Member Handbook
The Sharp Health Plan Member Handbook provides information on how to obtain covered benefits. For your convenience, the manual is divided into sections. Please click the link to the section you would like to view. To request a copy of the Member Handbook, please call Customer Care at (619) 228-2300 or toll-free at 1-800-359-2002, or e-mail customer.service@sharp.com.
2. Welcome to Sharp Health Plan
| • | About Sharp Health Plan |
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Booklets and Information |
| • | Choice of Plan Physicians and Plan Providers |
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Call Your PCP When You Need Care |
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Present Your Member ID Card and Pay Copayment |
4. How Do You Obtain Medical Care
| • | Use Your Member ID Card |
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Access Health Care Services Through Your Primary Care Physician |
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Obtain Required Authorization |
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Second Medical Opinions |
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Emergency Services and Care |
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Urgent Care Services |
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Language Assistance Services |
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Access for the Vision Impaired |
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Pre-existing Conditions |
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Case Management |
5. Who Can You Call With Questions?
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Customer Care |
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Nurse Connection |
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Premiums |
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Copayments |
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Annual Out-of-Pocket Maximum |
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What if You Get a Medical Bill? |
7. What Are Your Rights and Responsibilities as a Member?
| • | Member Rights and Responsibilities |
| • | Notice of Privacy Practices |
8. What Is the Grievance Process?
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Grievance Process |
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Binding Arbitration - Voluntary |
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Additional Resources |
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Mediation |
| • | Independent Medical Reviews |
9. What Are Your Covered Benefits?
11. How Do You Enroll in Sharp Health Plan?
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When Is an Employee Eligible to Enroll in Sharp Health Plan? |
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When Is a Dependent Eligible to Enroll in Sharp Health Plan? |
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Can You or Your Dependents Enroll Outside Your Initial or Open Enrollment Period? |
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How Do You Update Your Enrollment Information? |
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What If You Have Other Health Insurance Coverage? |
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What If You Are Eligible for Medicare? |
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What If You Are Injured at Work? |
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What If You Are Injured by Another Person? |
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When Can Your Coverage Be Changed Without Your Consent? |
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When Will Your Coverage End? |
12. Individual Continuation of Benefits
| • | Total Disability Continuation Coverage |
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COBRA Continuation Coverage |
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Cal-COBRA Continuation Coverage |
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Conversion Continuation Coverage |
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What Can You Do if You Believe Your Coverage Was Terminated Unfairly? |
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What Are Your Rights for Coverage After Disenrolling From Sharp Health Plan? |
| • | When Do You Qualify for Continuity of Care? |
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What Is the Relationship Between the Plan and Its Providers? |
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How Can You Participate in Plan Policy? |
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What Happens if You Enter Into a Surrogacy Arrangement? |
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