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Covered Benefits and Support for Diabetes

Posted by on Apr 10, 2019 in Access, Feature, Health and Wellness, News

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According to a 2017 report from the Centers for Disease Control and Prevention, diabetes affects 9.4 percent of the U.S. population and continues to be a growing health concern. Managing diabetes requires mindful awareness, and appropriate health screenings and care. Sutter Health Plus members have access to products, important benefits, resources and coordinated care for the treatment of diabetes.

Covered Benefits
Sutter Health Plus covers medically necessary diabetes products, such as insulin pumps and supplies, when authorized by the member’s medical group.

Diabetic monitors, test strips, lancets and prescription drugs are also available under the member’s pharmacy benefit, and may require prior authorization. Members with maintenance prescriptions may have the option of having up to a 100-day supply mailed directly to their home for the cost of two retail copays with free standard shipping.

Additionally, members’ medical coverage include no-cost preventive gestational diabetes screenings for maternity care and diabetes screenings for certain adults.

Telephonic Disease Management Program
Sutter Health Plus members have access to Sutter Health’s Telephonic Disease Management (TDM) program for diabetes. The program provides access to registered nurses or certified diabetes educators who act as a personal health coach. The member and coach work together to improve health, prevent complications, manage drugs, and coordinate care with the member’s primary care provider and care team.

There is no cost to participate in the TDM program—it’s an opportunity to make healthy lifestyle changes and receive personalized, ongoing support. Learn more about the program and others like it on our Health and Wellness page.

Personal Habits, Preventive Measures
Healthy personal habits are an essential part of diabetes management. The American Diabetes Association recommends avoiding smoking, eating eight to 10 servings of fruits and vegetables daily, and including 150 minutes of moderate-intensity aerobic activity weekly.

For specific benefit and cost-share information, members should consult the Evidence of Coverage and Disclosure Form (EOC) and Benefits and Coverage Matrix (BCM) on the Member Portal or call Member Services at 855-315-5800.

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