Sutter Health Plus

Company Carrier
Form Name Effective Date Download Form
New Group Submissions
New Business Submission Checklist - Small Group 1.22
01/01/2022 Download
Employer Application - Small Group 1.22
01/01/2022 Download
Sole Proprietor, Partner or Corporate Officer Eligibility Statement
01/01/2022 Download
New Business Submission Checklist - Large Group 1.22
01/01/2022 Download
Employer Application - Large Group 1.22
01/01/2022 Download
Administration
Employer Administrative Guide
01/01/2022 Download
Termination Form
01/01/2022 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Employee Enrollment and Change Form - Small Group 1.22
01/01/2022 Download
Employee Enrollment and Change Form - Large Group 1.22
01/01/2022 Download
Declination of Coverage Form
01/01/2022 Download
Continuity of Care Services Request Form
01/01/2022 Download
Disable Dependent Certification Form
01/01/2022 Download
Claim Forms
Authorization for the Use or Disclosure of Health Information
01/01/2022 Download
Member Claim Form
01/01/2022 Download
Mail Order Rx Delivery Form
01/01/2022 Download
Form Name Effective Date Download Form
2022 Small Group Standard Medical HMO
Platinum MS58 HMO
01/01/2022 Summary SBC
Platinum MS70 HMO
01/01/2022 Summary SBC
Gold MS52 HMO
01/01/2022 Summary SBC
Gold MS67 HMO
01/01/2022 Summary SBC
Gold MS73 HMO
01/01/2022 Summary SBC
Silver MS74 HMO
01/01/2022 Summary SBC
Silver SD47 HDHP HMO
01/01/2022 Summary SBC
Bronze MS76 HMO
01/01/2022 Summary SBC
Bronze SD38 HDHP HMO
01/01/2022 Summary SBC
2022 Small Group Plus Medical HMO (Contact your RBG representative for a Plus HMO plan quote)
Platinum MP58 Plus HMO
01/01/2022 Summary SBC
Platinum MP70 Plus HMO
01/01/2022 Summary SBC
Gold MP52 Plus HMO
01/01/2022 Summary SBC
Gold MP67 Plus HMO
01/01/2022 Summary SBC
Gold MP73 Plus HMO
01/01/2022 Summary SBC
Silver MP74 Plus HMO
01/01/2022 Summary SBC
Silver SP47 Plus HDHP HMO
01/01/2022 Summary SBC
Bronze MP76 Plus HMO
01/01/2022 Summary SBC
Bronze SP38 Plus HDHP HMO
01/01/2022 Summary SBC
2022 Large Group Medical HMO
Summit ML26 HMO
01/01/2022 Summary SBC
Summit ML27 HMO
01/01/2022 Summary SBC
Summit ML28 HMO
01/01/2022 Summary SBC
Summit ML29 HMO
01/01/2022 Summary SBC
Summit ML50 HMO
01/01/2022 Summary SBC
Summit ML51 HMO
01/01/2022 Summary SBC
Summit ML54 HMO
01/01/2022 Summary SBC
Peak ML20 HMO
01/01/2022 Summary SBC
Peak ML21 HMO
01/01/2022 Summary SBC
Peak ML22 HMO
01/01/2022 Summary SBC
Peak ML24 HMO
01/01/2022 Summary SBC
Peak ML25 HMO
01/01/2022 Summary SBC
Peak ML59 HMO
01/01/2022 Summary SBC
Peak ML60 HMO
01/01/2022 Summary SBC
Ridge ML56 HMO
01/01/2022 Summary SBC
Ridge ML57 HMO
01/01/2022 Summary SBC
Ridge ML58 HMO
01/01/2022 Summary SBC
Vista HD08 HDHP HMO
01/01/2022 Summary SBC
Vista HD09 HDHP HMO
01/01/2022 Summary SBC
Vista HD10 HDHP HMO
01/01/2022 Summary SBC
Vista HD15 HDHP HMO
01/01/2022 Summary SBC
Vista HD17 HDHP HMO
01/01/2022 Summary SBC
Vista HD18 HDHP HMO
01/01/2022 Summary SBC
Vista HD19 HDHP HMO
01/01/2022 Summary SBC
Form Name Effective Date Download Form
General Information
Small Group Medical Plan Comparisons 1.22
01/01/2022 Download
Large Group Medical Plan Comparisons 1.22
01/01/2022 Download
Small Group Underwriting Guidelines 1.22
01/01/2022 Download
Optional Benefits Plan Comparisons 1.22
01/01/2022 Download
Employer Premium Payment Options Flyer
01/01/2022 Download
Member Booklet - Great Coverage Starts Here
01/01/2022 Download
Pharmacy Benefits - Managing Your Prescriptions
01/01/2022 Download
Form Name Effective Date Download Form
SG Rate Guide - All Rating Areas [effective 1/1/2022]
01/01/2022 Download
SG Optional Benefits Rate Flyer [effective 1/1/2022]
01/01/2022 Download