Yes. Sutter Health Plus covers COVID-19 vaccines in accordance with the requirements established by the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This includes any vaccines administered over more than one injection.

Yes. If you are currently eligible to get a COVID-19 vaccine, Sutter Health Plus will cover it even if you get it from an out-of-network provider. This coverage is in accordance with the requirements established by the CARES Act.

As of May 12, 2021, all individuals in California age 12 and older are eligible to get COVID-19 vaccines. You can find more COVID-19 vaccine information in the Sutter Health COVID-19 FAQs. You can also get additional information on the CDPH website or the CDC website.

The CDC recommends additional vaccine doses for individuals with moderately to severely compromised immune systems and who previously received the Pfizer-BioNTech’s COVID-19 vaccine (Pfizer) or Moderna vaccines.

The FDA and CDC have not yet approved or recommended additional doses for anyone who received the Janssen/J&J vaccine. In addition, an additional dose of the Pfizer or Moderna vaccines are not recommended or available to the general public at this time.

You can contact your primary care physician (PCP) to see if they recommend a third dose for you. Your provider is still not able to schedule COVID-19 vaccines. See the question below for vaccine appointment resources.

You can also find more information on additional COVID-19 vaccine doses in the Sutter Health COVID-19 Vaccine Resources or on the CDC website.

The CDC recommends that the following populations should get a Pfizer booster shot at least six months after they completed the initial vaccine series:

• People age 65 and older and residents in long-term care settings
• People ages 50 to 64 with underlying medical conditions or at increased risk of social inequities

According to the CDC, a booster dose also is available for the following populations, at least six months after they completed their initial vaccine series, based on their individual benefits and risks:

• People ages 18 to 49 years with underlying medical conditions
• People ages 18 to 64 years who are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting

The FDA and CDC have not yet approved or recommended booster shots for the Moderna or Janssen/J&J COVID-19 vaccines.

You can contact your PCP to see if they recommend a booster shot for you. Your provider is still not able to schedule COVID-19 vaccines. See below for vaccine appointment resources.

You can also find more information on booster COVID-19 vaccine doses in the Sutter Health COVID-19 Vaccine Resources or on the CDC website.

Sutter Health Plus wants to remind our members that COVID-19 vaccine appointments are based on availability. The following resources may provide information about COVID-19 vaccine appointments:

• The Sutter Health COVID-19 Vaccine Resources
• Your local pharmacy
• The California COVID-19 website
• The California My Turn website

There is no member cost share for COVID-19 vaccines. This includes any vaccines administered over more than one injection. This cost share waiver is for the length of the public health emergency in accordance with state and federal regulations.

You can call Sutter Health Plus Member Services at (855) 315-5800. Member Services is available 8:00 am – 7:00 pm, Monday through Friday.

Yes, you can get a COVID-19 vaccine at home if you are getting home health services or otherwise homebound. You can schedule an in-home COVID-19 vaccine by:

• Visiting the California My Turn website and selecting the option for an in-home vaccine
• Calling the California COVID-19 Hotline at (833) 422-4255 and requesting an in-home vaccine

Yes, you can get help with transportation to a COVID-19 vaccination location if you are getting home health services, or are otherwise homebound, and do not want an in-home vaccine. You can request transportation to a COVID-19 vaccination location by:

• Visiting the California My Turn website and registering your need for transportation
• Calling the California COVID-19 Hotline at (833) 422-4255 and requesting an in-home vaccine

You can view more information in the Sutter Health FAQs. You can also get additional information on the CDPH website or the CDC website.

Sutter Health Plus covers medically necessary COVID-19 screening and testing (including antibody testing) for our members when ordered by a treating provider as part of an individual medical assessment. We encourage you to contact your PCP to see if they recommend screening or testing for you at this time.

Sutter Health Plus covers medically necessary treatment related to a diagnosis of COVID-19.

Sutter Health Plus does not require prior authorization at this time for services related to medically necessary COVID-19 screening, testing, or treatment.

We consider services medically necessary if you experience symptoms and meet CDC criteria for screening, testing, or treatment. We also defer to the clinical judgement of the treating provider to determine medical necessity.

Sutter Health Plus covers out-of-area urgent and emergent services for our members. Services related to COVID-19 are considered urgent at this time.

Sutter Health Plus understands that your prior authorization may have expired before you were able to use it due to COVID-19. We encourage you to contact your assigned medical group to determine if the original prior authorization will be honored or if you need a new prior authorization. Your assigned medical group is listed on the front of your Sutter Health Plus Member ID Card. You can find their phone number on your Sutter Health Plus Member Portal account, or call Sutter Health Plus Member Services at (855) 315-5800. Member Services is available 8:00 am – 7:00 pm, Monday through Friday.

Sutter Health Plus covers telehealth visits. We encourage members to schedule video or telephonic visits for your convenience. You can access telehealth services by using:

• Video Visits with licensed providers for treatment and advice. Video Visits are available 8:00 am – 8:00 pm every day from a smartphone, tablet or computer
• The Sutter Health Plus 24-Hour Nurse Advice line at (855) 836-3500.

You can also contact your PCP directly to discuss symptoms and additional telehealth options that might be available through their medical group.

Sutter Health Plus covers telehealth services offered by our plan partner, U.S. Behavioral Health Plan, California (USBHPC), for the treatment of mental health, behavioral health and substance use disorders. You can call USBHPC at (855) 202-0984 or go to their website to find a provider or set up an appointment.

There is no member cost share for COVID-19 screening and testing when done by a treating provider as part of an individual medical assessment in accordance with state and federal regulations.

This cost share waiver is for the length of the public health emergency in accordance with state and federal regulations. There is currently no end date because the public health emergency is ongoing.

For treatment related to a confirmed diagnosis of COVID-19 received after September 30, 2020, the standard member cost share applies.

There was no member cost share applied to medically necessary treatment related to a confirmed diagnosis of COVID-19 between February 4, 2020, and September 30, 2020.

Common services related to medically necessary COVID-19 screening and testing include, but are not limited to, primary care provider (PCP) office visits, urgent care visits, emergency department visits, telehealth visits, and lab tests.

Standard member cost shares apply to outpatient prescription drugs related to COVID-19.

Sutter Health Plus waived the standard member cost shares associated with telehealth for covered services between April 1, 2020 and December 31, 2020.

Effective January 1, 2021, standard member cost shares apply to telehealth for covered services.

Sutter Health Plus waived the standard member cost shares associated with telehealth for covered behavioral health services between April 1, 2020 and December 31, 2020.

Effective January 1, 2021, standard member cost shares apply to telehealth for covered services.

Yes. Sutter Health Plus notified medical groups of the no member cost share requirement for services related to COVID-19 screening and testing on March 11, 2020. Sutter Health Plus notified medical groups of the no member cost share requirement for telehealth services and COVID-19 treatment on April 23, 2020.

You can call Sutter Health Plus Member Services at (855) 315-5800. Member Services is available 8:00 am to 7:00 pm, Monday through Friday.

We recommend contacting your PCP to ask if COVID-19 screening or testing is needed based on your personal circumstances. If your PCP recommends COVID-19 screening or testing, they will be able to help direct you to a location that can provide you services. Working with your PCP to get testing at an in-network location helps your doctor manage your care more effectively.

If you need more help, you can call Sutter Health Plus Member Services at (855) 315-5800. Member Services is available 8:00 am – 7:00 pm, Monday through Friday.

You can access telehealth services by using:

• Video visits with licensed providers for treatment and advice. Video visits are available 8:00 am – 8:00 pm every day from a smartphone, tablet or computer.
• The Sutter Health Plus 24-Hour Nurse Advice line at (855) 836-3500.

You can also contact your PCP directly to discuss symptoms and additional telehealth options that might be available through their medical group.

You can call USBHPC at (855) 202-0984 or go to their website to find a provider or set up an appointment.

USBHPC offers resources to help manage increased stress and anxiety due to COVID-19 on their website. You can also call USBHPC’s toll-free COVID-19 help line at (866) 342-6892.

You can call Sutter Health Plus Member Services at (855) 315-5800. Member Services is available 8:00 am – 7:00 pm, Monday through Friday.

You should call your PCP or the Sutter Health Plus 24-Hour Nurse Advice Line for help with clinical questions. You can call Sutter Health Plus 24-Hour Nurse Advice Line at (855) 836-3500.

You also have access to video visits with licensed providers for treatment and advice. Video visits are convenient and ease pressure on provider offices, emergency rooms, and urgent care centers. Video visits are available 8:00 am – 8:00 pm every day from a smartphone, tablet or computer.

You can view more information in the Sutter Health FAQs. You can also get additional information on the CDC website.