TO: Fresno Unified School District Employee Health Care Plan Participants in PPO Plan Options A and B
DATE: June 1, 2016
Effective July 1, 2016, Sutter Health System facilities and providers will be considered out-of-network facilities and providers. This change is due to a recent contract dispute between Sutter Health System and individual employer health plans that you may have recently seen in the news. In an effort to protect its rights under the Plan, the JHMB has decided not to agree to a new contract with the Sutter Health System.
As a result, on or after July 1, 2016, covered services received at Sutter Health System facilities or from Sutter Health System providers will be covered at the non-PPO benefit level (e.g., subject to the out-of-network deductible, coinsurance, and out-of-pocket maximum), resulting in higher out-of-pocket costs for you and your family.
This change will likely have a minimal impact on most Plan participants, because Sutter Health System facilities and providers are predominantly located in Northern California. However, if you live or are traveling in Northern California and/or you seek care from a Sutter Health System facility or provider, please remember that the services will be treated as out-of-network services.
Be sure to ask first – “Are you part of Sutter Health system?”
In the PDF available for download below, you will find a list of Sutter Health System hospitals. While the list only highlights hospitals, there are many more facilities and providers affiliated with Sutter Health System. Should you wish to seek the services of a new provider under the PPO plan, please be sure to ask if they are part of the Sutter Health System. If they are, their services will be billed at the non-PPO benefit level.
SPECIAL NOTE: Due to system complexities during this change, information available via the Anthem Blue Cross website may not be accurate regarding identifying Sutter Health System providers. We strongly advise that you first follow up with your physician/provider or the Sutter Health System website at www.sutterhealth.org to verify their affiliation.
Please download official notice below to review the list of Sutter Health System Hospitals affected by this change (on page 2).