request Form to your former physician to release your records. To request medical records, speak with your new Sutter Health Plan PCP.

Your dependent must select a PCP and medical group within the Sutter Health Plan service area. Urgent and emergency care outside the service area is covered, but your dependent must receive all follow-up care from their medical group.

You can change your PCP anytime through the Member Portal or by calling Customer Service at 855-315-5800.

Your Sutter Health Plan ID card lists your PCP, medical group, out-of-pocket deductibles, important contact information and more.

Sutter Health Plan mails member ID cards for each covered member (you and any dependents you have) a few days after you enroll.

Log in to your Member Portal to access your Benefits and Coverage Matrix (BCM), Evidence of Coverage and Disclosure Form (EOC) and Summary of Benefits and Coverage (SBC).