rate guide 2021 individual and family plans · 2020. 12. 21. · rate guide 2021 individual and...

Rate Guide 2021 Individual and Family Plans

Member Services 1-855-315-5800 | sutterhealthplus.org B-20-034

http://sutterhealthplus.org

Plan Name (2021) Platinum MI01 HMO (2021) Gold MI02 HMO (2021) Silver MI03 HMO (2021) Bronze MI04 HMO

Plan Number MI01 MI02 MI03 (3) MI04 Age Platinum Gold Silver Bronze

0-14 $449.32 $386.23 $343.01 $256.12

15 $489.26 $420.56 $373.50 $278.89

16 $504.53 $433.69 $385.16 $287.59

17 $519.80 $446.81 $396.82 $296.30

18 $536.25 $460.95 $409.37 $305.67

19 $552.69 $475.09 $421.93 $315.04

20 $569.73 $489.73 $434.93 $324.75

21 $587.36 $504.89 $448.39 $334.81

22 $587.36 $504.89 $448.39 $334.81

23 $587.36 $504.89 $448.39 $334.81

24 $587.36 $504.89 $448.39 $334.81

25 $589.70 $506.89 $450.17 $336.14

26 $601.44 $516.99 $459.14 $342.83

27 $615.54 $529.11 $469.90 $350.87

28 $638.45 $548.80 $487.39 $363.93

29 $657.24 $564.96 $501.74 $374.64

30 $666.64 $573.03 $508.91 $380.00

31 $680.74 $585.15 $519.67 $388.03

32 $694.83 $597.27 $530.43 $396.07

33 $703.64 $604.84 $537.16 $401.09

34 $713.04 $612.92 $544.33 $406.44

35 $717.74 $616.96 $547.92 $409.12

36 $722.44 $621.00 $551.51 $411.80

Sutter Health Plus Rate Guide Thank you for considering Sutter Health Plus as your health plan partner. This guide can help you find Individual and Family Plan (IFP) monthly premiums and select the right plan to fit your budget.

IFP Rates As an IFP member, you must pay a monthly premium to Sutter Health Plus for health care coverage. Your monthly premium is based on the plan you select, the age of each covered member as of the coverage effective date, the ZIP code where you live or reside, and if you are obtaining individual or family coverage. IFP plans follow a calendar year cycle—January 1 to December 31—and always renew on January 1 regardless of the original coverage effective date.

Use the following steps to calculate your monthly premium.

For Yourself 1. Find your county, ZIP code and rating region using the map on page 4.

2. Use your age as of your coverage effective date.*

3. Select a plan.

4. Calculate monthly premium.

Example: A 36 year old in Region 3 on the Silver MI03 HMO plan.

Rating Region 3 El Dorado (partial), Placer (partial), Sacramento and Yolo Counties

(4) (2)

*For example, if you enroll with Sutter Health Plus with a coverage effective date of March 1 for your first year, then we use your age as of March 1. When your coverage renews on January 1 of the following year, we base your renewal rate on your age as of January 1.

Page 2 Sutter Health Plus 2021 Individual and Family Plan Rates | Effective January 1, 2021


Plan Number MI01 MI02 MI03 (3) MI04 Age Platinum Gold Silver Bronze

0-14 - child #1 $474.75 $408.09 $362.42 $271.98

15 - child #2 (2) $516.95 $444.36 $394.64 (4) $296.16 16 $533.09 $458.23 $406.96 $305.40

17 $549.22 $472.10 $419.28 $314.65

18 - child #3 (2) $566.60 $487.04 $432.54 (4) $324.60 19 $583.97 $501.98 $445.81 $334.56

20 - child #4 (2) $601.97 $517.45 $459.55 (4) $344.87 21 $620.60 $533.46 $473.77 $355.54

22 $620.60 $533.46 $473.77 $355.54

23 $620.60 $533.46 $473.77 $355.54

24 $620.60 $533.46 $473.77 $355.54

25 $623.07 $535.58 $475.65 $356.95

26 $635.48 $546.25 $485.13 $364.07

27 $650.38 $559.06 $496.50 $372.60

28 $674.58 $579.86 $514.97 $386.46

29 $694.44 $596.93 $530.14 $397.84

30 $704.37 $605.47 $537.72 $403.53

31 $719.26 $618.27 $549.09 $412.06

32 $734.16 $631.07 $560.46 $420.59

33 $743.47 $639.07 $567.56 $425.93

34 - your spouse (2) $753.40 $647.61 $575.14 (4) $431.62 35 $758.36 $651.88 $578.93 $434.46

36 $763.33 $656.14 $582.72 $437.30

37 - you $768.29 $660.41 $586.51 $440.15

Totals Child #1 —

Child #2 $394.64

Child #3 $432.54

Child #4 $459.55

Your spouse $575.14

You $586.51

Total Monthly Premium: $2,448.38

For a Family 1. Find your county, ZIP code and rating region using

the map on page 4.

2. Use each enrolling family member’s age as of the coverage effective date:*

• You

• Your spouse or domestic partner

• Adult children ages 21 through 25

• Your three oldest children under age 21

El Dorado (partial), Placer (partial), Sacramento and Yolo Counties

Example: A family of four in Region 3 on the Silver MI03 HMO plan.

3. Select a plan.

4. Calculate the monthly premium for each family member.

• If you have more than three children under the age of 21, you will only pay premiums for the three oldest

• If you have more than three children and the oldest turns 21 during the current plan year, the rates will be adjusted at the next renewal

Rating Region 3

(4) (2)

If you have any questions or need assistance with this rate guide, please call Sutter Health Plus Member Services at 1-855-315-5800 Monday through Friday, 8 a.m. to 7 p.m.

*For example, if you enroll with Sutter Health Plus with a coverage effective date of March 1 for your first year, then we use your age as of March 1. When your coverage renews on January 1 of the following year, we base your renewal rate on your age as of January 1.


YOLO

SUTTER

SOLANO

SONOMA

SAN MATEO

SAN FRANCISCO

SANTA CRUZ

SAN JOAQUIN

STANISLAUS

SACRAMENTO

EL DORADO

ALAMEDA

PLACER

CONTRA COSTA

SANTA CLARA

Licensed Service Area

In Service Area

Out of Service Area

Alameda County Region 6 - Page 10 All ZIP codes

Contra Costa County Region 5 - Page 9 All ZIP codes

El Dorado County (partial) Region 3 - Page 7 95614 95635 95651 95664 95672 95682 95762

Placer County (partial) Region 3 - Page 7 95602 95603 95648 95650 95658 95661 95663 95677

95678 95681 95703 95713 95722 95746 95747 95765

Sacramento County Region 3 - Page 7 All ZIP codes

San Francisco County Region 4 - Page 8 All ZIP codes

San Joaquin County Region 10 - Page 14 All ZIP codes

San Mateo County Region 8 - Page 12 All ZIP codes

Santa Clara County (partial) Region 7 - Page 11 94022 94024 94040 94041 94043 94085 94086 94087

94089 94301 94303 94304 94305 94306 95002 95008

95013 95014 95030 95032 95033 95035 95050 95051

95053 95054 95070 95076 95110 95111 95112 95113

95116 95117 95118 95119 95120 95121 95122 95123

95124 95125 95126 95127 95128 95129 95130 95131

95132 95133 95134 95135 95136 95138 95139 95140

95148 95192

Santa Cruz County Region 9 - Page 13 All ZIP codes

Stanislaus County Region 10 - Page 14 All ZIP codes

Solano County Region 2 - Page 6 All ZIP codes

Sonoma County (partial) Region 2 - Page 6 94926 94927 94928 94931 94951 94952 94953 94954

94955 94972 94975 94999 95401 95402 95403 95404

95405 95406 95407 95409 95419 95421 95425 95430

95436 95439 95441 95442 95444 95446 95448 95450

95452 95462 95465 95471 95472 95473 95486 95492

Sutter County (partial) Region 1 - Page 5 95645 95668 95659

Yolo County Region 3 - Page 7 All ZIP codes

Some ZIP codes span more than one county. In that case, both the ZIP code and the county must be within the licensed service area for a member to enroll.


Sutter County (partial)

Rating Region 1


Plan Number MI01 MI02 MI03 MI04

Age Platinum Gold Silver Bronze

0-14 $484.85 $416.77 $370.13 $277.77

15 $527.95 $453.81 $403.03 $302.46

16 $544.42 $467.98 $415.61 $311.90

17 $560.90 $482.14 $428.19 $321.34

18 $578.65 $497.40 $441.74 $331.50

19 $596.39 $512.65 $455.29 $341.67

20 $614.77 $528.45 $469.32 $352.20

21 $633.80 $544.81 $483.84 $363.10

22 $633.80 $544.81 $483.84 $363.10

23 $633.80 $544.81 $483.84 $363.10

24 $633.80 $544.81 $483.84 $363.10

25 $636.32 $546.97 $485.77 $364.55

26 $649.00 $557.87 $495.45 $371.81

27 $664.21 $570.95 $507.06 $380.52

28 $688.93 $592.19 $525.93 $394.68

29 $709.21 $609.63 $541.41 $406.30

30 $719.35 $618.34 $549.15 $412.11

31 $734.56 $631.42 $560.76 $420.83

32 $749.77 $644.49 $572.38 $429.54

33 $759.28 $652.67 $579.63 $434.99

34 $769.42 $661.38 $587.37 $440.80

35 $774.49 $665.74 $591.24 $443.70

36 $779.56 $670.10 $595.12 $446.61

37 $784.63 $674.46 $598.99 $449.51

38 $789.70 $678.82 $602.86 $452.41

39 $799.84 $687.53 $610.60 $458.22

40 $809.98 $696.25 $618.34 $464.03

41 $825.19 $709.32 $629.95 $472.75

42 $839.77 $721.85 $641.08 $481.10

43 $860.05 $739.29 $656.56 $492.72

44 $885.40 $761.08 $675.92 $507.24

45 $915.19 $786.68 $698.66 $524.31

46 $950.68 $817.19 $725.75 $544.64

47 $990.61 $851.52 $756.23 $567.52

48 $1,036.24 $890.74 $791.07 $593.66

49 $1,081.24 $929.42 $825.42 $619.44

50 $1,131.95 $973.00 $864.13 $648.49

51 $1,182.02 $1,016.04 $902.35 $677.17

52 $1,237.15 $1,063.44 $944.44 $708.76

53 $1,292.93 $1,111.38 $987.02 $740.71

54 $1,353.14 $1,163.14 $1,032.98 $775.21

55 $1,413.35 $1,214.89 $1,078.95 $809.70

56 $1,478.63 $1,271.01 $1,128.78 $847.10

57 $1,544.54 $1,327.67 $1,179.10 $884.86

58 $1,614.89 $1,388.14 $1,232.81 $925.16

59 $1,649.75 $1,418.10 $1,259.42 $945.13

60 $1,720.10 $1,478.58 $1,313.12 $985.44

61 $1,780.95 $1,530.88 $1,359.57 $1,020.29

62 $1,820.87 $1,565.20 $1,390.05 $1,043.17

63 $1,870.94 $1,608.24 $1,428.28 $1,071.85

64-99 $1,901.35 $1,634.38 $1,451.49 $1,089.27


Solano and Sonoma (partial) Counties

Rating Region 2




0-14 $474.75 $408.09 $362.42 $271.98

15 $516.95 $444.36 $394.64 $296.16

16 $533.09 $458.23 $406.96 $305.40

17 $549.22 $472.10 $419.28 $314.65

18 $566.60 $487.04 $432.54 $324.60

19 $583.97 $501.98 $445.81 $334.56

20 $601.97 $517.45 $459.55 $344.87

21 $620.60 $533.46 $473.77 $355.54

22 $620.60 $533.46 $473.77 $355.54

23 $620.60 $533.46 $473.77 $355.54

24 $620.60 $533.46 $473.77 $355.54

25 $623.07 $535.58 $475.65 $356.95

26 $635.48 $546.25 $485.13 $364.07

27 $650.38 $559.06 $496.50 $372.60

28 $674.58 $579.86 $514.97 $386.46

29 $694.44 $596.93 $530.14 $397.84

30 $704.37 $605.47 $537.72 $403.53

31 $719.26 $618.27 $549.09 $412.06

32 $734.16 $631.07 $560.46 $420.59

33 $743.47 $639.07 $567.56 $425.93

34 $753.40 $647.61 $575.14 $431.62

35 $758.36 $651.88 $578.93 $434.46

36 $763.33 $656.14 $582.72 $437.30

37 $768.29 $660.41 $586.51 $440.15

38 $773.25 $664.68 $590.30 $442.99

39 $783.18 $673.21 $597.88 $448.68

40 $793.11 $681.75 $605.46 $454.37

41 $808.01 $694.55 $616.83 $462.90

42 $822.28 $706.82 $627.73 $471.08

43 $842.14 $723.89 $642.89 $482.46

44 $866.96 $745.23 $661.84 $496.68

45 $896.13 $770.30 $684.11 $513.39

46 $930.88 $800.18 $710.64 $533.30

47 $969.98 $833.78 $740.48 $555.70

48 $1,014.66 $872.19 $774.59 $581.30

49 $1,058.73 $910.07 $808.23 $606.54

50 $1,108.37 $952.74 $846.13 $634.98

51 $1,157.40 $994.88 $883.56 $663.07

52 $1,211.39 $1,041.29 $924.78 $694.00

53 $1,266.00 $1,088.24 $966.47 $725.29

54 $1,324.96 $1,138.92 $1,011.47 $759.06

55 $1,383.92 $1,189.59 $1,056.48 $792.84

56 $1,447.84 $1,244.54 $1,105.28 $829.46

57 $1,512.38 $1,300.02 $1,154.55 $866.43

58 $1,581.26 $1,359.23 $1,207.14 $905.90

59 $1,615.40 $1,388.57 $1,233.19 $925.45

60 $1,684.28 $1,447.78 $1,285.78 $964.92

61 $1,743.86 $1,499.00 $1,331.26 $999.05

62 $1,782.95 $1,532.60 $1,361.11 $1,021.44

63 $1,831.98 $1,574.75 $1,398.53 $1,049.53

64-99 $1,861.76 $1,600.34 $1,421.26 $1,066.59


El Dorado (partial), Placer (partial), Sacramento and Yolo Counties

Rating Region 3




0-14 $449.32 $386.23 $343.01 $257.41

15 $489.26 $420.56 $373.50 $280.29

16 $504.53 $433.69 $385.16 $289.04

17 $519.80 $446.81 $396.82 $297.79

18 $536.25 $460.95 $409.37 $307.21

19 $552.69 $475.09 $421.93 $316.64

20 $569.73 $489.73 $434.93 $326.39

21 $587.36 $504.89 $448.39 $336.50

22 $587.36 $504.89 $448.39 $336.50

23 $587.36 $504.89 $448.39 $336.50

24 $587.36 $504.89 $448.39 $336.50

25 $589.70 $506.89 $450.17 $337.83

26 $601.44 $516.99 $459.14 $344.56

27 $615.54 $529.11 $469.90 $352.64

28 $638.45 $548.80 $487.39 $365.76

29 $657.24 $564.96 $501.74 $376.53

30 $666.64 $573.03 $508.91 $381.91

31 $680.74 $585.15 $519.67 $389.99

32 $694.83 $597.27 $530.43 $398.07

33 $703.64 $604.84 $537.16 $403.11

34 $713.04 $612.92 $544.33 $408.50

35 $717.74 $616.96 $547.92 $411.19

36 $722.44 $621.00 $551.51 $413.88

37 $727.14 $625.04 $555.09 $416.57

38 $731.83 $629.07 $558.68 $419.26

39 $741.23 $637.15 $565.86 $424.65

40 $750.63 $645.23 $573.03 $430.03

41 $764.73 $657.35 $583.79 $438.11

42 $778.23 $668.96 $594.10 $445.85

43 $797.03 $685.12 $608.45 $456.61

44 $820.52 $705.31 $626.39 $470.07

45 $848.13 $729.04 $647.46 $485.89

46 $881.02 $757.31 $672.57 $504.73

47 $918.02 $789.12 $700.82 $525.93

48 $960.31 $825.47 $733.10 $550.16

49 $1,002.01 $861.32 $764.94 $574.05

50 $1,049.00 $901.71 $800.81 $600.97

51 $1,095.40 $941.59 $836.23 $627.55

52 $1,146.50 $985.52 $875.24 $656.82

53 $1,198.19 $1,029.95 $914.70 $686.44

54 $1,253.99 $1,077.91 $957.29 $718.40

55 $1,309.78 $1,125.87 $999.89 $750.37

56 $1,370.28 $1,177.87 $1,046.07 $785.03

57 $1,431.36 $1,230.38 $1,092.70 $820.02

58 $1,496.56 $1,286.42 $1,142.47 $857.37

59 $1,528.86 $1,314.19 $1,167.13 $875.88

60 $1,594.06 $1,370.23 $1,216.90 $913.23

61 $1,650.44 $1,418.70 $1,259.95 $945.53

62 $1,687.45 $1,450.51 $1,288.20 $966.73

63 $1,733.85 $1,490.39 $1,323.62 $993.31

64-99 $1,762.03 $1,514.62 $1,345.13 $1,009.45


San Francisco County

Rating Region 4




0-14 $502.02 $431.53 $383.24 $287.61

15 $546.65 $469.89 $417.31 $313.17

16 $563.71 $484.56 $430.33 $322.95

17 $580.77 $499.22 $443.36 $332.72

18 $599.14 $515.02 $457.39 $343.25

19 $617.52 $530.81 $471.41 $353.77

20 $636.55 $547.17 $485.94 $364.68

21 $656.25 $564.10 $500.98 $375.96

22 $656.25 $564.10 $500.98 $375.96

23 $656.25 $564.10 $500.98 $375.96

24 $656.25 $564.10 $500.98 $375.96

25 $658.86 $566.35 $502.98 $377.46

26 $671.99 $577.63 $512.99 $384.98

27 $687.74 $591.17 $525.02 $394.00

28 $713.33 $613.17 $544.56 $408.66

29 $734.33 $631.22 $560.59 $420.69

30 $744.83 $640.25 $568.60 $426.71

31 $760.58 $653.78 $580.63 $435.73

32 $776.33 $667.32 $592.65 $444.75

33 $786.17 $675.78 $600.16 $450.39

34 $796.67 $684.81 $608.18 $456.41

35 $801.92 $689.32 $612.19 $459.42

36 $807.17 $693.83 $616.19 $462.42

37 $812.42 $698.35 $620.20 $465.43

38 $817.67 $702.86 $624.21 $468.44

39 $828.17 $711.88 $632.23 $474.46

40 $838.67 $720.91 $640.24 $480.47

41 $854.42 $734.45 $652.26 $489.49

42 $869.51 $747.42 $663.79 $498.14

43 $890.51 $765.47 $679.82 $510.17

44 $916.76 $788.04 $699.86 $525.21

45 $947.61 $814.55 $723.40 $542.88

46 $984.36 $846.14 $751.46 $563.93

47 $1,025.70 $881.68 $783.02 $587.62

48 $1,072.95 $922.29 $819.09 $614.69

49 $1,119.54 $962.34 $854.66 $641.38

50 $1,172.04 $1,007.47 $894.74 $671.46

51 $1,223.88 $1,052.03 $934.31 $701.16

52 $1,280.98 $1,101.11 $977.90 $733.86

53 $1,338.72 $1,150.75 $1,021.98 $766.95

54 $1,401.07 $1,204.34 $1,069.57 $802.66

55 $1,463.41 $1,257.93 $1,117.17 $838.38

56 $1,531.00 $1,316.03 $1,168.77 $877.10

57 $1,599.25 $1,374.69 $1,220.87 $916.20

58 $1,672.09 $1,437.31 $1,276.48 $957.93

59 $1,708.19 $1,468.33 $1,304.03 $978.61

60 $1,781.03 $1,530.95 $1,359.64 $1,020.34

61 $1,844.03 $1,585.10 $1,407.73 $1,056.43

62 $1,885.37 $1,620.64 $1,439.29 $1,080.12

63 $1,937.21 $1,665.20 $1,478.87 $1,109.82

64-99 $1,968.70 $1,692.27 $1,502.90 $1,127.85


Contra Costa County

Rating Region 5




0-14 $511.40 $439.59 $390.40 $292.98

15 $556.86 $478.67 $425.11 $319.02

16 $574.24 $493.61 $438.37 $328.98

17 $591.62 $508.55 $451.64 $338.94

18 $610.34 $524.64 $465.93 $349.66

19 $629.06 $540.73 $480.22 $360.38

20 $648.44 $557.39 $495.02 $371.49

21 $668.51 $574.64 $510.34 $382.99

22 $668.51 $574.64 $510.34 $382.99

23 $668.51 $574.64 $510.34 $382.99

24 $668.51 $574.64 $510.34 $382.99

25 $671.17 $576.93 $512.37 $384.51

26 $684.54 $588.42 $522.58 $392.17

27 $700.59 $602.21 $534.83 $401.36

28 $726.66 $624.63 $554.73 $416.30

29 $748.05 $643.01 $571.06 $428.55

30 $758.75 $652.21 $579.23 $434.68

31 $774.79 $666.00 $591.47 $443.87

32 $790.83 $679.79 $603.72 $453.06

33 $800.86 $688.41 $611.38 $458.81

34 $811.56 $697.60 $619.54 $464.94

35 $816.91 $702.20 $623.63 $468.00

36 $822.25 $706.80 $627.71 $471.06

37 $827.60 $711.39 $631.79 $474.13

38 $832.95 $715.99 $635.87 $477.19

39 $843.65 $725.19 $644.04 $483.32

40 $854.34 $734.38 $652.20 $489.45

41 $870.39 $748.17 $664.45 $498.64

42 $885.76 $761.39 $676.19 $507.45

43 $907.15 $779.78 $692.52 $519.70

44 $933.89 $802.76 $712.93 $535.02

45 $965.31 $829.77 $736.92 $553.02

46 $1,002.75 $861.95 $765.50 $574.47

47 $1,044.86 $898.15 $797.65 $598.60

48 $1,093.00 $939.52 $834.39 $626.17

49 $1,140.46 $980.32 $870.63 $653.36

50 $1,193.94 $1,026.29 $911.45 $684.00

51 $1,246.75 $1,071.69 $951.77 $714.26

52 $1,304.91 $1,121.68 $996.17 $747.58

53 $1,363.74 $1,172.25 $1,041.08 $781.28

54 $1,427.24 $1,226.84 $1,089.56 $817.66

55 $1,490.75 $1,281.43 $1,138.04 $854.04

56 $1,559.61 $1,340.62 $1,190.60 $893.49

57 $1,629.13 $1,400.38 $1,243.68 $933.32

58 $1,703.33 $1,464.16 $1,300.33 $975.83

59 $1,740.10 $1,495.77 $1,328.39 $996.90

60 $1,814.31 $1,559.55 $1,385.04 $1,039.41

61 $1,878.48 $1,614.72 $1,434.03 $1,076.17

62 $1,920.60 $1,650.92 $1,466.18 $1,100.30

63 $1,973.41 $1,696.31 $1,506.50 $1,130.55

64-99 $2,005.49 $1,723.89 $1,530.99 $1,148.93


Alameda County

Rating Region 6




0-14 $463.29 $398.23 $353.67 $265.41

15 $504.47 $433.63 $385.11 $289.01

16 $520.21 $447.17 $397.13 $298.03

17 $535.96 $460.70 $409.15 $307.05

18 $552.91 $475.28 $422.09 $316.76

19 $569.87 $489.85 $435.04 $326.48

20 $587.43 $504.95 $448.45 $336.54

21 $605.61 $520.58 $462.33 $346.96

22 $605.61 $520.58 $462.33 $346.96

23 $605.61 $520.58 $462.33 $346.96

24 $605.61 $520.58 $462.33 $346.96

25 $608.02 $522.65 $464.17 $348.33

26 $620.14 $533.06 $473.41 $355.27

27 $634.67 $545.55 $484.51 $363.60

28 $658.29 $565.86 $502.54 $377.13

29 $677.67 $582.51 $517.33 $388.23

30 $687.36 $590.84 $524.73 $393.78

31 $701.89 $603.34 $535.82 $402.11

32 $716.43 $615.83 $546.92 $410.44

33 $725.51 $623.64 $553.86 $415.64

34 $735.20 $631.97 $561.25 $421.19

35 $740.05 $636.13 $564.95 $423.97

36 $744.89 $640.30 $568.65 $426.74

37 $749.74 $644.46 $572.35 $429.52

38 $754.58 $648.63 $576.05 $432.29

39 $764.27 $656.96 $583.44 $437.85

40 $773.96 $665.28 $590.84 $443.40

41 $788.49 $677.78 $601.94 $451.72

42 $802.42 $689.75 $612.57 $459.70

43 $821.80 $706.41 $627.36 $470.81

44 $846.03 $727.23 $645.86 $484.68

45 $874.49 $751.70 $667.58 $500.99

46 $908.40 $780.85 $693.47 $520.42

47 $946.56 $813.65 $722.60 $542.28

48 $990.16 $851.13 $755.89 $567.26

49 $1,033.16 $888.09 $788.71 $591.89

50 $1,081.61 $929.73 $825.70 $619.65

51 $1,129.45 $970.86 $862.22 $647.05

52 $1,182.14 $1,016.15 $902.44 $677.24

53 $1,235.43 $1,061.96 $943.13 $707.77

54 $1,292.96 $1,111.41 $987.05 $740.73

55 $1,350.49 $1,160.86 $1,030.97 $773.69

56 $1,412.87 $1,214.48 $1,078.58 $809.43

57 $1,475.85 $1,268.62 $1,126.66 $845.51

58 $1,543.07 $1,326.40 $1,177.98 $884.02

59 $1,576.38 $1,355.04 $1,203.41 $903.10

60 $1,643.60 $1,412.82 $1,254.73 $941.61

61 $1,701.74 $1,462.79 $1,299.11 $974.92

62 $1,739.89 $1,495.59 $1,328.23 $996.78

63 $1,787.74 $1,536.71 $1,364.76 $1,024.18

64-99 $1,816.80 $1,561.69 $1,386.94 $1,040.83


Santa Clara County (partial)

Rating Region 7




0-14 $534.41 $459.38 $407.97 $306.16

15 $581.92 $500.21 $444.24 $333.38

16 $600.08 $515.82 $458.10 $343.78

17 $618.24 $531.43 $471.97 $354.19

18 $637.80 $548.25 $486.90 $365.39

19 $657.36 $565.06 $501.83 $376.60

20 $677.62 $582.48 $517.30 $388.21

21 $698.59 $600.50 $533.31 $400.22

22 $698.59 $600.50 $533.31 $400.22

23 $698.59 $600.50 $533.31 $400.22

24 $698.59 $600.50 $533.31 $400.22

25 $701.38 $602.89 $535.43 $401.81

26 $715.35 $614.90 $546.10 $409.82

27 $732.11 $629.31 $558.89 $419.42

28 $759.36 $652.73 $579.69 $435.03

29 $781.71 $671.95 $596.76 $447.84

30 $792.89 $681.56 $605.29 $454.24

31 $809.66 $695.97 $618.09 $463.85

32 $826.42 $710.38 $630.89 $473.45

33 $836.90 $719.39 $638.89 $479.46

34 $848.08 $729.00 $647.42 $485.86

35 $853.67 $733.80 $651.69 $489.06

36 $859.25 $738.60 $655.95 $492.26

37 $864.84 $743.41 $660.22 $495.46

38 $870.43 $748.21 $664.49 $498.67

39 $881.61 $757.82 $673.02 $505.07

40 $892.79 $767.43 $681.55 $511.47

41 $909.55 $781.84 $694.35 $521.08

42 $925.62 $795.65 $706.62 $530.28

43 $947.97 $814.87 $723.68 $543.09

44 $975.92 $838.89 $745.02 $559.10

45 $1,008.75 $867.11 $770.08 $577.91

46 $1,047.87 $900.74 $799.94 $600.32

47 $1,091.88 $938.57 $833.54 $625.53

48 $1,142.18 $981.80 $871.94 $654.35

49 $1,191.78 $1,024.44 $909.80 $682.76

50 $1,247.67 $1,072.48 $952.47 $714.78

51 $1,302.85 $1,119.92 $994.60 $746.40

52 $1,363.63 $1,172.16 $1,041.00 $781.22

53 $1,425.11 $1,225.00 $1,087.93 $816.44

54 $1,491.47 $1,282.05 $1,138.59 $854.46

55 $1,557.84 $1,339.09 $1,189.25 $892.48

56 $1,629.79 $1,400.94 $1,244.18 $933.70

57 $1,702.44 $1,463.40 $1,299.64 $975.32

58 $1,779.99 $1,530.05 $1,358.84 $1,019.74

59 $1,818.41 $1,563.08 $1,388.17 $1,041.76

60 $1,895.95 $1,629.73 $1,447.37 $1,086.18

61 $1,963.01 $1,687.38 $1,498.56 $1,124.60

62 $2,007.02 $1,725.21 $1,532.16 $1,149.81

63 $2,062.21 $1,772.65 $1,574.29 $1,181.43

64-99 $2,095.73 $1,801.46 $1,599.88 $1,200.63


San Mateo County

Rating Region 8




0-14 $482.55 $414.79 $368.37 $276.45

15 $525.44 $451.66 $401.12 $301.02

16 $541.84 $465.76 $413.64 $310.42

17 $558.24 $479.85 $426.16 $319.81

18 $575.90 $495.04 $439.64 $329.93

19 $593.56 $510.22 $453.12 $340.05

20 $611.85 $525.94 $467.09 $350.53

21 $630.79 $542.22 $481.55 $361.38

22 $630.79 $542.22 $481.55 $361.38

23 $630.79 $542.22 $481.55 $361.38

24 $630.79 $542.22 $481.55 $361.38

25 $633.30 $544.38 $483.46 $362.81

26 $645.92 $555.22 $493.09 $370.04

27 $661.06 $568.23 $504.65 $378.71

28 $685.66 $589.38 $523.43 $392.81

29 $705.84 $606.73 $538.84 $404.37

30 $715.93 $615.41 $546.54 $410.15

31 $731.07 $628.42 $558.10 $418.83

32 $746.21 $641.43 $569.66 $427.50

33 $755.67 $649.56 $576.88 $432.92

34 $765.76 $658.24 $584.58 $438.70

35 $770.81 $662.58 $588.44 $441.59

36 $775.86 $666.92 $592.29 $444.48

37 $780.90 $671.25 $596.14 $447.38

38 $785.95 $675.59 $599.99 $450.27

39 $796.04 $684.27 $607.70 $456.05

40 $806.13 $692.94 $615.40 $461.83

41 $821.27 $705.95 $626.96 $470.50

42 $835.78 $718.43 $638.03 $478.81

43 $855.97 $735.78 $653.44 $490.38

44 $881.20 $757.46 $672.71 $504.83

45 $910.84 $782.95 $695.34 $521.82

46 $946.17 $813.31 $722.30 $542.05

47 $985.91 $847.47 $752.64 $564.82

48 $1,031.32 $886.51 $787.31 $590.84

49 $1,076.11 $925.01 $821.50 $616.50

50 $1,126.57 $968.38 $860.02 $645.41

51 $1,176.40 $1,011.22 $898.06 $673.95

52 $1,231.28 $1,058.39 $939.96 $705.39

53 $1,286.79 $1,106.10 $982.33 $737.19

54 $1,346.71 $1,157.61 $1,028.08 $771.52

55 $1,406.63 $1,209.12 $1,073.82 $805.85

56 $1,471.60 $1,264.97 $1,123.42 $843.07

57 $1,537.21 $1,321.36 $1,173.50 $880.66

58 $1,607.22 $1,381.55 $1,226.95 $920.77

59 $1,641.91 $1,411.37 $1,253.44 $940.64

60 $1,711.93 $1,471.55 $1,306.89 $980.76

61 $1,772.49 $1,523.60 $1,353.12 $1,015.45

62 $1,812.22 $1,557.76 $1,383.45 $1,038.21

63 $1,862.06 $1,600.60 $1,421.49 $1,066.76

64-99 $1,892.32 $1,626.61 $1,444.60 $1,084.10


Santa Cruz County

Rating Region 9




0-14 $471.02 $404.88 $359.58 $269.84

15 $512.89 $440.87 $391.54 $293.83

16 $528.89 $454.63 $403.76 $303.00

17 $544.90 $468.39 $415.98 $312.17

18 $562.14 $483.21 $429.14 $322.05

19 $579.38 $498.03 $442.30 $331.93

20 $597.24 $513.38 $455.93 $342.15

21 $615.72 $529.27 $470.04 $352.75

22 $615.72 $529.27 $470.04 $352.75

23 $615.72 $529.27 $470.04 $352.75

24 $615.72 $529.27 $470.04 $352.75

25 $618.17 $531.37 $471.91 $354.15

26 $630.49 $541.96 $481.31 $361.20

27 $645.26 $554.66 $492.59 $369.67

28 $669.28 $575.30 $510.93 $383.42

29 $688.98 $592.24 $525.97 $394.71

30 $698.83 $600.71 $533.49 $400.36

31 $713.61 $613.41 $544.77 $408.82

32 $728.38 $626.11 $556.05 $417.29

33 $737.62 $634.05 $563.10 $422.58

34 $747.47 $642.52 $570.62 $428.22

35 $752.40 $646.75 $574.38 $431.04

36 $757.32 $650.98 $578.14 $433.87

37 $762.25 $655.22 $581.90 $436.69

38 $767.17 $659.45 $585.66 $439.51

39 $777.03 $667.92 $593.18 $445.15

40 $786.88 $676.39 $600.70 $450.80

41 $801.65 $689.09 $611.98 $459.26

42 $815.82 $701.26 $622.79 $467.38

43 $835.52 $718.20 $637.83 $478.66

44 $860.15 $739.37 $656.64 $492.77

45 $889.09 $764.25 $678.73 $509.35

46 $923.56 $793.88 $705.05 $529.11

47 $962.35 $827.23 $734.66 $551.33

48 $1,006.69 $865.33 $768.50 $576.72

49 $1,050.40 $902.91 $801.88 $601.77

50 $1,099.66 $945.25 $839.48 $629.99

51 $1,148.30 $987.06 $876.61 $657.85

52 $1,201.87 $1,033.11 $917.50 $688.54

53 $1,256.05 $1,079.68 $958.87 $719.58

54 $1,314.54 $1,129.96 $1,003.52 $753.09

55 $1,373.03 $1,180.24 $1,048.17 $786.60

56 $1,436.45 $1,234.75 $1,096.59 $822.94

57 $1,500.49 $1,289.80 $1,145.47 $859.62

58 $1,568.83 $1,348.54 $1,197.64 $898.77

59 $1,602.69 $1,377.65 $1,223.50 $918.17

60 $1,671.04 $1,436.40 $1,275.67 $957.33

61 $1,730.14 $1,487.21 $1,320.79 $991.19

62 $1,768.93 $1,520.55 $1,350.40 $1,013.41

63 $1,817.58 $1,562.36 $1,387.54 $1,041.28

64-99 $1,847.12 $1,587.76 $1,410.09 $1,058.20


Sutter Health Plus 2021 Individual and Family Plan Rates | Effective January 1, 2021

San Joaquin and Stanislaus Counties

Rating Region 10




0-14 $432.18 $371.50 $329.93 $247.60

15 $470.60 $404.52 $359.26 $269.60

16 $485.29 $417.15 $370.47 $278.02

17 $499.98 $429.77 $381.68 $286.43

18 $515.80 $443.37 $393.76 $295.50

19 $531.61 $456.97 $405.83 $304.56

20 $548.00 $471.05 $418.34 $313.94

21 $564.96 $485.63 $431.29 $323.66

22 $564.96 $485.63 $431.29 $323.66

23 $564.96 $485.63 $431.29 $323.66

24 $564.96 $485.63 $431.29 $323.66

25 $567.21 $487.56 $433.00 $324.95

26 $578.50 $497.27 $441.63 $331.42

27 $592.06 $508.93 $451.98 $339.19

28 $614.10 $527.87 $468.80 $351.81

29 $632.17 $543.41 $482.60 $362.17

30 $641.21 $551.18 $489.50 $367.35

31 $654.77 $562.83 $499.85 $375.12

32 $668.33 $574.49 $510.20 $382.88

33 $676.81 $581.77 $516.67 $387.74

34 $685.84 $589.54 $523.57 $392.92

35 $690.36 $593.43 $527.02 $395.51

36 $694.88 $597.31 $530.47 $398.09

37 $699.40 $601.20 $533.92 $400.68

38 $703.92 $605.08 $537.37 $403.27

39 $712.96 $612.85 $544.27 $408.45

40 $722.00 $620.62 $551.18 $413.63

41 $735.56 $632.28 $561.53 $421.40

42 $748.55 $643.45 $571.45 $428.84

43 $766.63 $658.99 $585.25 $439.20

44 $789.23 $678.41 $602.50 $452.15

45 $815.78 $701.23 $622.77 $467.36

46 $847.42 $728.43 $646.92 $485.48

47 $883.01 $759.02 $674.09 $505.87

48 $923.69 $793.99 $705.14 $529.17

49 $963.80 $828.47 $735.76 $552.15

50 $1,008.99 $867.32 $770.26 $578.05

51 $1,053.62 $905.68 $804.34 $603.62

52 $1,102.77 $947.93 $841.86 $631.77

53 $1,152.49 $990.66 $879.81 $660.25

54 $1,206.16 $1,036.80 $920.78 $691.00

55 $1,259.83 $1,082.93 $961.75 $721.75

56 $1,318.02 $1,132.95 $1,006.17 $755.09

57 $1,376.77 $1,183.45 $1,051.03 $788.75

58 $1,439.48 $1,237.36 $1,098.90 $824.67

59 $1,470.55 $1,264.07 $1,122.62 $842.47

60 $1,533.26 $1,317.97 $1,170.49 $878.40

61 $1,587.50 $1,364.59 $1,211.90 $909.47

62 $1,623.09 $1,395.18 $1,239.07 $929.86

63 $1,667.72 $1,433.55 $1,273.14 $955.43

64-99 $1,694.83 $1,456.85 $1,293.83 $970.95

Page 14

Rate Guide 2021 Individual and Family PlansSutter Health Plus Rate GuideIFP RatesFor YourselfFor a Family

Licensed Service AreaAlameda CountyContra Costa CountyEl Dorado County (partial)Placer County (partial)Sacramento CountySan Francisco CountySan Joaquin CountySan Mateo CountySanta Clara County (partial)Santa Cruz CountyStanislaus CountySolano CountySonoma County (partial)Sutter County (partial)Yolo County

Rating Region 1 Sutter County (partial)Rating Region 2 Solano and Sonoma (partial) CountiesRating Region 3 El Dorado (partial), Placer (partial), Sacramento and Yolo CountiesRating Region 4 San Francisco CountyRating Region 5 Contra Costa CountyRating Region 6 Alameda CountyRating Region 7 Santa Clara County (partial)Rating Region 8 San Mateo CountyRating Region 9 Santa Cruz CountyRating Region 10 San Joaquin and Stanislaus Counties

rate guide 2021 individual and family plans · 2020. 12. 21. · rate guide 2021 individual and...

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