Out-of-area care for your employees

Out-of-area care

• When your employees and their covered dependents are out of Sharp Health Plan’s service area, they are covered for emergency and urgent care services due to unforeseen illness or injury.
• Routine health services, such as checkups or preventive care visits, are not covered outside of the service area.
• Employees should tell their primary care physician (PCP) about any care they receive when they’re away.

How to get out-of-area care

To make sure your employees can get the care they need, there are several ways to seek out-of-area care:

• Emergency services

  
  For life or limb-threatening emergencies, employees don’t need to contact their PCP before calling “911” or going to a hospital.

• Emergency Travel Services

  
  Assist America connects Sharp Health Plan members to global emergency travel assistance, even when they’re out of the country. If a member is traveling abroad and needs medical care, Assist America can assist with admitting them to a qualified medical facility along with many other valuable assistance services.

• Urgent services

  
  Out-of-area urgent care services are considered emergency services and do not require authorization from a PCP.

• Telehealth

  
  Telehealth services like video and phone visits may be available when determined by a doctor to be medically appropriate. Appointments must be with an in-network provider.

• MinuteClinic

  
  Convenient walk-in medical clinics are located in pharmacies within the CVS Caremark® network, where employees can receive treatment for minor illnesses or injuries.

• Sharp Nurse Connection^®

  
  Registered nurses are available after-hours to answer health-related questions or offer assistance with finding the right care. Employees can call the after-hours hotline at 1-800-359-2002, 5 pm – 8 am, Monday to Friday, or 24 hours on weekends.

• Prescription coverage

  
  Employees can fill prescriptions at pharmacies within the CVS Caremark^® network while outside of the service area and apply for reimbursement if they need to pay for a refill that’s normally covered by their plan.
  • CalPERS members: Refer to OptumRx.
  • Teamsters members: Refer to Sav-RX.

Questions?

If your employees have questions, please direct them to review their member handbook (also called Evidence of Coverage). They may also contact Customer Care using the phone number on the back of their Sharp Health Plan member ID card.

Get our quick guide to accessing out-of-area care, designed just for your employees. Download below and share:

Point of Service (POS) plans*

When outside of Sharp Health Plan’s service area, your employees who are enrolled in POS plans may choose where they want to receive care. Depending on which POS plan they have, POS members can choose from up to three different coverage tier options. We recommend that your employees read their Member Handbook online in their Sharp Health Plan online account for details.