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 are 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 24/7, 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
center.
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 OB/GYN 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 carelonbh.com/sutterhealthplan
and select Find Providers at the top of the page.
These services are provided through Carelon Behavioral
Health of California, Inc.
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 13 through 22.
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're 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 by using CVS Caremark
Retail-90 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 24/7 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 a personalized health assessment (PHA),
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 to 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, the 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
(H.S.A.)-compatible high-deductible health plan
(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.
1.
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 the costs for covered services
until your deductible is met.
2.
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.
3.
Lastly, there's the Family Deductible.
This applies to all members within a family.
The deductible is met when any 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) enrolled in an HDHP 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 $3,4300
on healthcare services, but they still have $700 dollars to spend
until they meet the family deductible of $5,000.
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 100% of his hospitalization
until the remaining $700 of the family deductible is met.
The family deductible will only be met when the family spends
$5,000 on healthcare services as a whole.
Please take a few minutes to review the following slides
with your specific benefit plan information.
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 from 8:00 a.m.
to 7:00 p.m., including holidays.
You can also email the team at shpcustomerservi
ce@sutterhealth.org.
We can't wait to welcome you, or welcome you back,
to Sutter Health Plan!
