Choosing a health plan is a big decision -- we understand.
That's why it's important to review your options.
So, let's take a closer look at why we might
be the right plan for you.
We're an HMO health plan that provides you
with the comprehensive healthcare coverage you want.
Our network includes over 8,000 providers and 28 hospitals
across 16 counties, including many of Sutter
Health's award-winning doctors, clinicians and hospitals.
This means you'll have the care and coverage you need for all
of life's ups and downs.
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?
We have an easy-to-use online provider locator tool where you
can find doctors accepting new patients near you by entering
your city or ZIP code and checking the "Accepting new
patients" box.
You can also search by specialty or facility type.
But don't worry; if you don't select a PCP when you enroll,
we'll assign one to you.
We know life can get busy.
That's why we offer convenient care options
like video visits, Sutter Walk-In Care and urgent care.
You can book a video visit with your PCP
through My Health Online (or MHO),
Sutter's patient portal, for most of your healthcare needs,
even complex issues.
If your PCP doesn't offer video visits --
you can still use MHO to see another Sutter clinician
virtually for minor health issues.
Sutter Walk-In Care is a convenient option
available in the Greater Sacramento
Area for everyday health needs.
And depending on your plan, your cost share
may even be lower than a PCP visit.
For those times when you need care right now,
we've got you covered.
If you're within our service area,
simply head to an in-network urgent care location.
And even if you find yourself outside the service area,
you can access any urgent care facility.
If you have a dependent who lives outside the service area
-- they're covered for urgent care, too!
However, for routine and follow-up 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.
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 and finding an in-network provider
for mental health or substance use disorders is easy.
Go to liveandworkwell.com and select
Find Care at the top of the page.
These services are provided through USBHPC, U.S. Behavioral
Health Plan, California.
Your USBHPC benefits also give members aged 13 and older access
to on-demand coping tools, meditations, mental wellness
support, self-care techniques, and more
through Self Care by AbleTo.
So, check it out!
Teens and young adults also have resources available --
designed specifically for them.
Scout by Sutter Health is a personalized
online and app-based 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 make getting your prescriptions
convenient with CVS Caremark.
You can either pick up your prescriptions
at retail chains like Raley's, Safeway and Costco,
to name a few, 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 preventive prescriptions,
including birth control and smoking cessation products.
You also have coverage for preventive care services,
including routine health and physical exams
and other preventive care services
that help detect and prevent illnesses.
These are available at no cost to you.
Sometimes, it can be difficult to determine
when you should see a doctor.
That's why we offer a 24/7 nurse advice line with registered
nurses to help guide you to the right level of care
for your needs.
You're not alone in your journey to better health.
We're here to support you with the resources you need!
You have access to a variety of health and wellness tools,
including our Health and Wellness Site
with a personal health assessment and action plan
modules, as well as our Health Coaching Program.
Are you new to Sutter Health Plan?
If you are, you and your covered dependents
will receive your member ID cards by mail
within a few days of enrolling.
You'll also receive a Welcome Book
full of information about your benefits and how to access care.
As soon as you receive your member ID card,
be sure to schedule a new patient
appointment with your PCP to establish care.
And to help you navigate your care and coverage,
our Customer Service team will call you
during your first month of coverage,
but if we don't have your number,
please feel free to call us.
We'd love the opportunity to review your benefits,
answer any questions you might have,
and help you schedule your new patient
appointment with your PCP if you haven't done so already.
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.
If you need a replacement card for any reason,
you can request one anytime through your member portal.
Register for the 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.
Scheduling appointments, viewing test results,
or communicating with your care team is easy with MHO.
Whether using the contactless check-in feature on the app
or signing up for appointment reminders through text,
MHO makes managing your health convenient.
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 offer set copays for many covered services
and may have a coinsurance where you
pay a percentage of the cost for some 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
100% of the out-of-pocket costs for all covered services
until you meet the deductible.
But once you reach the 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 the next slide.
Whether you choose a Traditional plan or a High Deductible Health
Plan, with Sutter Health Plan, preventive services
are covered at no cost share and you are not
subject to a deductible.
Let's review the three types of deductibles for High Deductible
Health Plans.
1.
The first one is an Individual or Self-Only Deductible.
This applies to individuals who enroll in a plan by themselves.
They will pay 100% of the costs for covered services
until their deductible is met.
2.
The second type of deductible is an Individual Family Member
Deductible.
This applies to each person within a family.
This means each family member pays
100% of the costs for covered services
until their individual family member deductible
or the entire family deductible is met, whichever comes first.
3.
Lastly, there is 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.
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 High Deductible Health Plan with
an individual family member deductible of $3,300
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 $3,300 on her hand surgery and has met
the individual family member deductible of $3,300.
Combined, the family spent $4,200 on healthcare services,
but they still have $800 dollars until they meet the family
deductible of $5,000.
In April, both Grace and Robert were hospitalized
because of 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 100% of his hospitalization
until the remaining $800 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 visit sutterhealthplan.org/contact
to reach us.
We hope to welcome you, or welcome you back,
to Sutter Health Plan!
