Sutter Health Plan Introduces New Point-of-Service Plans for Large Employers

Aug 6, 2026 | 2026, Access, Affordability, News

Sutter Health Plan is expanding its portfolio of coverage options with the introduction of new point-of-service (POS) plans designed for large employer groups effective Jan. 1, 2027, pending regulatory approval by the Department of Managed Health Care. The new plans combine the value of Sutter Health Plan’s coordinated HMO network with expanded coverage options across California and beyond, helping employers support a distributed workforce without adding complexity to plan administration.

Available with copay and deductible plan designs, the POS plans provide flexible coverage for employees and dependents who may live outside the Sutter Health Plan service area, travel frequently or want additional choice in where they receive care. The plans maintain a simple, location-based tier structure that encourages the use of high-value, coordinated care while extending access when members need care elsewhere.

“Today’s employers are supporting increasingly mobile and geographically diverse workforces,” said Aparna Abburi, CEO of Sutter Health Plan. “Our new POS plans offer the flexibility large employers need while preserving the coordinated, high-quality care experience that defines Sutter Health Plan. Employees can access care where they need it, whether they are at home, traveling within California or outside the state, while employers benefit from a plan design that encourages value-based, in-network care and helps manage healthcare costs.”

All POS plans include access to the Tier 1 Sutter Health Plan HMO Network, where members have the lowest out-of-pocket costs. Members select a primary care physician (PCP) within the Sutter Health Plan HMO Network who helps coordinate their care and referrals. The Tier 1 network includes access to Sutter’s integrated network of providers and facilities across Northern California.

For members who need care outside the service area, additional coverage tiers provide greater flexibility.

Tier 1: Sutter Health Plan HMO Network

  • In-network care within the service area
  • Lowest out-of-pocket costs
  • Access to Sutter Health Plan network providers, including Sutter Health facilities
  • PCP-guided care coordination and referrals
  • Behavioral health benefits through Carelon Behavioral Health of California, Inc. (Carelon)

Tier 2: Prudent Buyer Plan® Network

  • Care received within California but outside the Sutter Health Plan HMO Network
  • Access to Anthem’s Prudent Buyer Plan Network* providers
  • Higher out-of-pocket costs than Tier 1
  • No PCP referral required
  • Some services require precertification or prior authorization from Sutter Health Plan
  • Behavioral health benefits through Carelon

Tier 3: Out-of-Network Coverage (available with select plans)

  • Provides coverage outside California, with the highest out-of-pocket costs
  • Limited out-of-network benefits for certain outpatient services
  • Enhanced plan option available with expanded Tier 3 coverage
  • No PCP referral required, though some services require precertification or prior authorization
  • Behavioral health services available through out-of-network providers

The new POS offerings are designed to complement, not replace, traditional HMO coverage. POS plans must be offered alongside a Sutter Health Plan traditional HMO plan and are available to large employer groups in which no more than 20% of eligible employees reside outside the Sutter Health Plan service area.

By combining coordinated in-network care with expanded access beyond the service area, the new POS plans help employers meet the evolving needs of their workforce while encouraging care choices that can lower overall healthcare costs. The tiered structure rewards members for using high-value network providers while still providing access to additional care options when needed.

Employers and brokers can learn more by reviewing the 2027 Plan Comparisons Point-of-Service Plans and requesting a quote from Tammy Mendez, Large Group Account Executive. Current employer groups can contact their dedicated Account Manager or Bonnie Jones, Manager of Account Management.

* The Prudent Buyer Plan Network is Anthem’s Prudent Buyer PPO CA Network.

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