- Make sure you understand what services are covered by Sutter Health Plus while you’re away from home.
- Check your Evidence of Coverage and Disclosure Form (EOC) for specifics on what to do in case of an emergency while you’re away.
- Register for the Sutter Health Plus Member Portal; you can access your benefits, copays, member identification (ID) cards and more from your computer, tablet or smartphone.
- Remember to pack your member ID card, which contains important contact information.
- Make sure your preventive immunizations are up-to-date, including your annual flu shot.
- If you’re leaving the country, talk to your doctor, in advance, about vaccinations or drugs specific to the region you’re visiting; vaccination and drugs needed for travel may not be covered by Sutter Health Plus. Review your EOC for details.
- Learn about travel alerts and warnings, safety, security, and healthcare through the U.S. Department of State.
- If you have an ongoing medical condition, visit your doctor.
- Refill your eligible prescriptions to have enough to last while you’re away.
- Find and save the local 911 equivalent phone number.
Things to Do Before Your Trip
If You Need Emergency or Urgent Care During Your Trip
- If you have a medical emergency or need urgent care, go to the nearest hospital or medical facility that can give you the care you need; you don’t need approval from Sutter Health Plus to get emergency or urgent care.
- If you are admitted to an out-of-network hospital, after your treating physician determines you are medically stable, contact Sutter Health Plus Member Services at (855) 315-5800 as soon as reasonably possible to request authorization for any post-stabilization care you may need.
- Sutter Health Plus determines if you should receive care from the out-of-network provider, or arranges to have another designated provider care for you while you’re away.
- If you don’t notify Sutter Health Plus as soon as reasonably possible, we may not cover services you receive after transfer to a network provider would have been possible.
There are several ways to get your prescription while you are away from home:
- Request a vacation override, allowing you to pick up your prescription drug early (up to a 90-day supply) by calling CVS Caremark® at (844) 740-0635; members are eligible for one vacation override per prescription within any six-month period.
- If you have valid refills left on your prescription, transfer your prescription from your local pharmacy to an in-network pharmacy for pick-up (you can transfer certain drugs only once).
- If you have a new prescription, fill it at any network pharmacy. For a list of network pharmacies, search Find a Pharmacy at CVS Caremark.
- If you use mail order, get up to a 100-day supply, as your benefit plan allows, for the same copay as a two-month retail supply; sign up with CVS Caremark Mail Service Pharmacy at (844) 740-0635 or visit CVS Caremark. Mail order does not apply to specialty drugs.
How to File a Claim After Your Trip
- If you received emergency or urgent care from an out-of-network provider and need to file a claim for out-of-pocket costs, you must file a claim for reimbursement.
- For medical services, complete a Member Claim Form located on the Sutter Health Plus Member Portal or you can download a PDF version. Include any bills and receipts from the provider.
- If you paid out-of-pocket for a prescription drug at a retail pharmacy, submit a claim at CVS Caremark.
- Sutter Health Plus will send you a written decision within 30 days after we receive the claim from you or the out-of-network provider, unless we notify you within that initial 30 days that we need additional information.
- If your claim is denied in whole or in part, we will send you a written decision explaining the denial, and how to file a grievance.
For more information on preparing for your trip, receiving urgent or emergency care, or claims submissions, call Sutter Health Plus Member Services at (855) 315-5800.