On Jan. 1, 2015, Blue Shield of California sent letters to members who have used Sutter Health providers in Northern California, informing them that the Blue Shield/Sutter Health contract was terminated, effective Dec. 31, 2014.
However, to ensure an orderly transition of care for members, Blue Shield and Sutter Health have agreed to a six-month transition period through June 30, 2015, while they continue contract negotiations. There will be no disruption of care during the transition period.
UC is closely monitoring the situation and will provide additional information when it is available, but no later than the end of April 2015. There is no need for employees or retirees to make changes at this time; therefore the University is not authorizing a special opportunity for employees and retirees to change medical plans at this time. Contract negotiations are ongoing, and it is UC’s hope that Sutter Health and Blue Shield will come to an agreement before the transition period ends on July 1.
Blue Shield has issued a fact sheet to address concerns about the contract issue. The fact sheet describes the six-month transition period during which plan members may continue to use Sutter providers.
How this may affect you
University of California employees and non-Medicare retirees will be affected if they use Sutter providers and they are enrolled in the following UC health plans:
- Blue Shield Health Savings Plan
- Core Medical Plan
- UC Care Plan
During the transition period — through June 30, 2015 — UC Care plan members will continue to receive services at the same level as they had previously:
- If the Sutter provider is in UC Select, the member is responsible for a copayment.
- If the Sutter provider is in Blue Shield Preferred, services will be covered at the in-network level, but out-of-pocket costs may be higher because Sutter’s costs may be higher.
- If the Sutter provider was out-of-network in 2014, it will remain out-of-network during the transition period.
Blue Shield Health Saving Plan and Core Plan members will continue to be covered at the in-network level (80%) through June 30, 2015. However, Sutter’s charges may be higher, which may result in higher out-of-pocket costs for Sutter’s services.
Effective July 1, 2015, if a contract has not been negotiated, Sutter Health providers will be considered “out-of-network” for the above health plans, with special exceptions made for those under a current course of treatment who apply to Blue Shield for continuity of care. Medicare-eligible retirees may not be affected in most cases; see the fact sheet for details by plan.
View the chart of affected Sutter Health and alternative providers in the Blue Shield network for your location for more information.