Point of service (POS) plan

We offer employers flexible plans to meet their employees’ needs.

Our POS plan is a three-tier employer group plan, offering more flexibility through three distinct options for coverage. Members can choose to receive care within Sharp Health Plan’s broadest HMO network, Aetna’s Open Choice PPO network, or any other licensed care provider in the U.S.

San Diego Zoo Wildlife Alliance employees: please log in to Sharp Connect to view your POS plan details.

Tier 1

Sharp Health Plan Choice HMO Network

Lowest out-of-pocket costs.

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

Here’s what to remember about Tier 1:

  • Your PCP is your main point of contact for when accessing Tier 1 benefits. They’ll handle your care, coordinate any treatments, and more.
  • 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.

Here’s what to remember about Tier 2:

  • 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.

Precertification

Precertification means prior approval from Sharp Health Plan. It’s a good idea to talk to your Aetna Open Choice provider before you receive services, to make sure they receive any required precertification from Sharp Health Plan in advance. This will help manage your out-of-pocket costs.

Tier 3

Out-of-network

Highest out-of-pocket costs.

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

Here’s what to remember about Tier 3:

  • This option has the highest cost share, but offers more flexibility and allow 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.

Precertification

Precertification means prior approval from Sharp Health Plan. It’s a good idea to talk to your out-of-network provider before you receive services, to make sure they receive any required precertification from Sharp Health Plan in advance. This will help manage your out-of-pocket costs.