Download Broker Forms - Sharp Health Plan of San Diego, California

Find forms and documents below including enrollment applications and benefits and coverage documents you may need to manage your clients.

Select a category from the list below to view and download the forms you need.

Applications and enrollment

Broker materials request form
Use this form to submit a request for marketing, enrollment, and benefit materials to help sell our plans.
Online form

Declaration of domestic partnership
Members who are not legally married but wish to add their domestic partner to their plan should fill out this form to see if they qualify.

Employee enrollment application
Use this form for employees who are ready to apply for coverage with Sharp Health Plan.
English (PDF) | Spanish (PDF)

Employer group size attestation form
Use this form to attest to the size of your employer group.
English (PDF)

Large group enrollment application
Use this form to apply for health insurance on behalf of a large employer group.
English (PDF)

Small group enrollment application
Use this form to apply for health insurance on behalf of a small employer group.
English (PDF)

Special enrollment application
Use this form to apply for coverage on behalf of an individual or family during the special enrollment period.
English (PDF) | Spanish (PDF)

Benefits and coverage

Declination of coverage
Members who currently have coverage through their spouse or a parent can use this form to indicate that they are waiving coverage at this time.
English (PDF)

Request for continuity of care
Members can use this form to submit a request to continue receiving medical services with their current health care provider until they complete their care.
English (PDF)

Broker information

Broker link generator
Use this form to generate your unique broker link for our individual and family plans.
Online form

Update my profile information
Log in to your Sharp Connect account to update your provider profile information such as your name, email, or address.
Online form

W9
Use this form to verify your social security number and tax identification number.
English (PDF)

Member-related forms

Authorization for use or disclosure of health information
Members can use this form to give permission to Sharp Health Plan to share their personal health information with someone they choose.
English (PDF) | Spanish (PDF)

Request an ID card
Log in to your Sharp Connect account to order a replacement ID card for your clients.
Online form

Not finding what you're looking for? Additional member-related forms can found in the members section of our website.

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