Medicare or other insurance coverage

Do you have health insurance from more than one plan? Let us know here.


Maybe both you and your spouse have coverage, or maybe you just became eligible for Medicare. For whatever reason, if you find yourself covered by another insurance company, we need to know to ensure that we are managing your benefits correctly.

What’s the difference between primary and secondary coverage?


Primary coverage

Your primary plan is the plan that is responsible for paying your medical claims first.

Secondary coverage
Your secondary coverage provides reimbursement for your medical expenses after your primary plan has paid its share, according to your benefit plan.

You cannot choose which plan is your primary coverage — those rules are set by law.

Let us know about other health insurance 

You can 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.

Do you have Medicare coverage?

Reason for Medicare coverage: (please check one)






Do you have health insurance coverage other than Sharp Health Plan?

Type of policy: (please check one)




Type of coverage: (please check one)





Electronic signatures are required

By completing and submitting this form you certify that all information provided in this form is complete and accurate to the best of your knowledge, and you authorize Sharp Health Plan to verify the information provided in this form.

Thank you for taking time to complete this form. If you have any questions or need to update information provided previously, please call Customer Care at 1.800.359.2002.

FBT: SharpHealthPlan.com no longer supports this Internet browser. For the best experience on our website, please upgrade your browser to the latest version.