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    Participating Health Plans

    Last Updated: October 13, 2017

    Click here for Medicare Plans

    Please note, if you are an HMO/POS health plan member and pick a primary care physician in the Mills-Peninsula Division of PAMF, your specialty care, laboratory and radiology services will be provided by physicians in the Mills-Peninsula network. This network includes specialist physicians in Daly City, San Bruno, Millbrae, Burlingame, Foster City, and San Mateo.

    While we strive to keep this list up to date, it's always best to check with your health plan to determine the specific details of your coverage, including benefit designs and Sutter provider participation in your provider network. It is important to note that not all of the Sutter Health network of providers necessarily participate in all of a health plan's products or networks.

    Sutter Health, on behalf of our network of providers, is currently in negotiations with the following health plans to renew our contracts for 2018:

    • Health Net
    • United HealthCare
    We hope to successfully complete these renewals by the end of 2017.

    Individual and Family Plans


    Individual and Family Plans (IFP) may be purchased outside the state’s health benefit exchange (Covered California) through the health plan or an insurance broker. For more information, please contact the health plan or insurance broker of your choice directly. If you qualify for a federal tax credit or subsidy, you must enroll for coverage through Covered California to receive this financial assistance.

    Blue Shield Bronze PPO
    Blue Shield Gold PPO
    Blue Shield Minimum Coverage PPO
    Blue Shield Platinum PPO
    Blue Shield Silver PPO
    Blue Shield $0 Cost Share PPO
    Health Net IFP Bronze PPO
    Health Net IFP Minimum Coverage PPO
    Health Net IFP Gold PPO
    Health Net IFP Platinum PPO
    Health Net IFP Silver PPO
    Sutter Health Plus Individual and Family Plan HMO (not currently available in Santa Cruz)

    Covered California


    Covered California is this state's Health Benefit Exchange. If you buy coverage through Covered California, you may qualify for federal tax credits or subsidies. (You may also purchase individual and family plans outside of Covered California.) For more information regarding plans offered in your zip code, please visit www.CoveredCA.com, or call 800-300-1506.

    Blue Shield Bronze PPO
    Blue Shield Gold PPO
    Blue Shield Minimum Coverage PPO
    Blue Shield Platinum PPO
    Blue Shield Silver PPO
    Blue Shield IFP Full Network PPO
    Blue Shield $0 Cost Share PPO
    Blue Shield PPO Small Group
    Health Net PPO for Small Business Health Options Program (SHOP)

    Insurance Plans

    Aetna
    Aetna Affordable Health Choices (Indemnity)
    Aetna Choice POS
    Aetna Choice POS II
    Aetna Open Access Elect Choice (EPO)
    Aetna Open Access Managed Choice (POS/PPO)
    Aetna Savings Plus PPO (only at San Mateo/Burlingame area locations)
    Aetna Select EPO
    Aetna Signature Administrators (PPO)
    Aetna Student Health Program
    Aetna Value Network (AVN) (only at San Mateo/Burlingame area locations)
    Aexcel & Aexcel Plus (also known as Aetna Performance Network)
    Choose and Save (also known as Aetna Performance Network)
    Behavioral Health Program
    Elect Choice EPO
    HMO
    HMO Deductible Plans
    Health Fund HMO
    Health Fund PPO
    Managed Choice POS (POS/PPO)
    NationCare (Open Choice) PPO
    National Advantage Plan (NAP)
    Open Access Select (EPO)
    Open Choice PPO
    Quality Point of Service (QPOS)
    Stanford Healthcare (SHC) Tier 2
    Traditional Choice
    US Access (HMO/POS)

    Anthem Blue Cross
    Advantage HMO
    Advantage PPO (Tier 1)
    Anthem Blue Cross HMO (California Care)
    Anthem Blue Cross HMO/POS (California Care Plus)
    Anthem Blue Cross HMO Saver Small Group Plan (only at Mountain View/Sunnyvale, San Jose/Los Gatos area locations)
    Anthem Blue Cross Individual HMO (only at Mountain View/Sunnyvale, San Jose/Los Gatos area locations)
    Anthem Blue Cross Small Group HMO
    Anthem Bronze EPO (Prudent Buyer Plan)
    Anthem Gold EPO (Prudent Buyer Plan)
    Anthem Platinum EPO (Prudent Buyer Plan)
    Anthem Silver EPO (Prudent Buyer Plan)
    Behavioral Health Program
    BlueCard (Blue Cross Blue Shield PPO)
    Blue Cross PPO (Prudent Buyer Plan)
    CalPERS EPO
    Direct Access HMO (Traditional HMO Network)
    Federal Employee Program (FEP) PPO
    Geo Blue
    Indemnity
    Major Risk Medical Insurance Program (MRMIP)
    Managed Care Services (MCS)
    My Choice PPO
    PERS Care
    PERS Choice
    Care Advocate PPO
    Smart Sense
    University of California Health Insurance Plan PPO (Tier 1)
    UC Care PPO (Tier 1)

    Blue Shield
    BlueCard (Blue Cross Blue Shield PPO)
    Blue Shield Access+ HMO Plan
    Blue Shield Access+ HMO/EPO CalPERS Limited Network
    Blue Shield Added Advantage Point of Service (POS)
    Blue Shield Bronze PPO
    Blue Shield Gold PPO
    Blue Shield Life & Health Insurance Company
    Blue Shield Minimum Coverage PPO
    Blue Shield Platinum PPO
    Blue Shield Small Group PPO
    Blue Shield Silver PPO
    Blue Shield Spectrum PPO Plan
    Blue Shield Spectrum PPO Savings Plan
    Blue Shield $0 Cost Share PPO
    Federal Employee Program (FEP) PPO
    Full Network PPO
    Indemnity
    Shared Advantage PPO (Other Payer)
    Shared Advantage Plus PPO (ASO Payer)
    Vital Shield 900 & 2900 Plans

    Cigna
    Allegiance Benefit Plan Management
    Cigna Care Network
    Commercial HMO/POS
    EPO Plan
    Global Health Advantage (PPO)
    Indemnity Plan
    International Plan
    Network HMO/POS
    Open Access Plus (PPO)
    Preferred Provider Organization (PPO)

    Health Net
    Blue & Gold HMO (only at San Mateo/Burlingame area locations)
    Centene Corporation Self-Insured Group Health PPO
    Elect Open Access POS, for Large Group and Small Group
    Elect POS, for Large Group and Small Group
    Health Net PPO, for Individuals, Large Group, and Small Group
    Health Net IFP Bronze PPO
    Health Net IFP Minimum Coverage PPO
    Health Net IFP Gold PPO
    Health Net IFP Platinum PPO
    Health Net IFP Silver PPO
    Health Net PPO for Small Business Health Options Program (SHOP)
    Healthy Heart HMO
    HMO, Flex Funded
    HMO, for Large Group and Small Group
    Managed Health Network (MHN)
    Salud HMO Plus Large/Custom Group
    Select POS (two and three tier), for Large Group and Small Group
    Seniority Plus (Medicare Advantage HMO) (Employer-Sponsored) - Medicare Advantage Plan Info
    Seniority Plus Complete
    Seniority Plus Green
    Seniority Plus Ruby
    Vaden EPO

    HealthSmart
    Preferred Provider Organization PPO (confirm provider participation with your Employee Benefits Department or health plan)
    ChoiceCare Network (confirm provider participation with your Employee Benefits Department or health plan)

    Multiplan
    Complementary Network PPO (confirm provider participation with your Employee Benefits Department or health plan)

    Pacific Health Alliance
    Preferred Provider Organization PPO (confirm provider participation with your Employee Benefits Department or health plan)

    PHCS
    Primary Network PPO (confirm provider participation with your Employee Benefits Department or health plan)

    Sutter Health Plus
    Individual and Family Plan HMO
    Large Group HMO
    Small Group HMO

    For more information about Sutter Health Plus’ plans, benefits and services,
    please contact 1-855-325-5200 or www.sutterhealthplus.org.

    Sutter Select
    EPO
    EPO Plus
    PPO

    TriCare
    Extended Care Option (ECHO)
    Extra
    Prime
    Prime Remote
    Reserve Select
    Standard

    United Healthcare
    AARP MedicareComplete SecureHorizons Plan 1 & 2 (HMO) Medicare Advantage Plan Info
    Definity Health
    Health Plan of Nevada (HMO)
    Nexus ACO (Tier 2)
    Sierra Health and Life (PPO)
    Signature Freedom (SDHP)
    Signature Independence (Indemnity)
    Signature Options (PPO)
    Signature POS
    Signature Value (HMO)
    Signature Value Access (EPO)
    Signature Value Alliance HMO (includes CalPERS & AON Exchange)
    United Healthcare Choice (Non-Tiered)
    United Healthcare Choice Plus (Non-Tiered)
    United Healthcare EPO
    United Healthcare Options PPO
    United Healthcare POS
    United Healthcare Select and Select Plus (PPO)
    United Indemnity Plan
    United Managed Indemnity Plan
    United Healthcare Group Medicare Advantage (HMO) Medicare Advantage Plan Info
    United Healthcare Group Medicare Advantage (PPO) Medicare Advantage Plan Info
    United Healthcare MedicareComplete (HMO) Medicare Advantage Plan Info
    US Behavioral Health Plan, California (USBHPC)

    Valley Health Plan
    Commercial HMO

    Psychiatry & Behavioral Health Plans


    Aetna Behavioral Health Program
    Anthem Blue Cross Behavioral Health Program
    Health Net Managed Health Network (MHN)
    Magellan Behavioral Health
    United Healthcare US Behavioral Health Plan, California (USBHPC)

    Coverage for psychiatric and behavioral health services varies by health plan. Some plans have a "carve-out" for mental health care, meaning services are covered by a separate organization that the patient must contact directly.

    Medicare Advantage Plans


    Health Net Medicare Advantage Products

    • Healthy Heart HMO
    • Seniority Plus Complete
    • Seniority Plus Green
    • Seniority Plus Ruby
    • Seniority Plus (employer-sponsored)
    Please check with your health plan if you have any questions about coverage or specific products offered. Plan contact information: Health Net Seniority Plus (a Medicare Advantage Plan) 1-800-275-4737 (TDD/TTY 1-800-929-9955), 8 a.m. to 8 p.m., 7 days a week. www.healthnet.com

    United Healthcare Medicare Advantage Products

    • AARP MedicareComplete SecureHorizons Plan 1 & 2 (HMO)
    • United Healthcare Group Medicare Advantage (HMO)
    • United Healthcare Group Medicare Advantage (PPO)
    • United Healthcare MedicareComplete (HMO)
    Please check with your health plan if you have any questions about benefits, specific products, or provider network. Plan contact information: United Healthcare of California, 1-800-607-2877 (TDD/TTY: 711), 8 a.m. to 8 p.m., 7 days a week. www.UHCMedicareSolutions.com

    PAMF also participates in Medicare A & B and Medicare Supplement ("Medi-Gap") insurance plans. If you are a Medicare Advantage patient and revert to traditional Medicare, you may keep your current provider(s). The open enrollment period for Medicare Advantage plans is October 15 to December 7. For more information, visit www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day/7 days a week.

    Additional Information


    We make every effort to keep this list as accurate as we can for our current participating health plans. Plan names may change at the discretion of the insurance company. We have listed our participating plans based on the product names provided by the insurance companies. Even so, it is possible that not every health plan and circumstance is addressed here. Please check with your health plan if you have any questions about benefits, specific products, or provider network.

    You can obtain the most accurate and timely information by calling your insurance company or employer's benefits department and confirming your coverage level when choosing a PAMF physician.

    Special note for POS, PPO, and Indemnity plans not listed:
    You always have a choice of seeing a physician who is not listed in the PPO or POS directory. A copay and/or deductible may apply. Consult your benefits summary or evidence of coverage for details.

    If you have questions about participating health plans, call our toll free number -- 1-877-252-1777, Monday through Friday, 8 a.m. to 5 p.m.


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