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

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. Sutter Health Plus understands that COVID-19 vaccine supplies are limited. We want to assure you that, 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.

The timeline for distribution to the general public depends on vaccine supply and the guidance of public health officials. According to the California Department of Public Health (CDPH) COVID-19 Vaccination Plan, the initial supplies are designated for critical populations. These populations are outlined on the California COVID-19 website.

Sutter Health Plus understands that you may be eager to get a COVID-19 vaccine. Our providers cannot administer COVID-19 vaccines outside of the guidelines established by the CDPH vaccine distribution process.

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.

Sutter Health Plus wants to remind our members that COVID-19 vaccine supplies are limited. Even if a member is currently eligible to receive a COVID-19 vaccine at this time, it may be difficult to find an appointment to get the vaccine administered.

The following resources may provide more information about COVID-19 vaccine appointment availability:

• 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 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 1-855-315-5800. Member Services is available 8 a.m. to 7 p.m., Monday through Friday.

You can view more information in the Sutter Health COVID-19 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 primary care physician (PCP) to see if he or she recommends 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 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 covers telehealth visits. 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.

Sutter Health Plus covers telehealth services offered by our plan partner, U.S. Behavioral Health Plan of 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 is waiving 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 is waiving 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 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.