Schools Insurance Group Open Enrollment

Your health coverage should work as hard as you do.
Whether you're reviewing your current plan or exploring something new, let's take a closer
look at why we might be the right plan for you.
Sutter Health Plan offers plans that provide you with the comprehensive healthcare coverage
you want. Our network of award-winning providers
includes many of Sutter Health's doctors, clinicians, and hospitals.
That means you'll have the care and coverage you need when and where you need it.
With an HMO health plan, you and your covered dependents choose a primary care physician,
also known as a PCP, to manage and coordinate your healthcare needs.
Your PCP will refer you to specialty care, X-rays, lab work, and other services as needed.
Keep in mind that when you choose your PCP, you're also selecting their medical group and
care team, who work together to help you and your family stay healthy.

Need help finding a PCP?
Use our Find a Provider tool to search by name, specialty, or location and filter by medical
group, gender, language, and whether providers are accepting new patients.
Some PCPs also offer a Book an Appointment feature, so you can schedule directly from
their profile. We know life moves fast, and we're here to
keep pace with you. That's why we offer convenient care options
like video visits, Sutter Walk-In Care, and urgent care.
Booking a video visit directly with your PCP is simple through My Health Online, or MHO,
Sutter's secure patient portal.
Many PCPs offer video visits for routine to complex healthcare needs.
And if your PCP doesn't offer video visits, you still have options.
You can use MHO to connect with another Sutter clinician for minor issues or join the virtual
queue for an on-demand video visit available twenty-four/seven with no appointment needed.

If you need care soon but can't get in with your PCP, Sutter Walk-In Care offers a
convenient option for everyday health needs with locations available in the greater
Sacramento area.
And depending on your plan, your cost share may even be lower than a PCP visit.
When you need care right now, but it's not an emergency, we make sure you're covered.
Within our service area, you can use any in-network urgent care.
If you're out of our service area, you can access urgent care wherever you are.
Dependents outside the service area can access urgent care too.
For ongoing or routine care, they'll need to see their PCP or a provider within their
assigned medical group in the service area.
In an emergency, you can access emergency care from any facility in or out of the Sutter
Health Plan network without a referral.
Let's go over some of your benefits and how to use them when accessing care.
While you can always schedule directly with your PCP, some services may require a referral
and prior authorization from your medical group.
Your PCP will refer you and request authorization when necessary.
However, there are certain services where you can schedule care directly, including
obstetrical or routine gynecological services with an OBGYN in your medical group, mental
health or substance use disorder services with in-network providers, and if your employer
offers additional acupuncture or chiropractic services, you won't need a referral.
Your mental health is just as important as your physical health.
That's why finding in-network care for mental health and substance use
treatment should be simple.
Go to carillonbh.com/sutterhealthplan and select Find Providers at the top of the page.
These services are provided through Carillon Behavioral Health of California Incorporated.
Teens and young adults also have resources available designed specifically for them.
Scout by Sutter Health is a personalized app-based online program for individuals ages
thirteen to twenty-two.
Scout helps build resilience and offers engaging ways to manage their mental health at
no cost.
It's also available for their parents, caregivers, and loved ones, so they can better
understand and support them.
We are here to make filling your prescriptions easy with CVS Caremark.
You can either pick up your prescriptions at most retail chains where you may already shop,
or you may be able to save time and money using CVS Caremark's Retail ninety or CVS
Caremark Mail Service Pharmacy to fill your maintenance medications.
Your benefits include coverage for routine health exams and other preventive care
services designed to detect and prevent illnesses early, available at no cost to you.
Plus, you also have coverage for preventive prescriptions, including birth control and
smoking cessation products.

When you're unsure if you need to see a doctor, we make it easy.
Our twenty-four/seven nurse advice line with experienced registered nurses is always
available to help you determine the best care for you.
Your health journey is unique, and we're here to support you every step of the way.
With tools like personalized health assessments, action plan modules, and access
to our health coaching program, you'll have the resources and guidance to take control of
your health and make lasting changes that help you achieve your wellness goals.
If you're new to Sutter Health Plan, you and your covered dependents will receive your
member ID cards in the mail, along with a welcome guide that highlights your benefits
and explains how to access care.
Once you receive your member ID card, be sure to schedule a new patient appointment with
your PCP to establish care.
Also, look for a welcome email to help you navigate your care and coverage.
Need to review your benefits, answer questions, or need assistance to schedule your new
patient appointment with your PCP?
Our customer service team is here to help you get the care you need without the extra steps.
If you're a renewing member, we'll mail you a new member ID card and a flyer with reminders
on where and how to access your benefit documents, a member reference guide, pharmacy
information, and more.

Your member ID card lists your PCP and medical group, deductibles, the
nurse advice line, and more.
You'll need to show it when accessing care or picking up a prescription.If you need a
replacement card for any reason, you can request one anytime through your member portal.
Register for the Sutter Health Plan member portal for a convenient way to view your plan
documents, check your copays and claims, request an ID card, and even change your PCP.
With MHO, managing your care is right at your fingertips.
You can easily schedule appointments, check test results, and communicate
with your care team.
Plus, features like contactless check-ins and text reminders help you stay on top of your
health with ease. You can choose between two types of health
plans, a traditional health plan or a health savings account compatible high deductible
health plan, also known as an HDHP.
Traditional plans typically offer set copays and may have a coinsurance where you pay a
percentage of the cost for covered services.
Many traditional plans may also have a deductible, meaning you'll have to pay for
covered services until the deductible is met.
Once you've met the deductible, you'll be responsible for applicable cost shares for all
covered services until you reach the out-of-pocket maximum.
If you choose an HDHP, you'll pay the full cost for all covered services until you meet
your deductible.
But once you reach your deductible, you'll only pay the applicable cost share for covered
services until your out-of-pocket maximum is met.
We'll review the three types of deductibles in a moment.
Whether you choose a traditional plan or an HDHP with Sutter Health Plan, preventive
services are covered at no cost share and are not subject to a deductible.

Let's review the three types of deductibles for HDHPs.
The first one is an individual or self-only deductible.
This applies if you enroll in a plan for yourself only, and you pay a hundred percent
of the costs for covered services until your deductible is met.
The second type of deductible 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.
Finally, there's the family deductible.
This applies to all members within a family.
The deductible is met when one family member's or combination of family members' costs for
covered services reaches the family deductible.
Once it's met, no one in the family pays toward the deductible anymore, 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 healthcare needs and budget.
Let's see what this might look like.
Here's an example of a family of four, Robert, Grace, Tyler, and Ava.
They're enrolled in an HDHP with an individual family member deductible of thirty-four
hundred dollars and a family deductible of five thousand dollars.
In March, Robert paid four hundred dollars for diagnostic services.
Tyler paid three hundred for labs, and Ava paid two hundred for physician fees.
Grace spent thirty-four hundred dollars on her hand surgery and has met the individual family
member deductible of thirty-four hundred on healthcare services.
But they still have seven hundred dollars to spend until they meet the family deductible of
five thousand dollars.

In November, both Grace and Robert were hospitalized due to the flu.
Since Grace has already met her individual deductible, she is only responsible for the
applicable cost shares, such as copays 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 a hundred percent of his hospitalization until
the remaining seven hundred dollars of the family deductible is met.
The family deductible will only be met when the family spends five thousand dollars on
healthcare services as a whole.

If you have any questions about your coverage or need help selecting a PCP, please contact our
customer service team.
They're available Monday through Friday, eight AM to seven PM, including holidays.
You can also email the team at shpcustomerservice@sutterhealth.org.
We can't wait to welcome you or welcome you back to Sutter Health Plan.