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

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

Submit a 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.

Add an employee to a group plan
Use this form for employees who are ready to apply for coverage with Sharp Health Plan.
English (PDF) | Spanish (PDF)

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

Apply for large group health insurance
Use this form to apply for health insurance on behalf of a large employer group with more than 101 full-time equivalent employees.
English (PDF)

Apply for small group health insurance
Use this form to apply for health insurance on behalf of a small employer group (1-100 full-time equivalent employees).
English (PDF)

Apply for an individual or family plan on behalf of someone else
Use this form to apply for coverage on behalf of an individual or family during the special enrollment period.
Apply online | English (PDF) | Spanish (PDF)

Benefits and coverage

Submit a 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

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

W-9
Use this form to verify your social security number and tax identification number.
English (PDF)

Member-related forms

Share 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 a member 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 be found in the members section of our website.

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