On average, your health plan pays 60 percent of your medical expenses, and you pay 40 percent.
On average, your health plan pays 70 percent of your medical expenses, and you pay 30 percent.
On average, your health plan pays 80 percent of your medical expenses, and you pay 20 percent.
On average, your health plan pays 90 percent of your medical expenses, and you pay 10 percent.
Based on income - available only at CoveredCa.
SUTTER HEALTH is not offered via CoveredCA
If you are under 30, you may be able to buy an additional health insurance plan option called minimum coverage plan.
Selecting the right health plan is a big decision—we’re here to help.
Open Enrollment is your opportunity to review and choose the coverage that fits your needs. From Nov. 1, 2024, through Jan. 31, 2025, you can select a plan for coverage starting in 2025.
Please reach out to us and we can provide a side by side personalized rate guide.
If you would like to apply for one of the Sutter Health Plans, we can help you complete and submit your application.
The Sutter Health network in Northern California offers access to a diverse and expansive group of doctors and healthcare providers, ensuring patients can receive high-quality, coordinated care across various specialties and locations. Covering urban, suburban, and rural areas, the network includes over 5,000 primary care physicians and specialists, along with 24 hospitals and more than 200 clinics. This extensive reach allows patients to conveniently access preventive, routine, and specialized medical services close to home.
Sutter Health physicians collaborate across disciplines, enabling a comprehensive approach to patient health. The network includes providers within Sutter’s Medical Foundations, such as Palo Alto Medical Foundation, Sutter Medical Foundation, and Sutter East Bay Medical Foundation, creating a seamless experience across different care settings. With access to innovative treatments, advanced technology, and a commitment to compassionate care, Sutter Health’s network of doctors in Northern California aims to meet the diverse healthcare needs of the communities it serves.
Search Sutter Health Plus network of doctors, hospitals and other healthcare providers by location, specialty and more!
Get the care you need when you need it. Choose from video visits, Sutter Walk-In Care, and urgent care.
Acupuncture and Chiropractic Benefits are provided by ACN Group of California (800) 428-6337. Optional acupuncture or chiropractic (or both) services are available for small and large group members when elected by the employer.
Refer to the Sutter Health Plus Evidence of Coverage and Disclosure Form for information regarding your acupuncture or chiropractic benefits.
External links to the ACN Group of California, OptumHealth website are provided for your convenience. Please select the Sutter Health Plus plan when searching for providers.
On this site you can find information on finding a provider and preventive health education.
Behavioral Health benefits are provided by U.S. Behavioral Health Plan, California (USBHPC) (855) 202-0984. Members have access to mental health and substance use disorder (MH/SUD) treatment services through USBHPC. Members do not need a referral from their primary care physician and can search for providers directly through USBHPC.
USBHPC uses clinical criteria based on sound clinical evidence to make coverage decisions for behavioral health services. Members can access the clinical criteria and training resources for its use on the USBHPC website. Select Clinical Criteria under the Resources heading at the bottom of the page. Members can also call USBHPC at (855) 202-0984 to request the actual criteria used to make certain coverage decisions.
Refer to the Sutter Health Plus Evidence of Coverage and Disclosure Form for additional information regarding USBHPC and your MH/SUD benefits.
Disclaimer from Sutter Health::
When you join Sutter Health Plus, you will choose a primary care physician (PCP). Your PCP provides most of your primary health care and coordinates care you may need from other providers. Your PCP will refer you as needed to providers for specialty care, X-ray, laboratory and other medical services. If you do not choose a PCP, we will assign one to you within a 15 mile radius from your residential address. When you choose your PCP, you are also selecting a medical group.
Many covered services, including visits to a specialist, require a referral or prior authorization from your medical group. Your PCP will make referrals to specialists within the same medical group. If you know you need specialty care and have a specific specialist in mind, check the directory to see what medical group the specialist is in. In certain situations, a specialist in the Sutter Health Plus network that is outside your medical group may also be available by referral. Make sure you choose your PCP within that medical group.
You can access emergency and urgent care when you need it from any facility, in or out of the Sutter Health Plus network, without a referral.
Please call Member Services weekdays, 8:00 am – 7:00 pm at (855) 315-5800 or contact us with any questions regarding the provider locator results.
View information on the Sutter Health Plus provider verification process.
If you would like to request a printed copy of the provider directory or report an inaccuracy in the data, please call Member Services weekdays, 8:00 am – 7:00 pm at (855) 315-5800, contact us or email SHPMemberServices@sutterhealth.org.
To request a printed copy of the provider directory by mail, please mail your request to:
Sutter Health Plus
Attn: Provider Directory Request
P.O. Box 160307
Sacramento, CA 95833
Please be advised, you do not need to be a Sutter Health Plus member to request a provider directory or report an inaccuracy in the data.
PLEASE NOTE: Some hospitals and other providers do not provide one or more of the following services that may be covered under your plan contract and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you enroll. Call your prospective doctor, medical group, independent practice association or clinic, or call Member Services weekdays, 8:00 am – 7:00 pm at (855) 315-5800 to ensure that you can obtain the health care services that you need.
Sutter Health Plus offers access to reputable medical facilities throughout California:
Here is a list of Sutter Heatlh hospitals in California:
Northern California:
ALTA BATES SUMMIT MEDICAL CENTER - ALTA BATES CAMPUS
2450 Ashby Ave
Berkeley, 94705
ALTA BATES SUMMIT MEDICAL CENTER - SUMMIT CAMPUS
350 Hawthorne Ave
Oakland, 94609
CALIFORNIA PACIFIC MEDICAL CENTER - DAVIES CAMPUS
45 Castro St
San Francisco, 94114
CALIFORNIA PACIFIC MEDICAL CENTER - MISSION BERNAL CAMPUS AND ORTHOPEDIC INSTITUTE
3555 Cesar Chavez St
San Francisco, 94110
CALIFORNIA PACIFIC MEDICAL CENTER - Pacific Height Outpatient Center
2333 Buchanan St
San Francisco, 94115
CALIFORNIA PACIFIC MEDICAL CENTER - VAN NESS CAMPUS
1101 Van Ness Ave
San Francisco, 94109
CHILDREN'S HOSPITAL OF OAKLAND
747 52Nd St
Oakland, 94609
DAMERON HOSPITAL
525 W Acacia
Stockton, 95203
DOMINICAN HOSPITAL
1555 Soquel Dr
Santa Cruz, 95065
EDEN MEDICAL CENTER
20103 Lake Chabot Rd
Castro Valley, 94546
EL CAMINO HOSPITAL
2500 Grant Rd
Mountain View, 94040
EL CAMINO HOSPITAL LOS GATOS
815 Pollard Rd
Los Gatos, 95032
LUCILE PACKARD CHILDREN'S HOSPITAL
725 Welch Rd
Palo Alto, 94304
MEMORIAL MEDICAL CENTER MODESTO
1700 Coffee Rd
Modesto, 95355
MILLS-PENINSULA MEDICAL CENTER
1501 Trousdale Dr
Burlingame, 94010
NOVATO COMMUNITY HOSPITAL
180 Rowland Way
Novato, 94945
SEQUOIA HOSPITAL
170 Alameda De Las Pulgas
Redwood City, 94062
ST. JOSEPH'S MEDICAL CENTER
1800 N California St
Stockton, 95204
STANFORD HEALTH CARE TRI-VALLEY
5555 W Las Positas Blvd
Pleasanton, 94588
SUTTER AUBURN FAITH HOSPITAL
11815 Education St
Auburn, 95602
SUTTER DAVIS HOSPITAL
2000 Sutter Pl
Davis, 95616
SUTTER DELTA MEDICAL CENTER
3901 Lone Tree Way
Antioch, 94509
SUTTER MATERNITY & SURGERY CENTER
2900 Chanticleer Ave
Santa Cruz, 95065
SUTTER MEDICAL CENTER SACRAMENTO
2825 Capitol Ave
Sacramento, 95816
SUTTER ROSEVILLE MEDICAL CENTER
One Medical Plaza Dr
Roseville, 95661
SUTTER SANTA ROSA REGIONAL HOSPITAL
30 Mark West Springs Rd
Santa Rosa, 95403
SUTTER SOLANO MEDICAL CENTER
300 Hospital Dr
Vallejo, 94589
SUTTER TRACY COMMUNITY HOSPITAL
1420 North Tracy Blvd
Tracy, 95376
WATSONVILLE COMMUNITY HOSPITAL
75 Nielson St
Watsonville, 95076
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Federal tax reform legislation was signed into law on December 22, 2017 and contains a provision that eliminates the individual mandate penalty starting in year 2019. The penalty is back in California for year 2020 read more on our blog
At Insurance Center Helpline Inc. we’re dedicated to providing you with the best healthcare options available, and we’re proud to offer Sutter Health HMO individual insurance plans. With a focus on high-quality, affordable healthcare, Sutter Health HMO is designed to meet your needs at every stage of life, giving you peace of mind and access to exceptional care across Northern California.
1. Comprehensive Provider Network
Sutter Health HMO offers a robust network of doctors, hospitals, and specialists, ensuring you have access to excellent medical care close to home. From preventive services to specialist visits, you’ll find the care you need within Sutter’s extensive network.
2. Affordable and Predictable Costs
Sutter Health HMO plans provide predictable healthcare costs that help you plan your budget more effectively.
3. Personalized, Coordinated Care
Sutter Health HMO members receive coordinated care across a network of skilled healthcare providers. Your primary care physician works with you to manage referrals and ensure you receive the right care at the right time.
4. Preventive Services at No Cost
As a Sutter Health HMO member, you’ll have access to preventive care services, such as annual check-ups, screenings, and vaccinations, at no additional cost. Preventive care is essential for maintaining good health and catching issues early.
Whether you’re self-employed, a freelancer, or simply looking for individual health coverage, Sutter Health HMO plans offer high-quality, affordable healthcare for individuals and families alike. With access to primary and specialty care, mental health services, and more, you can rest assured that you’re in good hands.
Let us help you find the Sutter Health HMO plan that’s right for you! Our licensed agents are here to answer your questions, guide you through plan options, and help you navigate enrollment with ease. Contact [Agency Name] today to get started on your journey to better healthcare with Sutter Health HMO.
Health insurance plans in the United States are categorized into metal tiers, which are based on the level of coverage and cost-sharing they offer. These metal tiers include:
Bronze: Bronze plans typically have the lowest monthly premiums but also have the highest out-of-pocket costs. These plans cover an average of 60% of healthcare costs, leaving the insured responsible for the remaining 40%.
Silver: Silver plans typically have slightly higher monthly premiums than Bronze plans, but also have lower out-of-pocket costs. These plans cover an average of 70% of healthcare costs, leaving the insured responsible for the remaining 30%.
Gold: Gold plans typically have higher monthly premiums than Silver plans, but also have lower out-of-pocket costs. These plans cover an average of 80% of healthcare costs, leaving the insured responsible for the remaining 20%.
Platinum: Platinum plans typically have the highest monthly premiums but also have the lowest out-of-pocket costs. These plans cover an average of 90% of healthcare costs, leaving the insured responsible for the remaining 10%.
In addition to the metal tiers, some insurance providers may also offer Catastrophic plans, which are available to individuals under the age of 30 or those who qualify for a hardship exemption. These plans have very low monthly premiums but also have high deductibles and out-of-pocket costs.
It's important to note that the specific benefits and costs of each plan can vary depending on the insurance provider and the specific plan details. When selecting a health insurance plan, it's important to consider your individual healthcare needs and budget, and to carefully review plan details and compare options to ensure that you choose a plan that meets your needs.
What is the difference between an HMO health insurance and PPO?
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