Frequently Asked Questions
Are all Sutter Health-affiliated providers included in the Sutter Health Plus network?
No. Sutter Health Plus has a service area in which it offers healthcare coverage. Not all Sutter Health-affiliated hospitals, physician organizations and other healthcare services are in the Sutter Health Plus service area or network. Visit the Provider Locator for a list of participating providers and locations.
Can I go to a non-participating provider?
Sutter Health Plus does not cover care provided by non-participating providers unless your medical group provides a referral or prior authorization.
Do I need to choose a PCP?
Yes. As a new Sutter Health Plus member, you must select a PCP. When you choose a PCP, you’re also selecting a medical group. A PCP provides most of your primary healthcare and coordinates care from other providers. A PCP refers you as needed to providers for specialty care, X-ray, laboratory or other medical services. If you do not choose a PCP, we will assign one to you.
How can I check to see if my current prescription drugs are covered?
Check the Sutter Health Plus Formulary to see if the prescription drug requires a prior authorization.
How can I find out if my current Sutter Health-affiliated provider is included in the Sutter Health Plus network?
Visit the Provider Locator to see if your current or preferred doctor (PCP or specialist) is included in the Sutter Health Plus provider network.
How do I find a PCP?
You can find an in-network PCP by visiting the Provider Locator.
How will Sutter Health Plus obtain my previous medical records?
If your former medical group is Kaiser Permanente, UC Davis Medical Group, UC San Francisco Health, or Stanford Health, your new Sutter Health Plus provider may have electronic access to your medical records; if you request records from your former physician for personal use, you may be charged a fee.
If your former PCP is with Sutter Independent Physicians, Brown & Toland Medical Physicians, or another medical group, you need to send a Medical Records Request Form to your former physician to release your records. Talk to your new Sutter Health Plus provider about the process of requesting medical records.
I'm new to Sutter Health Plus. Can I keep my current PCP?
You can keep your current PCP if he or she is a Sutter Health Plus participating provider. You must actively select the provider as your PCP by entering the provider’s name and Sutter Health Plus provider identification number on the enrollment application and check that you're a current patient on your enrollment form.
I'm new to Sutter Health Plus. Can I keep my current specialist?
You can keep your specialist if he or she is a Sutter Health Plus participating provider and within the same medical group as your PCP. If you know that you need specialty care and have a specific Sutter Health Plus specialist in mind, you need to select a PCP that is in the same medical group as the specialist.
First, check the Provider Locator to see what medical group the specialist is in. Second, choose a PCP within that medical group. You need to ask your new PCP for a referral to the specialist. In certain situations, a specialist in the Sutter Health Plus network that is outside your medical group may also be available by referral.
If I live outside of the service area can I still select Sutter Health Plus?
Yes. To qualify for membership, you must live or reside (or work, for employer group plans) in the Sutter Health Plus service area.
My dependent is outside of the service area. How can he or she get medical services?
Your dependent must select a PCP within the Sutter Health Plus service area who will provide primary care or coordinate care from other providers. While Sutter Health Plus covers out-of-area urgent and emergency care, your dependent must receive all routine and follow-up care from the assigned medical group within the service area.
What if I need to see a specialist?
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 Provider Locator to see what medical group the specialist is in. Make sure you choose a PCP within that medical group.
What if I want to change my PCP later?
You can change your PCP at any time by calling Sutter Health Plus Member Services at (855) 315-5800 or through the Member Portal.
What information can I find on my ID card?
Your primary care physician (PCP) and medical group are identified on the ID card. The card also includes important contact information for you and your providers. You should always present your ID card when seeking medical care. If you're new to Sutter Health Plus, we will also send you a Welcome Book containing information and resources to help you navigate your healthcare.
What is Sutter Health Plus’ service area?
The Sutter Health Plus provider network in the greater Sacramento, Central Valley and Bay Area communities includes 30 hospitals and campuses, more than 7,000 providers and dozens of care centers, urgent care centers and other locations.
When will I receive a Sutter Health Plus member identification (ID) card and what information does the card contain? Will dependents receive their own ID cards?
Sutter Health Plus mails member ID cards for each covered member a few days after the member is enrolled. Your PCP and medical group are identified on the ID card. The card also includes important contact information for you and your providers. You should always present your ID card when seeking medical care. If you’re new to Sutter Health Plus, we will also send you a Welcome Book containing information and resources to help you navigate your healthcare.
Where can I find more information about my health plan coverage?
You can access your Benefits and Coverage Matrix (BCM), Evidence of Coverage and Disclosure Form (EOC), Summary of Benefits and Coverage (SBC) on the Member Portal (Login required).