Find a health insurance form

You can get the information that you need quickly with these commonly requested forms.

Find health insurance forms and documents below including medical, pharmacy, insurance claim forms, and other documents you may need to manage your health plan.

Select a category from the list below to view and download the forms you need.

 
Authorizations and referrals

  • Authorization for use or disclosure of health information
  • Use this form to give permission to Sharp Health Plan to share your personal health information with someone you choose.
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  • file icon  English (PDF) | file icon Spanish (PDF)

  • Case management referral form
  • Log in to your Sharp Connect account to submit a request to be referred to a case management program. This form can be found on the Prevention & Wellness page.
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  • Online form external link icon

  • Disease management referral form
  • Log in to your Sharp Connect account to submit a request to be referred to a disease management program. This form can be found on the Prevention & Wellness page.
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  • Online form external link icon

  • Prescription drug prior authorization or step therapy execution request
  • Use this form to submit a prior authorization request for medications or step therapy.
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  • file icon English (PDF)


 
Benefits and coverage

  • Medicare or other insurance coverage questionnaire
  • Use this form to let us know if you have any other health insurance coverage, including Medicare, in addition to your coverage with Sharp Health Plan.
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  • Online form external link icon

  • Request for continuity of care
  • Use this form to submit a request to continue receiving medical services with your current health care provider until your provider completes your care.
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  • file icon English (PDF)


 
Claims

  • Deductible credit request form
  • Use this form to submit a request to Sharp Health Plan for a deductible credit.
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  • file icon English (PDF)

  • Member reimbursement request form - medical services
  • Use this form to ask for a refund from Sharp Health Plan for the cost of approved medical services.
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  • file icon English (PDF)

  • Prescription reimbursement claim form
  • Use this form to ask for a refund from Sharp Health Plan for the cost of medication you paid for out of pocket.
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  • file icon English (PDF)


 
Grievances and appeals


  • Cancellation of health care coverage grievance form
  • Use this form to file a grievance regarding the cancellation, rescission, or nonrenewal of health care coverage to the Department of Managed Health Care (DMHC).
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  • Online form external link icon  |  file icon English (PDF)


 
IRS 1095 forms

A 1095 form may be needed for your taxes. You may have received a physical copy of your 1095 tax form in January. This form may come from Sharp Health Plan, Covered California, or your employer depending on how you are enrolled with us.

For more information about your 1095 tax form, visit our 1095 form page or read our frequently asked questions.


 
Manage my plan

  • Account change form
  • Use this form if you are an individual or family plan member and would like to make changes to your benefit plan such as changing your plan or adding coverage for dependents.
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  • file icon English (PDF)

  • Primary care physician selection form
  • Use this form if you would like to choose or change your primary care physician (PCP).
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  • Online form external link icon

  • Request an ID card
  • Log in to your Sharp Connect account to order a replacement ID card or print out a temporary ID card.
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  • Online form external link icon

  • Special enrollment application form
  • Use this form to apply for health insurance during the Special Enrollment period.
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  • file icon English (PDF) | file icon Spanish (PDF)
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  • Looking for health coverage? Get a quote for an individual or family plan today using our quick and easy online quoting tool.

  • Termination form
  • Use this form if you are currently enrolled in an individual or family plan with Sharp Health Plan and would like to cancel your coverage. You may also log in to your Sharp Connect account to fill out a termination form online.
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  • Online form external link icon  |  file icon English (PDF)

  • Update my contact information
  • Log in to your Sharp Connect account to update your contact information such as your email address and phone number.
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  • Online form external link icon


Not finding what you’re looking for?

Let’s talk. Call us at 1-800-359-2002 or send us a message