As a CalPERS member, you have important choices
to makethisOpen Enrollment.Take the timeto find
a health plan that fits your healthcare needs.Let's take
a look at whatSutterHealth Plan has to offer.
First, let's make sure Sutter Health Plan is available to you.
For the 2027 plan year, eligible CalPERS Basic members
who live or work in Placer, Sacramento, San Joaquin, Solano,
Stanislaus or Yolo counties can choose Sutter Health Plan
during Open Enrollment.
Open Enrollment runs from September 14
through October 9, 2026, and coverage
is effective January 1, 2027.
If Sutter Health Plan is being offered where you live or work,
here's what you can expect as a member.
When you choose Sutter Health Plan,
you'll have comprehensive coverage and access
to an award-winning network of doctors, hospitals and care
teams working together to help make healthcare easier
to navigate.
That coordinated approach starts with your primary care physician
-- also known as a PCP.
When you enroll, you and each of your covered dependents
are assigned a PCP.
Think of your PCP as your healthcare partner.
They'll help you navigate your care
and coordinate services, including referrals
to specialists, X-rays, lab and other services when needed.
If you already have a Sutter PCP,
you'll keep them when you enroll in Sutter Health Plan.
You'll also continue to have access to your medical history
through My Health Online, Sutter's secure patient portal.
Looking for a provider?
You can use our Find a Provider tool to search
by name, specialty, or location, and filter
by medical group, gender, language,
and whether providers are accepting new patients.
Some PCPs also offer a Book an Appointment feature,
so you can schedule directly from their profile.
With Sutter Health Plan, you have convenientaccess to care,
including video visits, Sutter Walk-In Care and urgent care,
so you can get the care you need when and where you need it.
Booking a video visit directly with your PCP
is simple through My Health Online.
Many PCPs offer video visits for routine to complex healthcare
needs.
And if your PCP doesn't offer video visits,
you still have options.
You can use My Health Online to connect with another Sutter
clinician for minor issues or join the virtual queue
for an On-Demand Video Visit, available 24/7,
with no appointment needed.You must be physically located
in California at the time of your appointment to participate
in video visits.
If you need care soon and can't get in with your PCP.
Sutter Walk-In Care offers a convenient option
for everyday health needs, with locations
available in the Greater Sacramento Area.
When you need care right away but it's not an emergency,
you're covered.
Within the service area, you can visit any in-network urgent care
center.
If you're traveling or outside the service area,
urgent care coverage is available wherever you are.
Dependents who live outside the service area
can also access urgent care and emergency services.
For routine or follow-up care, they'll
work through their assigned PCP and medical group.
Emergency care is always covered, in or out of network,
without a referral.
It's also helpful to understand how certain benefits work when
specialty services are needed.
While you can always schedule directly with your PCP,
some services may require a referral and prior authorization
from your medical group.
Your PCP will refer you and request authorization
when necessary.
However, there are certain services
where you can schedule care directly
with in-network providers without a referral,
including: Obstetrical or routine gynecological services.
Mental health or substance use disorder services.
And acupuncture or chiropractic services.
Your mental health is as important
as your physical health.
Your mental health and substance use treatment services are
provided throughCarelonBehavioral Health
of California, Inc.To find in-network care for these
services, go to carelonbh.com/sutterhealthplan
and select Find Providers at the top of the page.
Your outpatient prescription drug coverage
is administered by CVS Caremark.
Visit caremark.com/calpers or call CVS Caremark Customer Care
at 833-291-3649 if you have questions about
your prescription drug benefits.
Preventive care plays an important role
in helping you stay healthy.
Your benefits include coverage for routine health exams
and other preventive care services --
designed to detect and prevent illnesses early --
available at no cost to you.
When you're unsure what kind of care you need,
help is just a phone call away.
Our 24/7 nurse advice line connects you with experienced
registered nurses who can help you determine the best level
of care for you.
Beyond your everyday healthcare needs,
you also have access to programs designed to support your overall
health and well-being.From health coaching and complex case
management to Mahmee and our Health and Wellness site,
you'll find personalized guidance,
support and resources to help you reach your wellness goals.
Once you've enrolled, we'll help you get started.
You'll receive member ID cards for you and your covered
dependents, along with a New Member Guide
that explains your benefits and how to access care.
If youwereassigned a new PCP, be sure to schedule a new patient
appointment after you receive your ID cardtoestablishcare.
You'll also receive a welcome email
with information and resources to help
you navigate your coverage.
Your member ID card lists your PCP and medical group, the nurse
advice line, and more.
You'll need to show it when accessing care.
If you need a new card, you can print or request
oneonSutter Health Plan's secureMember Portal.
The Sutter Health Plan member portal is a convenient resource,
allowing you to view plan documents,
check copays and claims, request an ID card,
change your PCP and more.
To make it even easier to access important information,
CalPERS members have a dedicated microsite.
There, you'll find benefit documents, plan information,
resources and helpful tools.
You can access the site at sutterhealthplan.org/calpers
Managing your healthcareisalsoconvenient
and easy with My Health Online.
Stay connected to your Sutter providers and care team,
scheduleappointmentsandcheck test resultson
the go.My Health Online also has features
likecontactless check-in and appointment reminders
through text to help you stay on top of yourhealth.
Your CalPERS plan option through Sutter Health Plan
is a traditional HMO plan with set copays
for covered services and no annual medical deductible.
Many outpatient services, including PCP,
specialist and video visits have a $15 copay.In addition,
preventive care services are covered at no cost
to you, helping you stay on top of your health
through routine wellness visits, recommended screenings,
immunizations and preventive lab services.
Please take a few minutes to review the following slides
with your specific CalPERS benefit plan information
If you have any questions about your coverage
or want to learn more about your benefits,
our dedicated CalPERS Customer Service team is here to help.
You can reach us Monday through Friday from 8 a.m. to 7 p.m.
at 833-674-2334.
You can also email the team at shpcustomerservi
ce@sutterhealth.org or visit sutterhealthplan.org/calpers.
We can't wait to welcome you to Sutter Health Plan!
