Sutter Health Plan
Sutter Health Plan is a not-for-profit HMO health insurance provider serving individuals, families, and employer groups across Northern California through an integrated network of over 8,000 providers affiliated with parent Sutter Health.
- Company typePrivate
- Founded-
- HeadquartersSacramento, United States
- Headcount101–250
- GTM typeB2B and B2C
- OfferingServices
What Sutter Health Plan does
Sutter Health Plan is a not-for-profit health maintenance organization (HMO) that provides comprehensive health insurance coverage to individuals, families, and employer groups across Northern California, including the Greater Sacramento area, Central Valley, and Bay Area. It operates as a subsidiary of Sutter Health and is also known under the trade name Sutter Health Plus. The plan's product portfolio spans Individual and Family Plans (Platinum, Gold, Silver, and Bronze metal tiers), Small Group Plans for employers with 1-100 employees (including HDHP options), and Large Group Plans for employers with 101+ employees (Summit, Peak, Ridge, and Vista HDHP tiers). Members select a primary care physician who coordinates care within an integrated network of over 8,000 providers that is structurally aligned with Sutter Health's hospital and clinic footprint.
The plan's underlying technology stack includes the My Health Online patient portal and mobile app for appointments, lab results, video visits, and prescription management, plus an HL7 FHIR-based API Developer Portal supporting CMS Interoperability and Patient Access Rule compliance. Distribution is hybrid: dedicated account executives (Tammy Mendez for large groups, Sean Donnalley for small groups) cover direct employer relationships, while broker partnerships with AMWINS Connect, CRC Benefits, Word & Brown, Emerson Rogers, and Warner Pacific, plus quoting platforms HealthConnect and Quotit, handle small-group and individual/family distribution. Optional benefits are delivered through partner integrations: CVS Caremark for pharmacy, Delta Dental for pediatric dental, VSP for vision, ACN Group/OptumHealth for acupuncture and chiropractic, and Carelon Behavioral Health (effective January 1, 2026) for mental health and substance use disorder services.
Revenue is generated entirely through recurring monthly health insurance premiums across the three customer segments, with pricing structured by metal tier for individuals and by customized plan design for employer groups. The company employs 145 people at its Sacramento, CA headquarters and uses digital member, broker, employer, and provider portals for self-service administration. Publicly disclosed financial figures are not available.
Sutter Health Plan firmographics
Firmographics- Name
- Sutter Health Plan
- Legal name
- Sutter Health Plan
- Website
- https://sutterhealthplan.org
- Company type
- Private
- Operating status
- Operating
- Headcount range
- 101–250 employees
- Short description
- Sutter Health Plan is a not-for-profit HMO health insurance provider serving individuals, families, and employer groups across Northern California through an integrated network of over 8,000 providers affiliated with parent Sutter Health.
- Ownership category
- akta.pro rank
Sutter Health Plan industry classification
Industry- Product category
- Health Insurance (HMO Managed Care)
- NAICS
- Direct Health and Medical Insurance Carriers (524114), Direct Life, Health, and Medical Insurance Carriers (52411)
- SIC
- Hospital & Medical Service Plans (6324)
- akta.pro primary industry
- Managed Care / Network-Based Group Health Plans (Carrier Network Products) (FSAIAFAO)
- akta.pro secondary industries
- Group HMO Plans (FSAIAFAK), Large Group Health Insurance (Mid-Market & National Accounts) (FSAIAFAE), CO-OP / Nonprofit Individual Market Plans (HLAEABAH), Public Sector & Government Employer Group Health Plans (FSAIAFAF)
Keywords
Where Sutter Health Plan is headquartered
LocationHeadquarters
- HQ city
- Sacramento
- HQ country
- United States
- HQ region
- North America
Offices2 records
Markets served
Sutter Health Plan business model
Business model- GTM type
- B2B and B2C
- Offering type
- Services
- Cost components
- Personnel, Operations, Marketing or Sales, Technology or R&D, Infrastructure
Revenue model
- Health Insurance Premiums: Sutter Health Plan generates revenue through monthly premium payments from individuals, families, and employer groups. The company offers individual and family plans, small group plans (1-100 employees), and large group plans (101+ employees). Premiums are paid on a monthly basis and cover comprehensive healthcare services including preventive care, hospitalization, prescription drugs, mental health services, and specialized benefits.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | Individual and Family Plans - HMO with Platinum, Gold, Silver, and Bronze tiers |
| Subscription | Monthly | Small Group Plans - HMO with Platinum, Gold, Silver, and Bronze tiers including HDHP options |
| Subscription | Monthly | Large Group Plans - Custom employer plans including Summit, Peak, Ridge, and Vista HDHP tiers |
Go-to-market motion2 records
Distribution channels4 records
Marketing channels7 records
Sutter Health Plan product offering
Product offeringCore offering
Sutter Health Plan is a not-for-profit HMO that sells health insurance coverage to individuals, families, and employer groups across Northern California. The plan offers Individual and Family Plans with Platinum/Gold/Silver/Bronze metal tiers, Small Group Plans for employers with 1-100 employees, and Large Group Plans for employers with 101+ employees, all delivered through an integrated provider network of over 8,000 clinicians affiliated with the Sutter Health delivery system.
Product overview
Sutter Health Plan is an HMO (Health Maintenance Organization) health insurance provider offering comprehensive coverage with access to a trusted network of award-winning care in Northern California. The product portfolio consists of three main plan categories: Individual and Family Plans (Platinum, Gold, Silver, Bronze HMO tiers), Small Group Plans (for employers with 1-100 employees, including HDHP options), and Large Group Plans (for employers with 101+ employees, including Summit, Peak, Ridge, and Vista HDHP tiers). Optional benefit modules include dental (Delta Dental), vision (VSP), acupuncture and chiropractic (ACN Group/OptumHealth), and behavioral health (Carelon Behavioral Health). Members access care through a digital ecosystem that includes the My Health Online patient portal, Scout wellness app for teen mental health, video visit capabilities, and Sutter Walk-In Care clinics. Pharmacy benefits are managed through CVS Caremark. The company operates distinct member, broker, employer, and provider portals for self-service functionality.
Differentiator
Problem solved
Functional benefit
Products and services
- Individual and Family Plans HMO health insurance purchased directly by individuals or families, with Platinum, Gold, Silver, and Bronze tier options available for the 2026 plan year (plan codes MI01 Platinum, MI02 Gold, MI03 Silver, MI04 Bronze). Coverage includes preventive care, hospitalization, prescription drugs, mental health services, and pediatric dental and vision for dependents under 19.
- Small Group Plans HMO health insurance for California employers with 1 to 100 employees, including 2026 traditional HMO options (MS90 Platinum, MS97/MS93 Gold, MS94 Silver, MS49 Bronze) and HDHP variants (SD32, SD31, SD23). Optional adult dental and vision benefits can be elected by the employer, and broker access is available through HealthConnect and Quotit quoting platforms.
- Large Group Plans Customized HMO health plans for California employers with 101 or more employees, offered in 2026 tiers including Summit (LG18-LG22), Peak (LG23-LG29), Ridge (LG30-LG32), and Vista HDHP (HL10-HL14). Plans are sold through dedicated account executives and support optional acupuncture and chiropractic benefits.
- Pharmacy Benefits Pharmacy benefit management for Sutter Health Plan members, delivered through CVS Caremark. Includes retail pharmacy access, mail order service, specialty prescriptions, claims processing, and medication prior authorization requests.
- Behavioral Health Benefits Mental health and substance use disorder services for Sutter Health Plan members, managed through Carelon Behavioral Health of California, Inc. as of January 1, 2026. Provides access to in-person and telehealth visits with evidence-based treatments.
- Dental Benefits Pediatric dental benefits provided through Delta Dental's DeltaCare USA Network for Small Group and Individual/Family plan members until the end of the month they turn 19. Optional adult dental benefits are available for Small Group employers that elect to include them.
- Vision Benefits Pediatric vision benefits provided through VSP Vision Care for Small Group and Individual/Family plan members until age 19, including annual refractive eye exams. Large Group plans include annual refractive eye exam coverage, and optional vision coverage can be elected by Small and Large Group employers.
- Acupuncture and Chiropractic Benefits Optional acupuncture and chiropractic benefits delivered through ACN Group of California (also known as OptumHealth Physical Health of California) when elected by an employer group.
Quantifiable outcome
- Over 8,000 providers in network across Sacramento, Central Valley and Bay Area
- +1 more outcomes
Companies that use Sutter Health Plan
Customer profileNamed customers2 records
Segments5 records
Ideal customer profiles4 records
Sutter Health Plan technology and API
TechnologyTechnology focussed No
API detail
- Has API
- Yes
- API docs
- API detail
Core technology
AI maturity
App detail
Integration8 records
Feature4 records
Sutter Health Plan partnerships and signals
Strategic signalPartnerships
Twelve partnerships are on record, tiered core and secondary.
- Carelon Behavioral Health of California, Inc.coreCarelon Behavioral Health replaced U.S. Behavioral Health Plan, California (USBHPC) as the behavioral health plan partner for Sutter Health Plan, effective January 1, 2026. Carelon manages all mental health and substance use disorder services covered under Sutter Health Plan benefits, providing personalized care through in-person and telehealth visits with evidence-based treatments.
- CVS CaremarkcoreCVS Caremark manages pharmacy benefits for Sutter Health Plan members, including retail pharmacies, mail order prescriptions, specialty prescriptions, claims processing and medication prior authorization requests.
- Delta Dental (DeltaCare USA Network)coreDelta Dental provides pediatric dental benefits through the DeltaCare USA Network for small group and individual/family plan members until age 19. Small group employers can also elect optional adult dental benefits.
- VSP Vision CarecoreVSP provides pediatric vision benefits for small group and individual/family plan members until age 19, including annual refractive eye exams. Large group plans receive annual refractive eye exam coverage.
- ACN Group of California (OptumHealth Physical Health of California)secondaryACN Group of California provides acupuncture and chiropractic optional benefits when elected by employer groups. Also called OptumHealth Physical Health of California.
- HealthConnectsecondaryHealthConnect is a quoting platform used for small group plan quotes and enrollment, enabling brokers to generate quotes and manage small group employer enrollments.
- QuotitsecondaryQuotit is a quoting platform used for small group plan quotes, allowing brokers to compare options and generate quotes for small group employers.
- AMWINS ConnectsecondaryAMWINS Connect is a general agency partner for small group plan distribution, providing broker support and access to Sutter Health Plan products.
- CRC BenefitssecondaryCRC Benefits is a general agency partner for small group plan distribution through the BenefitMall platform.
- Word & BrownsecondaryWord & Brown is a general agency partner for small group plan distribution, offering broker resources and product access.
- Emerson RogerssecondaryEmerson Rogers is a general agency partner for small group plan distribution.
- Warner PacificsecondaryWarner Pacific is a general agency partner for small group plan distribution in California.
Scale indicators3 records
Recent moves6 records
Expansion highlights5 records
Sutter Health Plan competitors and assessment
Company assessmentDirect peers
- Kaiser Permanente: Integrated payer-provider HMO with dominant Northern California presence across Sacramento, Bay Area, and Central Valley. Directly competes with Sutter Health Plan for individual, small group, and large group HMO members using an integrated care model similar in concept but larger in scale.
- Western Health Advantage: Sacramento-based not-for-profit HMO health plan serving Northern California employers and individuals. Directly competes in the same Sacramento service area with overlapping provider networks and similar small-group and large-group distribution through brokers.
Broad incumbents
- Cigna: Global health services company offering HMO, PPO, and EPO products with California presence in individual and group markets. Competes for large-group national accounts and broker-distributed small-group business in Northern California.
- Aetna (CVS Health): National health insurer with California HMO and PPO products; parent CVS Health also owns CVS Caremark which is Sutter Health Plan's PBM partner. Competes for large group and individual members while sharing pharmacy infrastructure.
- Health Net: California-focused health plan offering HMO, PPO, and Medicare products across individual, small group, and large group segments. Overlaps with Sutter Health Plan in individual ACA marketplace and employer-sponsored group business in Northern California.
- Blue Shield of California: California's largest not-for-profit health plan offering HMO, PPO, and tandem products across individual, small group, and large group markets. Competes head-to-head with Sutter Health Plan in Northern California but with broader product portfolio, wider provider network, and significantly larger scale.
- UnitedHealthcare: Nation's largest health insurer with broad California presence across HMO, PPO, and tiered network products. Competes with Sutter Health Plan in large group and individual markets with substantially greater scale, capital, and product breadth.
- Anthem Blue Cross: Major California health insurer offering HMO, PPO, and EPO products across individual, small group, and large group markets. Competes with Sutter Health Plan for broker-sold small group and large group business with national brand backing and broader provider networks.
Regional players
- Sharp Health Plan: San Diego-based not-for-profit HMO affiliated with Sharp HealthCare system. Comparable regional integrated payer-provider model with similar size and structure to Sutter Health Plan, but operating in a different Southern California geography.
- Santa Clara Family Health Plan: Local HMO health plan serving Santa Clara County with Medi-Cal and commercial products. Comparable regional, mission-driven HMO model in the Bay Area but with focus on government-sponsored plans rather than commercial employer segments.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat5 records
Key risks6 records
Key highlights6 records
Customer concentration
Sutter Health Plan social profiles
Digital presenceSutter Health Plan compliance and trust
Trust signalCompliance3 records
Sutter Health Plan financial estimates
Financial estimateRevenue estimate
Valuation estimate
Sutter Health Plan leadership team
Management profileNumber of profiles
Profiles2 records
Sutter Health Plan funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Sutter Health Plan M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Sutter Health Plan
What does Sutter Health Plan do?
Sutter Health Plan is a not-for-profit HMO that sells health insurance coverage to individuals, families, and employer groups across Northern California. The plan offers Individual and Family Plans with Platinum/Gold/Silver/Bronze metal tiers, Small Group Plans for employers with 1-100 employees, and Large Group Plans for employers with 101+ employees, all delivered through an integrated provider network of over 8,000 clinicians affiliated with the Sutter Health delivery system.
Is Sutter Health Plan a public or private company?
Sutter Health Plan is a private company. It is classified as nonprofit foundation owned and is currently operating.
When was Sutter Health Plan founded?
Sutter Health Plan was founded in -1. It employs 101 to 250 people.
Where is Sutter Health Plan based?
Sutter Health Plan is headquartered in Sacramento, United States, in the North America region.
How does Sutter Health Plan make money?
One revenue line is on record: health Insurance Premiums.
Who are Sutter Health Plan's main competitors?
Direct peers on record are Kaiser Permanente and Western Health Advantage. Broad incumbents are Cigna, Aetna (CVS Health), Health Net, Blue Shield of California, UnitedHealthcare and Anthem Blue Cross. Regional players are Sharp Health Plan and Santa Clara Family Health Plan.
Does Sutter Health Plan have an API?
Yes. The Sutter Health Plan developer portal offers HL7 FHIR-based Patient Access and Provider Directory Application Programming Interfaces (APIs) in line with the Centers for Medicare & Medicaid Services (CMS) Interoperability and Patient Access Rule. These APIs enable developers to create tools that give patients secure access to their health data and enhance interoperability. Developer documentation is at docs.safhir.io/client-sutterhealthplus.html.
What industry is Sutter Health Plan in?
Sutter Health Plan's product category is Health Insurance (HMO Managed Care). Its primary akta.pro industry code is FSAIAFAO, Managed Care / Network-Based Group Health Plans (Carrier Network Products), with a secondary code of FSAIAFAK, Group HMO Plans. Its NAICS code is 524114 and its SIC code is 6324.