Forms

These commonly requested forms are provided to assist you in managing your employees' enrollment with Sharp Health Plan.

Group forms

•	Group Administration Manual
•	Master Group Application — Large Group HMO
•	Master Group Application — Small Group HMO
•	Master Group Application — Small Group HMO-PPO
•	Employer Health Questionnaire (25+ employees)

Member forms

•	Authorization for Use or Disclosure of Protected Health Information — English
•	Authorization for Use or Disclosure of Protected Health Information — Spanish
•	Declination of Coverage — HMO
•	Declination of Coverage — Small Group PPO
•	Designation of Personal Representative
•	Domestic Partnership Declaration
•	Employee Application — Large Group HMO
•	Employee Application — Small Group HMO
•	Employee Application — Small Group PPO
•	Employee Application — Spanish
•	Member Reimbursement Form — Medical Services
•	Member Reimbursement Form — Prescription Drugs
•	Request for Continuity of Care Benefits

Order materials

The form provided below can be used to request marketing, enrollment and benefit materials.

•	Materials Request

We’re here to help

For general inquiries, please use our Contact Us Form.

If you need immediate assistance, please don’t hesitate to pick up the phone and call. We are available Monday through Friday, 8 am to 5 pm.

•	For information about premiums, renewals or materials: (619) 228-2429
•	For information about member-specific issues: (619) 228-2300 or 1-800-359-2002

You will need Adobe Acrobat Reader to view and download these files.