Information About COVID-19 Coverage, Cost and Access to Care

Sutter Health Plus covers medically necessary COVID-19 screening and testing (including antibody testing) for our members. We encourage you to contact your primary care physician (PCP) to see if he or she recommends screening or testing for you at this time.

If your test is not medically necessary and you do not meet the DMHC definition of an essential worker, you may be financially responsible for the test.

The DMHC defines essential workers as individuals who:

• Work at correctional facilities, congregate care facilities, or provide care in the home of an elderly person or person with a disability
• Work in job sectors where there is regular in-person contact with the public or people who may have been exposed to COVID-19 such as: health care, emergency services, public transportation, food service, or education
• Work in job sectors where there is frequent interaction with the public and six feet of space from other workers cannot be regularly maintained, such as retail, manufacturing, agriculture, or food manufacturing

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 Centers for Disease Control and Prevention (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 to 7:00 pm, Monday through Friday.

Sutter Health Plus offers telehealth services. We encourage members to schedule video or telephonic visits to help minimize spread of infection. You can access telehealth services by using:

• Video Visits with licensed providers for treatment and advice. Video Visits are available 8:00 am to 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.

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

For members that have symptoms or known or suspected exposure, there is no member cost share for medically necessary services related to COVID-19 screening and testing (including antibody testing). 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 members who are essential workers but do not have symptoms and known or suspected exposure, the standard member cost share applies.

For members who are not essential workers and do not have symptoms and known or suspected exposure, the member may be responsible for the full cost.

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 prescribed to manage symptoms of COVID-19, such as cough.

There are currently no prescription drugs approved by the Federal Drug Administration (FDA) for the treatment of COVID-19.

No. Sutter Health Plus is waiving the standard member cost shares associated with telehealth for covered services in an effort to minimize spread of infection. This is applicable to telehealth services provided to our members between April 1, 2020 and December 31, 2020.

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 1-855-315-5800. Member Services is available 8:00 a.m. to 7:00 p.m., 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 to 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 to 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 can help minimize the spread of infection and ease pressure on provider offices, emergency rooms, and urgent care centers. Video visits are available 8 a.m. to 8 p.m. 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.