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    Covered California and Sutter Health

    Covered California informationCovered California Opens new window is California's health insurance exchange, where individuals, families and small businesses can find affordable, quality health insurance. Open enrollment for 2017 coverage begins Nov. 1, 2016, and continues through Jan. 31, 2017.

    Sutter Health’s 2016 Participation in Covered California

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

    • Blue Shield*: All Sutter Health doctors and hospitals participate in Blue Shield’s individual and family PPO plan. This plan is available to all residents of Northern California.
    • Chinese Community Health Plan*: The following providers participate in Chinese Community Health Plan’s individual and family HMO plan: Physician Foundation Medical Associates (affiliated with Sutter Pacific Medical Foundation), California Pacific Medical Center (including St. Luke’s campus) and Mills-Peninsula Health Services.
    • Anthem Blue Cross: The following hospitals participate in the Anthem Blue Cross Pathway PPO individual and family 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, Sutter Coast Hospital, Sutter Delta Medical Center and Sutter Solano Medical Center.
    • United HealthCare: The following hospitals participate in the United HealthCare Core PPO individual and family plan: Memorial Hospital Los Banos, Sutter Tracy Community Hospital, Alta Bates Summit Medical Center, Sutter Delta Medical Center, Thunder Road Adolescent Center, Eden Medical Center, Menlo Park Surgical Hospital, Sutter Amador Hospital, Sutter Center for Psychiatry, Sutter Solano Medical Center, Sutter Surgical Hospital – North Valley, California Pacific Medical Center, Novato Community Hospital, Sutter Lakeside Hospital, Sutter Santa Rosa Regional Hospital and Sutter Coast Hospital.
    * Please note that Sutter Health, on behalf of our network of providers, is currently in negotiations with Blue Shield of California and Chinese Community Health Plan to renew our contracts for 2017. If you are a Blue Shield EPO or PPO member and the agreement is not renewed by December 31, 2016, you may continue to access your Sutter provider under your in-network benefit until the end of the contract transition period on June 30, 2017. Please check with your health plan if you have questions about coverage or specific products offered.

    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.


    What You Need to Know About Covered California

    • All health plans purchased through Covered California must cover certain services called essential health benefits. These include doctor visits, hospital stays, emergency care, maternity care, children’s care, prescriptions, medical tests and mental health care. They also must cover preventive care services, such as mammograms and colonoscopies.
    • If you buy coverage through Covered California, you may qualify for federal tax credits or subsidies. Expanded Medi-Cal eligibility makes it easier for low-income people to qualify for coverage.
    • The online Covered California cost calculatorOpens new window can help you estimate your cost to purchase health insurance in 2016 based on the information you provide. You can also learn the amount of financial assistance that may be available.
    • The plan options vary by location and are available at four different levels: bronze, silver, gold and platinum. A bronze plan has the lowest monthly premium whereas, in a platinum plan, the insurance company pays a much higher percentage of the cost of services but you will pay a much higher premium.
    • Young people can stay on their parents’ plans until age 26, and those under age 30 may qualify for less-comprehensive and less-costly “catastrophic coverage.”
    • Insurance companies must offer everyone insurance and can’t charge more for pre-existing conditions. Men and women will pay the same price.
    • New policies can no longer impose lifetime limits on benefits or rescind people’s coverage when they are sick.
    • Health plans can’t turn people down for coverage or charge more based on health status, claims history or expected use of health services.
    Beginning January 1, 2017, if you are enrolled in a Covered California PPO (Preferred Provider Organization) health plan you will be matched with a Primary Care Physician (PCP).
    • This added feature of your Covered California PPO health plan is intended to link you with a physician who can be your advocate and help you navigate the health system.
    • While having a PCP is important, you have no obligation to seek care from your PCP. You also do not need your PCP’s permission to seek treatment from other PCP’s or specialists in your provider network.
    • You can change your PCP at any time by contacting your health insurance company at the Customer Service phone number on your health plan identification card.
    • If you are not currently enrolled in a Covered California PPO plan and have questions about the PCP match process, please contact the Covered California Service Center Monday – Friday between 8 a.m. – 6 p.m. at (800) 300-1506 (TTY: [888] 889-4500

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