Sharp Health Plan

At Sharp Healthcare, it is our mission to improve the health of everyone we serve. And at San Diego’s leading health care provider, we’re proud to touch the lives of more individuals in our community than any other health care system.

Provider Finder

Form Name Effective Date Download Form
New Group Submission
New Business Submission Checklist
01/01/2020 Download
Employer Application - HMO Small Group 3.23
10/01/2023 Download
Employer Application - HMO Large Group 1.21
01/01/2021 Download
Employee Declination Spreadsheet
01/01/2020 Download
Employer Group Size Attestation Form
11/01/2023 Download
Small Group Initial Payment ACH Form
01/01/2020 Download
Sole Proprietor, Partner, or Corporate Officer Statement
01/01/2020 Download
In Force Group Forms
Correction to Group Statement
01/01/2020 Download
Administration
Group Administration Manual
01/01/2020 Download
Employer Sharp Connect Registration
01/01/2020 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Employee Enrollment Form 9.23
11/01/2023 Download
Declaration of Domestic Partnership
01/01/2020 Download
Request for Continuity of Care
01/01/2020 Download
Request for Continuity of Care (Spanish)
01/01/2020 Download
Claim Forms
Authorization for Use of Disclosure of Health Information
01/01/2020 Download
Medical Claim Form
01/01/2020 Download
Pharmacy Claim Form
01/01/2020 Download
Form Name Effective Date Download Form
2024 Medical HMO
Non-Mirrored Plans - These benefits are not available on the Exchange and are available with any Sharp network; Choice, Value, Performance and Premier
Platinum HMO NG 1
01/01/2024 Summary SBC
Platinum HMO NG WOW 1
01/01/2024 Summary SBC
Platinum HMO NG 2
01/01/2024 Summary SBC
Platinum HMO NG 3
01/01/2024 Summary SBC
Platinum HMO NG 4
01/01/2024 Summary SBC
Platinum HMO NG 7
01/01/2024 Summary SBC
Platinum HMO NG 8
01/01/2024 Summary SBC
Gold HMO NG 1
01/01/2024 Summary SBC
Gold HMO NG WOW 1
01/01/2024 Summary SBC
Gold HMO NG 2
01/01/2024 Summary SBC
Gold HMO NG 3
01/01/2024 Summary SBC
Gold HMO NG 4
01/01/2024 Summary SBC
Gold HMO NG 5
01/01/2024 Summary SBC
Gold HMO NG 6
01/01/2024 Summary SBC
Gold HMO NG 7
01/01/2024 Summary SBC
Silver HMO NG 1
01/01/2024 Summary SBC
Silver HMO NG WOW 1
01/01/2024 Summary SBC
Silver HMO NG 2
01/01/2024 Summary SBC
Bronze NG WOW 1
01/01/2024 Summary SBC
Bronze HDHP NG 1
01/01/2024 Summary SBC
Mirrored Plans - These are the same plan benefits and HMO networks as available on Covered California for Small Business
Performance Platinum 90 HMO 0/15 + Child Dental
01/01/2024 Summary SBC
Premier Platinum 90 HMO 0/20 + Child Dental
01/01/2024 Summary SBC
Performance Gold 80 HMO 350/25 + Child Dental
01/01/2024 Summary SBC
Premier Gold 80 HMO 250/35 + Child Dental
01/01/2024 Summary SBC
Performance Silver 70 HMO 2500/55 + Child Dental
01/01/2024 Summary SBC
Premier Silver 70 HMO 2500/55 + Child Dental
01/01/2024 Summary SBC
Premier Silver 70 HDHP HMO 2700/25% + Child Dental
01/01/2024 Summary SBC
Performance Bronze 60 HMO 6300/65 + Child Dental
01/01/2024 Summary SBC
Premier Bronze 60 HDHP HMO 7000/0% + Child Dental
01/01/2024 Summary SBC
Pseudo-Mirrored Plans - These are the same plan benefits available on the Exchange but available with other networks. PeVC = Performance, Value, Choice and PrVC = Premier, Value, Choice
Platinum 90 HMO 0/20/250 + Child Dental (PeVC)
01/01/2024 Summary SBC
Platinum 90 HMO 0/15/10% + Child Dental (PrVC)
01/01/2024 Summary SBC
Gold 80 HMO 250/35/600 + Child Dental (PeVC)
01/01/2024 Summary SBC
Gold 80 HMO 350/25/20% + Child Dental (PrVC)
01/01/2024 Summary SBC
Silver 70 HMO 2500/55/40% + Child Dental (PeVC-300)
01/01/2024 Summary SBC
Silver 70 HMO 2500/55/35% + Child Dental (PrVC-35%)
01/01/2024 Summary SBC
Silver 70 HDHP HMO 2700/25%/25% + Child Dental (PeVC)
01/01/2024 Summary SBC
Bronze 60 HMO 6300/65/40% + Child Dental (PrVC)
01/01/2024 Summary SBC
Bronze 60 HDHP HMO 7000/0%/0% + Child Dental (PeVC)
01/01/2024 Summary SBC
2024 Medical POS
Platinum POS NG 1
01/01/2024 Summary SBC
Gold POS NG 1
01/01/2024 Summary SBC
Silver POS NG 1
01/01/2024 Summary SBC
2023 Medical HMO
Non-Mirrored Plans - These benefits are not available on the Exchange and are available with any Sharp network; Choice, Value, Performance and Premier
Platinum HMO NG 1
01/01/2023 Summary SBC
Platinum HMO NG WOW 1 [New 10/1/2023]
10/01/2023 Summary SBC
Platinum HMO NG 2
01/01/2023 Summary SBC
Platinum HMO NG 3
01/01/2023 Summary SBC
Platinum HMO NG 4
01/01/2023 Summary SBC
Platinum HMO NG 7
01/01/2023 Summary SBC
Platinum HMO NG 8
01/01/2023 Summary SBC
Gold HMO NG 1
01/01/2023 Summary SBC
Gold HMO NG WOW 1 [New 10/1/2023]
10/01/2023 Summary SBC
Gold HMO NG 2
01/01/2023 Summary SBC
Gold HMO NG 3
01/01/2023 Summary SBC
Gold HMO NG 4
01/01/2023 Summary SBC
Gold HMO NG 5
01/01/2023 Summary SBC
Gold HMO NG 6
01/01/2023 Summary SBC
Gold HMO NG 7
01/01/2023 Summary SBC
Silver HMO NG 1
01/01/2023 Summary SBC
Silver HMO NG WOW 1 [New 10/1/2023]
10/01/2023 Summary SBC
Silver HMO NG 2
01/01/2023 Summary SBC
Bronze HDHP NG 1
01/01/2023 Summary SBC
Bronze NG WOW 1 [New 10/1/2023]
10/01/2023 Summary SBC
Mirrored Plans - These are the same plan benefits and HMO networks as available on Covered California for Small Business
Performance Platinum 90 HMO 0/15 + Child Dental
01/01/2023 Summary SBC
Premier Platinum 90 HMO 0/20 + Child Dental
01/01/2023 Summary SBC
Performance Gold 80 HMO 350/25 + Child Dental
01/01/2023 Summary SBC
Premier Gold 80 HMO 250/35 + Child Dental
01/01/2023 Summary SBC
Performance Silver 70 HMO 2500/55 + Child Dental
01/01/2023 Summary SBC
Premier Silver 70 HMO 2500/55 + Child Dental
01/01/2023 Summary SBC
Premier Silver 70 HDHP HMO 2700/25% + Child Dental
01/01/2023 Summary SBC
Performance Bronze 60 HMO 6300/65 + Child Dental
01/01/2023 Summary SBC
Premier Bronze 60 HDHP HMO 7000/0% + Child Dental
01/01/2023 Summary SBC
Pseudo-Mirrored Plans - These are the same plan benefits available on the Exchange but available with other networks. PeVC = Performance, Value, Choice and PrVC = Premier, Value, Choice
Platinum 90 HMO 0/20/250 + Child Dental (PeVC)
01/01/2023 Summary SBC
Platinum 90 HMO 0/15/10% + Child Dental (PrVC)
01/01/2023 Summary SBC
Gold 80 HMO 250/35/600 + Child Dental (PeVC)
01/01/2023 Summary SBC
Gold 80 HMO 350/25/20% + Child Dental (PrVC)
01/01/2023 Summary SBC
Silver 70 HMO 2500/55/40% + Child Dental (PeVC-300)
01/01/2023 Summary SBC
Silver 70 HMO 2500/55/35% + Child Dental (PrVC-35%)
01/01/2023 Summary SBC
Silver 70 HDHP HMO 2700/25%/25% + Child Dental (PeVC)
01/01/2023 Summary SBC
Bronze 60 HMO 6300/65/40% + Child Dental (PrVC)
01/01/2023 Summary SBC
Bronze 60 HDHP HMO 7000/0%/0% + Child Dental (PeVC)
01/01/2023 Summary SBC
2023 Medical POS
Platinum POS NG 1
01/01/2023 Summary SBC
Gold POS NG 1
01/01/2023 Summary SBC
Silver POS NG 1
01/01/2023 Summary SBC
Form Name Effective Date Download Form
General Information
Small Group Benefit Brochure 2023
11/01/2023 Download
Member Resource Guide 2023
11/01/2023 Download
Member Resource Kit 2023
11/01/2023 Download
HMO Underwriting Guidelines
01/01/2022 Download
POS Underwriting Guidelines
01/01/2022 Download
POS Plan Overview
11/01/2021 Download
Active & Fit Flyer
01/01/2020 Download
Emergency Travel Assistance
10/01/2023 Download
Best Health Coaching
01/01/2020 Download
Mail Order Pharmacy Brochure
01/01/2020 Download
Minute Clinic Flyer
10/01/2023 Download
Mobile App Flyer
10/01/2023 Download
HMO Network Comparison Guide 2022
01/01/2023 Download
HMO Licensed Service Areas
01/01/2020 Download
Choice Network Overview
11/01/2023 Download
Value Network Overview
11/01/2023 Download
Performance Network Overview
11/01/2023 Download
Premier Network Overview
11/01/2023 Download
2020 Choice Network Provider & Pharmacy Directory
01/01/2020 Download
2020 Value Network Provider & Pharmacy Directory
01/01/2020 Download
2020 Performance Network Provider & Pharmacy Directory
01/01/2020 Download
2020 Premier Network Provider & Pharmacy Directory
01/01/2020 Download
Pediatric Vision Flyer
01/01/2020 Download
Wellness Assessment 1-2-3 Flyer
10/01/2023 Download
Form Name Effective Date Download Form
Small Group Rate Sheet [effective 4/1/2024]
04/01/2024 Download
Small Group POS Rate Sheet [effective 4/1/2024]
04/01/2024 Download
Small Group Rate Sheet [effective 1/1/2024]
01/01/2024 Download
Small Group POS Rate Sheet [effective 1/1/2024]
01/01/2024 Download