Sutter Health Plus

Company Carrier
Form Name Effective Date Download Form
New Group Submissions
New Business Submission Checklist - Small Group 1.23
01/01/2023 Download
Employer Application - Small Group 1.23
01/01/2023 Download
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
12/01/2022 Download
New Business Submission Checklist - Large Group 1.23
01/01/2023 Download
Employer Application - Large Group 1.23
01/01/2023 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
12/01/2022 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Employee Enrollment and Change Form - Small Group 1.23
01/01/2023 Download
Employee Enrollment and Change Form - Large Group 1.23
01/01/2023 Download
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
2023 Small Group Standard Medical HMO
Platinum MS68 HMO
01/01/2023 Summary SBC
Platinum MS80 HMO
01/01/2023 Summary SBC
Gold MS62 HMO
01/01/2023 Summary SBC
Gold MS77 HMO
01/01/2023 Summary SBC
Gold MS83 HMO
01/01/2023 Summary SBC
Gold SD02 HDHP HMO
01/01/2023 Summary SBC
Silver MS84 HMO
01/01/2023 Summary SBC
Silver SD01 HDHP HMO
01/01/2023 Summary SBC
Bronze MS86 HMO
01/01/2023 Summary SBC
Bronze SD48 HDHP HMO
01/01/2023 Summary SBC
2023 Small Group Plus Medical HMO (Contact your RBG representative for a Plus HMO plan quote)
Platinum MP68 Plus HMO
01/01/2023 Summary SBC
Platinum MP80 Plus HMO
01/01/2023 Summary SBC
Gold MP62 Plus HMO
01/01/2023 Summary SBC
Gold MP77 Plus HMO
01/01/2023 Summary SBC
Gold MP83 Plus HMO
01/01/2023 Summary SBC
Gold SP02 HDHP Plus HMO
01/01/2023 Summary SBC
Silver MP84 Plus HMO
01/01/2023 Summary SBC
Silver SP01 HDHP Plus HMO
01/01/2023 Summary SBC
Bronze MP86 Plus HMO
01/01/2023 Summary SBC
Bronze SP48 HDHP Plus HMO
01/01/2023 Summary SBC
2023 Large Group Medical HMO
Summit ML61 HMO
01/01/2023 Summary SBC
Summit ML62 HMO
01/01/2023 Summary SBC
Summit ML63 HMO
01/01/2023 Summary SBC
Summit ML64 HMO
01/01/2023 Summary SBC
Summit ML65 HMO
01/01/2023 Summary SBC
Summit ML66 HMO
01/01/2023 Summary SBC
Summit ML67 HMO
01/01/2023 Summary SBC
Peak ML68 HMO
01/01/2023 Summary SBC
Peak ML69 HMO
01/01/2023 Summary SBC
Peak ML70 HMO
01/01/2023 Summary SBC
Peak ML71 HMO
01/01/2023 Summary SBC
Peak ML72 HMO
01/01/2023 Summary SBC
Peak ML73 HMO
01/01/2023 Summary SBC
Peak ML77 HMO
01/01/2023 Summary SBC
Ridge ML74 HMO
01/01/2023 Summary SBC
Ridge ML75 HMO
01/01/2023 Summary SBC
Ridge ML76 HMO
01/01/2023 Summary SBC
Vista HD20 HDHP HMO
01/01/2023 Summary SBC
Vista HD21 HDHP HMO
01/01/2023 Summary SBC
Vista HD22 HDHP HMO
01/01/2023 Summary SBC
Vista HD23 HDHP HMO
01/01/2023 Summary SBC
Vista HD24 HDHP HMO
01/01/2023 Summary SBC
Vista HD25 HDHP HMO
01/01/2023 Summary SBC
Vista HD26 HDHP HMO
01/01/2023 Summary SBC
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 1.23
01/01/2023 Download
Small Group Underwriting Guidelines 1.23
01/01/2023 Download
Small Group Medical Plan Comparisons 1.22
01/01/2022 Download
Small Group Underwriting Guidelines 1.22
01/01/2022 Download
Large Group Medical Plan Comparisons 1.23
01/01/2023 Download
Large Group Medical Plan Comparisons 1.22
01/01/2022 Download
Optional Benefits Plan Comparisons 1.23
01/01/2023 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 1/1/2023]
01/01/2023 Download
SG Optional Benefits Rate Flyer [effective 1/1/2023]
01/01/2023 Download
SG Rate Guide - All Rating Areas [effective 10/1/2022]
10/01/2022 Download
SG Optional Benefits Rate Flyer [effective 1/1/2022]
01/01/2022 Download