Sutter Health Plan has issued a portfolio update for their small group plans effective January 1, 2027.
Rate Changes
All regions are consistent and will receive a 3.8% increase for HMO, and 4.3% increase for HMO HSA plans. Quoting is expected to be available in the next week.
Plan Changes
Bronze MS59 HMO
| Benefit | 2026 | 2027 |
|---|
| Plan Name | Bronze MS49 HMO | Bronze MS59 HMO |
| Out-of-pocket Max | $9,800 individual / $19,600 family | $11,650 individual / $23,300 family |
| Specialist Copay | $95 | $100 |
Bronze SD33 HDHP HMO
| Benefit | 2026 | 2027 |
|---|
| Plan Name | Bronze SD23 HDHP HMO | Bronze SD33 HDHP HMO |
| Deductible | $7,200 individual / $14,400 family | $7,800 individual / $15,600 family |
| Out-of-pocket Max | $7,200 individual / $14,400 family | $7,800 individual / $15,600 family |
Gold MS10 HMO
| Benefit | 2026 | 2027 |
|---|
| Plan Name | Gold MS93 HMO | Gold MS10 HMO |
| Deductible | $250 individual / $500 family | $325 individual / $650 family |
| Out-of-pocket Max | $7,800 individual / $15,600 family | $8,600 individual / $17,200 family |
| PCP Copay | $35 | $40 |
| Specialist Copay | $55 | $60 |
| Lab Copay | $35 | $40 |
| X-ray Copay | $55 | $60 |
| Imaging (CT/PET/MRI) Copay | $250 | $350 |
| Rx Tier 2 (preferred brand) | $40 | $50 |
| Physician/Surgeon fee (outpatient surgery) | $35 | $50 |
| Emergency Room | $250 | $300 |
| Urgent Care | $35 | $40 |
| MH/SUD Individual Office Visit | $35 | $40 |
| MH/SUD Group Office Visit | $17.50 | $20 |
| MH/SUD Other Outpatient Services | $35 | $40 |
| Rehabilitation & Habilitation Copay | $35 | $40 |
| Skilled Nursing Care (per day, max 5 days) | $300 | $500 |
Gold MS32 HMO
| Benefit | 2026 | 2027 |
|---|
| Plan Name | Gold MS97 HMO | Gold MS32 HMO |
| Out-of-pocket Max | $5,000 individual / $10,000 family | $5,850 individual / $11,700 family |
Gold SD42 HDHP HMO
| Benefit | 2026 | 2027 |
|---|
| Plan Name | Gold SD32 HDHP HMO | Gold SD42 HDHP HMO |
| Deductible | $1,700 individual / $3,400 family | $1,750 individual / $3,500 family |
Platinum MS01 HMO
| Benefit | 2026 | 2027 |
|---|
| Plan Name | Platinum MS90 HMO | Platinum MS01 HMO |
| Out-of-pocket Max | $4,500 individual / $9,000 family | $5,000 individual / $10,000 family |
| PCP Copay | $20 | $25 |
| Specialist Copay | $30 | $40 |
| X-ray Copay | $30 | $35 |
| Imaging (CT/PET/MRI) Copay | $100 | $150 |
| Rx Tier 1 (generic) | $5 | $10 |
| Rx Tier 2 (preferred brand) | $20 | $25 |
| Rx Tier 3 (non-preferred brand) | $30 | $40 |
| Physician/Surgeon fee (outpatient surgery) | $25 | $35 |
| Emergency Room | $150 | $250 |
| Urgent Care | $20 | $25 |
| Inpatient Hospital Facility Copay | $250 per day | $300 per day |
| MH/SUD Individual Office Visit | $20 | $25 |
| MH/SUD Group Office Visit | $10 | $12.50 |
| MH/SUD Other Outpatient Services | $20 | $25 |
| Rehabilitation & Habilitation Copay | $20 | $25 |
Silver MS45 HMO
| Benefit | 2026 | 2027 |
|---|
| Plan Name | Silver MS94 HMO | Silver MS45 HMO |
| Pharmacy Deductible | $300 individual / $600 family | $350 individual / $700 family |
| Out-of-pocket Max | $8,750 individual / $17,500 family | $9,200 individual / $18,400 family |
| Coinsurance | 35% | 40% |
| PCP Copay | $55 | $60 |
| Rx Tier 1 (generic) | $19 | $20 |
| Rx Tier 2 (preferred brand) | $85 | $90 |
| MH/SUD Individual Office Visit | $55 | $60 |
| MH/SUD Group Office Visit | $27.50 | $30 |
| MH/SUD Other Outpatient Services | $55 | $60 |
| Rehabilitation & Habilitation Copay | $55 | $60 |
Silver SD41 HDHP HMO
| Benefit | 2026 | 2027 |
|---|
| Plan Name | Silver SD31 HDHP HMO | Silver SD41 HDHP HMO |
| Deductible | $2,800 individual / $3,400 embedded / $5,600 family | $3,100 individual / $3,500 embedded / $6,200 family |
| Out-of-pocket Max | $8,000 individual / $16,000 family | $8,700 individual / $17,400 family |
| X-ray Copay | $15 | $30 |
| Rx Tier 3 (non-preferred brand) | $80 Copay | 25% coinsurance up to $250 |
Updated 2027 Materials
- SBCs are available now
- SOBs are pending carrier release
- Forms are pending carrier release
- Product Guide is pending carrier release
Reminders
Contact your Amwins Benefits Regional Sales Manager for more information.
