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Summary of Benefits & Coverage

Important information for individuals

What you need to know

It’s easy to know about your benefits and coverage

In March 2010, Congress passed a historic health care reform law called the Affordable Care Act (ACA). Under it, health plans are required to provide consumers with a document giving them information about health plan benefits and coverage. This is a Summary of Benefits and Coverage (SBC) document.

The SBC gives you helpful information about what the plan covers. It also has examples of how much you might pay for certain health events or conditions. Remember, the SBC is only a summary. So, we’ve added other details about your plan here for you.

Be sure to visit these links for more information:

Find out what the bolded words in the SBC mean. Check out our glossary of coverage and medical terms. (Note: Some of the terms may not have the same meaning when used in your policy or plan. Your policy or plan governs)

Need to know which providers are in Sutter Health | Aetna’s network or have questions about prescription drug coverage?

  • Current Sutter Health | Aetna members: Just login to your secure member website using the link in the navigation bar to get information about your current plan.
  • Not a member yet:
  1. To check if a doctor is in network, go to our provider search tool and make sure to choose the plan that matches the one you are considering.
  2. For pharmacy benefit information, visit our pharmacy resources page. Sutter Health | Aetna pharmacy benefits are administered by Aetna. Aetna provides certain management services to Sutter Health | Aetna.

    Please note that these formularies are standard and may not reflect the formulary in your specific plan.

To obtain the terms of your policy or a copy of your plan document, please see below. Which policy or plan document do you need?

Questions?

Already an Sutter Health | Aetna member? Call Member Services at the toll-free number on your member ID card.

Not a member yet? Call the toll-free number on your SBC if you have any questions.

Important information for employers

Sutter Health | Aetna will give employers the information they need, but the law says employers have to give the SBCs to their employees. There are very specific rules about what employers have to provide and when. Read more about the standards to create and provide an accurate SBC.

Our Collaboration

We’re a healthcare company that brings together Sutter Health’s network of nationally recognized, high-quality doctors and hospitals with Aetna’s leading health plan expertise, cutting-edge data, analytics and health information technology, and shared care management capabilities. Together we bring a performance network†† to market with a goal to deliver a differentiated and personalized experience for members, designed to improve efficiency and lower the cost of care.

Great care, great value, always there for Northern Californians. 

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Many of the hospitals and physician organizations in the Sutter Health network have been recognized for quality achievements from The Joint Commission, The Leapfrog Group®, Integrated Healthcare and APG††Performance network refers to a network of providers who are clinically integrated.

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Health benefit plans are administered by Sutter Health and Aetna Administrative Services LLC. Sutter Health | Aetna is the brand name used for products and services provided by Sutter Health and Aetna Administrative Services LLC. Sutter Health | Aetna is an affiliate of Sutter Health and its affiliates (Sutter) and of Aetna Life Insurance Company and its affiliates (Aetna). Aetna, CVS Pharmacy, Inc. (which owns CVS® HealthHub® locations), and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health family of companies.

This material is for information only and is not an offer or invitation to contract. Health insurance plans contain exclusions and limitations. Not all health services are covered. See plan documents, consult with HR/Benefits Manager or call the member services number on the back of your ID card for details on benefits, exclusions, limitations and conditions of coverage. Providers are independent contractors and not our agents. Provider participation may change without notice. Sutter Health | Aetna does not provide care or guarantee access to health services. Plan features and availability are subject to change and may vary by location. Information is believed to be accurate as of the production date; however, it is subject to change.

Language Assistance can be provided by calling the number on your member ID Card. For additional language assistance: Español | 中文 | Tiếng Việt | 한국어 | Tagalog | Pусский | العربية | Kreyòl | Français | Polski | Português | Italiano | Deutsch | 日本語 | فارسی | Other Languages…