Point of Service (POS) plans

We offer three flexible plans designed with choice in mind.

Our POS plans are multi-tier employer group plans that offer more flexibility. POS members can choose to receive care within Sharp Health Plan’s HMO network, Aetna’s Open Choice PPO network, or any other care provider in the United States.


Benefits of our POS plans

  • Freedom of choice

    Our POS plans offer a wide network of providers, giving members the convenience of choosing who they want to seek care from.

  • Out-of-network availability

    While it’s recommended that members seek care from a provider within their network, POS members can choose to go outside their network to receive care. They’ll just have to pay more out-of-pocket costs to do so.


POS Concierge benefits

The POS Concierge Program is a free resource available to our POS plan members. Members will have access to these benefits:

  • Get answers to their benefit, billing and claim questions and explain how their plan works;     
  • Find network providers;
  • Prepare for appointments by confirming their eligibility; and
  • Determine precertification or authorization requirements.

Meet our POS Concierge

Our POS Concierge, Yvonne Mascareno, is our members' guide to understanding how their POS plan works. For immediate assistance, members should contact Customer Care at customer.service@sharp.com or by calling 1-858-499-8300.

Yvonne Mascareno
Yvonne Mascareno
Account Associate
1-858-499-8054
Email

Questions?

Brokers: To explore POS plan options and find out if your group is eligible, please contact your dedicated account management executive. Please note that the POS commission schedule mirrors the HMO schedule.

POS plan enrollees: We recommend reading your member handbook for details. You can access this by logging in to your Sharp Health Plan online account. You can also visit the FAQ to view provider directories for Tier 1 and Tier 2 and get more information about your plan.


Three-tier POS plan – small groups

A three-tier POS plan for eligible employers with 100 or fewer employees.


View all small group plan details & rates ➜

Tier 1: Sharp Health Plan Performance Network

Lowest out-of-pocket costs.

When accessing health services through this tier, you get the care you need from providers and hospitals in our Performance Network. Your primary care physician, or PCP, coordinates all of your care.

Tier 1 highlights

  • Your PCP is your main point of contact for when accessing Tier 1 benefits. They’ll handle your care, coordinate any treatments, and more.
  • Referrals may be needed when seeing a specialist within the Tier 1 network.
  • This tier requires less paperwork — for example, claims — and less member responsibility than other tiers.
  • Preventive care services are offered at no extra cost.
  • Copays or coinsurance costs apply for most other care visits and services.


Tier 2: Aetna Open Choice PPO Network

Higher out-of-pocket costs.

With Tier 2, you can get care from the Aetna Open Choice PPO® provider network — with no referral needed. It’s important to remember that when you choose to get care from the Aetna Open Choice PPO provider network, your out-of-pocket costs will be higher.

Use the tool below to search for an Aetna provider. Enter your ZIP code, then select the Open Choice PPO plan.

Tier 2 highlights

  • You can make appointments directly with providers in the Aetna Open Choice PPO network — no referral required.
  • Copays or coinsurance costs apply to every visit and service, in addition to your deductible.
  • You’ll need to get precertification before you can receive certain services from an Aetna Open Choice provider.


Tier 3: Out-of-network

Highest out-of-pocket costs.

Members can receive care from any care provider in the U.S., including physicians, specialists, hospitals or laboratories. Certain services may require precertification, or approval from Sharp Health Plan.

Tier 3 highlights

  • This option has the highest cost share but offers more flexibility and allows for care anywhere.
  • Referrals are not required; however, there will be more paperwork on your part, including claims and precertification.
  • Out-of-pocket costs could apply.


Three-tier POS plan – large groups

A three-tier POS plan for eligible employers with 101 or more employees. Download this flyer and brochure to share information with your clients.


View all large group plan details & rates ➜

Tier 1: Sharp Health Plan Choice Network

Lowest out-of-pocket costs.

When accessing health services through this tier, you get the care you need from providers and hospitals in our Choice Network. Your primary care physician, or PCP, coordinates all of your care.

Tier 1 highlights

  • Your PCP is your main point of contact for when accessing Tier 1 benefits. They’ll handle your care, coordinate any treatments, and more.
  • Referrals may be needed when seeing a specialist within the Tier 1 network.
  • This tier requires less paperwork — for example, claims — and less member responsibility than other tiers.
  • Preventive care services are offered at no extra cost.
  • Copays or coinsurance costs apply for most other care visits and services.


Tier 2: Aetna Open Choice PPO Network

Higher out-of-pocket costs.

With Tier 2, you can get care from the Aetna Open Choice PPO® provider network — with no referral needed. It’s important to remember that when you choose to get care from the Aetna Open Choice PPO provider network, your out-of-pocket costs will be higher.

Use the tool below to search for an Aetna provider. Enter your ZIP code, then select the Open Choice PPO plan.

Tier 2 highlights

  • You can make appointments directly with providers in the Aetna Open Choice PPO network — no referral required.
  • Copays or coinsurance costs apply to every visit and service, in addition to your deductible.
  • You’ll need to get precertification before you can receive certain services from an Aetna Open Choice provider.


Tier 3: Out-of-network

Highest out-of-pocket costs.

Members can receive care from any care provider in the U.S., including physicians, specialists, hospitals or laboratories. Certain services may require precertification, or approval from Sharp Health Plan.

Tier 3 highlights

  • This option has the highest cost share but offers more flexibility and allows for care anywhere.
  • Referrals are not required; however, there will be more paperwork on your part, including claims and precertification.
  • Out-of-pocket costs could apply.