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Big, small and everything in between

Here are commonly-used forms for individuals and groups.

Small group master application

We’re excited that after all the shopping around and research you’ve done, your group wants to partner up with us. Before we get started, we’ll need you to fill out this master application. Once it’s complete, send it over and we’ll take it from there.

DOWNLOAD APPLICATION ➜

Large group master application

Thanks for choosing us. We’re glad you’re ready to get your group covered with us. First, we’ll need some information about your company, employee eligibility, and your plan preferences. Then, we can start getting your group the care they need.

DOWNLOAD APPLICATION ➜

Sole proprietor, partner, or corporate officer statement

If the sole proprietor, partner, or corporate officer is not listed on the DE-6 tax form or the form isn’t available, they must fill out this short form and give us a few additional documents. 

DOWNLOAD FORM ➜

We're here to support you in any way we can. Contact us with your questions.

Take me there

Enrolling employees

When employees are ready to start getting coverage, they’ll need to fill out this form. This helps us organize and keep track of their benefits so that they can maximize their coverage and care.

DOWNLOAD APPLICATION ➜

Enrolling employees (Spanish)

Here's the employee enrollment form for our Spanish-speaking members.

DOWNLOAD APPLICATION ➜

More individual member forms

Not finding what you're looking for? Check out the Member Center for more individual member forms such as pharmacy or medical reimbursement.

TAKE ME THERE ➜

Correction to group statement

Use this form to report adjustments to your monthly statements.

DOWNLOAD FORM ➜

Request for quote checklist

Have the employer fill out this sheet so that we can get a good idea of their needs.

DOWNLOAD CHECKLIST ➜

Employer group size attestation

Use this form to attest to the size of your employer group. We'll need notification within 30 days of the change to the group size.

DOWNLOAD FORM ➜

Declaration of domestic partnership

Even if a member and their partner are not legally married, they may still qualify for benefits. Have them fill out this form declaring their domestic partnership to see if they’re eligible. 

DOWNLOAD FORM ➜

Continuity of care benefits

This form can help a member continue care with a non-Sharp provider until treatment of their acute condition is over or until the end of their pregnancy.

DOWNLOAD FORM ➜

Personal health information (PHI) release

Members can fill out this form if they would like their medical information shared with an organization, loved one, or representative.

DOWNLOAD

Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Sharp Health Plan, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 1.800.359.2002.

如果您，或是您正在協助的對象，有關於[插入SBM項目的名稱 Sharp Health Plan 方面的問題，您有權利免費以您的母語得到幫助和訊息。洽詢一位翻譯員，請撥電話 [在此插入數字 1.800.359.2002。

Nếu quý vị, hay người mà quý vị đang giúp đỡ, có câu hỏi về Sharp Health Plan, quý vị sẽ có quyền được giúp và có thêm thông tin bằng ngôn ngữ của mình miễn phí. Để nói chuyện với một thông dịch viên, xin gọi 1.800.359.2002.

Kung ikaw, o ang iyong tinutulangan, ay may mga katanungan tungkol sa Sharp Health Plan, may karapatan ka na makakuha ng tulong at impormasyon sa iyong wika ng walang gastos. Upang makausap ang isang tagasalin, tumawag sa 1.800.359.2002.

만약 귀하 또는 귀하가 돕고 있는 어떤 사람이 Sharp Health Plan에 관해서 질문이 있다면 귀하는 그러한 도움과 정보를 귀하의 언어로 비용 부담없이 얻을 수 있는 권리가 있습니다. 그렇게 통역사와 얘기하기 위해서는 1.800.359.2002로 전화하십시오.

Եթե Դուք կամ Ձեր կողմից օգնություն ստացող անձը հարցեր ունի Sharp Health Plan մասին, Դուք իրավունք ունեք անվճար օգնություն և տեղեկություններ ստանալու Ձեր նախընտրած լեզվով։ Թարգմանչի հետ խոսելու համար զանգահարե՛ք 1.800.359.2002։

اگر شما، يا کسی کە شما بە او کمک ميکنيد ، سوال در مورد Sharp Health Plan ، داشتە باشيد حق اين را داريد کە کمک و اطلاعات بە زبان خود را بە طور رايگان دريافت نماييد 1.800.359.2002. تماس حاصل نماييد .

Если у вас или лица, которому вы помогаете, имеются вопросы по поводу Sharp Health Plan, то вы имеете право на бесплатное получение помощи и информации на вашем языке. Для разговора с переводчиком позвоните по телефону 1.800.359.2002.

ご本人様、またはお客様の身の回りの方でも、Sharp Health Planについてご質問がございましたら、ご希望の言語でサポートを受けたり、情報を入手したりすることができます。料金はかかりません。通訳とお話される場合、1.800.359.2002までお電話ください。

إن كان لديك أو لدى شخص تساعده أسئلة بخصوص Sharp Health Plan ، فلديك الحق في الحصول على المساعدة والمعلومات الضرورية بلغتك من دون اية تكلفة. للتحدث مع مترجم اتصل ب ) 1.800.359.2002.

ਜੇ ਤੁਹਾਨ ੂੰ , ਜਾਂ ਤੁਸੀ ਜਜਸ ਦੀ ਮਦਦ ਕਰ ਰਹੇ ਹੋ , Sharp Health Planਕੋਈ ਸਵਾਲ ਹੈ ਤਾਂ, ਤੁਹਾਨ ੂੰ ਜਿਨਾ ਜਕਸੇ ਕੀਮਤ 'ਤੇ ਆਪਣੀ ਭਾਸਾ ਜਵਿੱਚ ਮਦਦ ਅਤੇ ਜਾਣਕਾਰੀ ਪਰਾਪਤ ਕਰਨ ਦਾ ਅਜਿਕਾਰ ਹੈ . ਦੁਭਾਸੀਏ ਨਾਲ ਗਿੱਲ ਕਰਨ ਲਈ, 1.800.359.2002 ਤੇ ਕਾਲ ਕਰੋ

ប្រសិនបរើអ្នក ឬនរណាម្ននក់ដែលអ្នកកំពុងដែជួយ ម្ននសំណួរអ្ំពី Sharp Health Plan បេ, អ្នកម្ននសិេធិេេួលជំនួយនិងព័ែ៌ម្នន បៅកនុងភាសា ររស់អ្នក បោយមិនអ្ស់ប្ាក់ ។ បែើមបីនិយាយជាមួយអ្នករកដប្រ សូម 1.800.359.2002 ។

Yog koj, los yog tej tus neeg uas koj pab ntawd, muaj lus nug txog Sharp Health Plan, koj muaj cai kom lawv muab cov ntshiab lus qhia uas tau muab sau ua koj hom lus pub dawb rau koj. Yog koj xav nrog ib tug neeg txhais lus tham, hu rau 1.800.359.2002.

यदि आपके ,या आप द्वारा सहायता ककए जा रहे ककसी व्यक्तत के Sharp Health Plan के बारे में प्रश्न हैं ,तो आपके पास अपनी भाषा में मुफ्त में सहायता और सूचना प्राप्त करने का अधिकार है। ककसी िुभाषषए से बात करने के लिए ,1.800.359.2002 पर कॉि करें।

หากคุณ หรือคนที่คุณกาลังช่วยเหลือมีคาถามเกี่ยวกับ Sharp Health Plan คุณมีสิทธิที่จะได้รับความช่วยเหลือและข้อมูลในภาษาของคุณได้โดยไม่มีค่าใช้จ่าย พูดคุยกับล่าม โทร 1.800.359.2002

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