These benefit changes will reduce member cost share for Mental Health, Behavioral Health and Substance Use Disorder (MH/SUD) and emergency medical transportation benefits. Previously filed claims will be retroactively adjusted back to dates of service on or after January 1, 2016. Members who paid the incorrect cost sharing amount will receive a separate letter and refund, as appropriate.
Blue Shield of California and Sutter Health have been engaged in discussions on rates and terms for a new network contract (HMO/PPO and in some cases, Group Medicare Advantage). Though we are still actively involved in negotiations, the current contract expired at 11:59 p.m. on December 31, 2016 and Sutter Health is no longer Blue Shield’s in-network provider effective January 1, 2017.
For 2017, Sutter Health Plus will be offering individual and family plans that mirror the standard benefit designs outlined by Covered California. These HMO plans, offered only by Sutter Health Plus, are not eligible for the ACA Premium Tax Credits. They will be offering the standard benefit design Platinum coinsurance, Gold coinsurance, Silver and Bronze health plans in the Sacramento Valley and Bay Area counties.