Broker forms

Find forms and resources for enrolling groups and navigating Sharp Health Plan as a broker.

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.
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  • Online form external link icon

  • 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.
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  • file icon English (PDF)

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

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

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

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

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


 
Broker information

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

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

  • W9
  • Use this form to verify your social security number and tax identification number.
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  • file icon 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.
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  • file icon  English (PDF) | file icon Spanish (PDF)

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

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


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