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    Covered California Frequently Asked Questions

    What is Sutter Health’s 2015 Participation in Covered California?

    Patients can access our affiliated hospitals and medical group doctors by choosing the following products available through Covered California:

    • Anthem Blue Cross: Sutter North Medical Group doctors and Sutter Surgical Hospital – North Valley are participating providers in the Anthem Blue Cross Pathway PPO individual and family plan. The following hospitals also participate in this plan: Alta Bates Summit Medical Center, California Pacific Medical Center (including St. Luke’s campus), Memorial Hospital Los Banos, Novato Community Hospital, Sutter Lakeside Hospital, Sutter Amador Hospital and Sutter Coast Hospital.
    • Blue Shield*: Most Sutter Health doctors and hospitals participate in Blue Shield’s individual and family plans. In Alameda County, we participate in Blue Shield’s Access Plus HMO plan available in the Small Business Health Options Program (SHOP).
    • Chinese Community Health Plan: The following providers participate in Chinese Community Health Plan’s individual and family HMO plan and Chinese Community Health Plan’s HMO plan in the SHOP: Physician Foundation Medical Associates, California Pacific Medical Center (including St. Luke’s campus) and Mills-Peninsula Health Services.
    * The Sutter Health and Blue Shield agreement expired on December 31, 2014. We have now entered into a six-month transition period of our agreement. Please check with Blue Shield directly by calling the customer service number on your health plan identification card or 1-800-200-3242 to ask how the transition agreement applies to you and your family.

    It’s important to note that not every health plan and product is available in every county in California. Please view the Accepted Health Plans list on our website and check with your health plan to verify details of coverage.

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    What is Covered California?

    Covered California became the state's established health exchange—the marketplace for Californians to purchase health insurance—on Oct.1, 2013. You can shop online, over the phone or in person to find and compare the health care insurance options available to you.

    Individuals can also learn if they qualify for federal financial assistance that can lower the cost of health insurance. In addition, individuals can find out if they qualify for health programs like Medi-Cal.
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    Who can use Covered California to purchase insurance?

    Legal residents of California without access to affordable health insurance through their employer or another government program can purchase health coverage through Covered California.
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    When can I purchase coverage through Covered California?

    Enrollment in health plans through Covered California begins Nov. 15, 2014 and continues until Feb. 15, 2015. You must purchase health insurance during this open-enrollment period in order to obtain coverage in 2015. If you do not enroll during this period, you will not be assured a health plan will cover you through Covered California.
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    What kind of health insurance will Covered California offer?

    Covered California offers the same high-quality health plans available on the private market today. These plans are guaranteed to provide essential levels of coverage and consumer protections required by the Affordable Care Act. Covered California will offer four basic levels of coverage: bronze, silver, gold and platinum. The levels are based on the percentage of an individual’s out-of-pocket costs and covered expenses paid by the health plan. For example, the bronze plan has the lowest monthly premium with the insurance company paying 60 percent of the cost of services and you paying 40 percent. The platinum plan has the highest premium with the insurance company paying 90 percent of the cost of services and you paying 10 percent.

    In addition to these traditional health plans, Covered California will offer what is called "catastrophic coverage," which helps protect a person from financial disaster in the event of a serious and expensive medical emergency. Covered California will provide catastrophic coverage to those up to age 30, or those individuals who can provide a certification that they are without affordable coverage or are experiencing hardship.
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    How will Covered California make it easier for me to compare different plans?

    Covered California will have four basic levels of coverage: bronze, silver, gold and platinum. This ranking system will make it easy to compare different health plans. As the metal category increases in value, so does the percent of medical expenses that a health plan will cover. You can choose to pay a higher monthly cost so that when you need medical care, you pay less. Or you can choose to pay a lower monthly cost so that when you need medical care, you pay more.
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    How much will it cost to purchase health insurance through Covered California?

    The cost of health insurance depends on how much coverage you choose to purchase and whether you qualify for financial assistance (see next question for examples) that can be paid to the private health plan you choose through Covered California to lower your monthly payment.

    You can access a cost calculatorOpens new window at that can help you determine about how much you will pay for insurance coverage, including what tax credits and subsidies might assist you in reducing your out-of-pocket costs.
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    What kind of help is available to help lower the cost of insurance?

    The government helps individuals seeking health coverage in three ways:

    1. Tax credits: Tax credits are available to lower the cost of health coverage for individuals and families who meet certain income requirements and do not have health insurance from an employer or a government program.
    2. Cost-sharing subsidies: Premium and cost-sharing subsidies reduce the amount of out-of-pocket health care expenses an individual or family has to pay. These expenses might include the copayments for health care services or other costs.
    3. Medi-Cal assistance: In 2014, the State of California expanded the Medicaid program (called Medi-Cal in California) to cover people under age 65, including people with disabilities, who meet certain income requirements.

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    Why does the law require me to purchase health insurance?

    A key goal of health care reform is to ensure everyone has affordable access to health coverage, regardless of his or her current health. However, if people waited until they were ill to purchase insurance, the choices for coverage would be small and expensive.
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    Do I have to buy health insurance?

    You should consider obtaining health insurance because it is an important way to gain access to medical care when you need it. In January 2014, the government began requiring most people to have health insurance or pay a penalty if they don't. Coverage may include employer-provided insurance, coverage someone buys on their own, Medicare or Medi-Cal.
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    Does the law cut my Medicare benefits?

    No, it does not eliminate or reduce benefits provided under Medicare.
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    Covered California web site for more information

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