These commonly requested forms are provided to assist you in managing your employees' enrollment with Sharp Health Plan.
Use this form to report adjustments to your monthly statements.
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.
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.
At some point during your care, you may want us to disclose your protected health information (PHI) to someone else, like your spouse or child. Here you’ll find the information you’ll need to authorize the release of health information.
Maybe an employee has coverage through their spouse or a parent and doesn’t want coverage right now, that’s okay. If they change their mind, have them fill out this form, indicating that they are waiving coverage at this time.
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.
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.
Members can find more information on how to provide access and share their health information with an organization, loved one, or representative.
Continuity of care means continued services, under certain conditions, with your current health care provider until your provider completes your care. Find out if you qualify and learn how to submit a request by visiting the webpage.
If you're looking to be reimbursed for eligible out-of-pocket medical expenses, be sure to submit this reimbursement request form within 180 days of the date of service.
If your doctor has prescribed a medication you’ve purchased from a pharmacy within the last 180 days, then you might be eligible for a reimbursement.
Use the 2019 reimbursement form for pharmacy services rendered before Jan. 1, 2020.
Let’s talk. Call us at 1-800-359-2002 or send us a message
FBT: SharpHealthPlan.com no longer supports this Internet browser. For the best experience on our website, please upgrade your browser to the latest version.