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Point of Service (POS) plans

We offer 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 licensed care provider in the United States. Behavioral health services, including mental health and substance use disorder services, are provided by Magellan Healthcare, Inc.1

Tier 1

Sharp Health Plan Performance Network

Receive care from any licensed providers and hospitals in our Performance Network.

  • Lowest out-of-pocket costs.
  • Referrals may be needed.
  • Your primary care physician, or PCP, coordinates all of your care.
  • Copays or coinsurance costs apply to every visit and service, in addition to your deductible.
  • Behavioral health care through Magellan (within California).
Find a Tier 1 medical provider
Find a behavioral health provider ➜

Tier 1

Sharp Health Plan Choice Network

Receive care from any licensed providers and hospitals in our Choice Network.

  • Lowest out-of-pocket costs.
  • Referrals may be needed.
  • Your primary care physician, or PCP, coordinates all of your care.
  • Copays or coinsurance costs apply to every visit and service, in addition to your deductible.
  • Behavioral health care through Magellan (within California).
Find a Tier 1 medical provider
Find a behavioral health provider ➜

Tier 2

Aetna Open Choice PPO® Network

Get care from the Aetna Open Choice PPO provider network.

  • Higher out-of-pocket costs.
  • No referrals necessary.
  • Copays or coinsurance costs apply to every visit and service, in addition to your deductible.
  • Certain services may require precertification or approval from Sharp Health Plan.
  • Behavioral health care through Magellan (outside of California).
Find a Tier 2 medical provider
Find a behavioral health provider ➜

Tier 3

Out-of-network

Members can receive care from any care provider in the U.S., including physicians, specialists, hospitals or laboratories.

  • Highest out-of-pocket costs.
  • No referrals necessary.
  • Certain services may require precertification or approval from Sharp Health Plan.
  • Behavioral health care through any non‑Magellan provider.

Benefits of our POS plans

Choices icon

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.

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Out-of-network availability

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

Get more information about your plan

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.

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.

Questions?

What is a POS plan?

Sharp Health Plan’s Point of Service Plan (POS) combines features of a health maintenance organization (HMO) and a Preferred Provider Organization (PPO). You can access care in three distinct tiers.

Your plan allows you to receive care within Sharp HealthCare’s integrated care delivery system (Tier 1), Aetna’s Open Choice PPO Network (Tier 2), or any non-participating provider of your choice (Tier 3).

Services in Tier 1 and Tier 2 are the most cost-effective. Tier 3 services are out-of-network and typically cost more than services provided in Tiers 1 and 2.


What is precertification?

Some services require approval from Sharp Health Plan before care is provided. This allows Sharp Health Plan to evaluate whether the care is medically necessary and eligible for coverage. Learn more about precertification.


How can I find a medical provider in Tier 1 or Tier 2?

  • Tier 1: Please use our provider directory and search under the Choice Network for Large Group plans and the Performance Network for Small Group plans.
  • Tier 2: Please visit the Aetna provider directory.
    • Please note: Do not use the Alternative Medicine search category. You can search for alternate care providers through our partner, American Specialty Health Plan, by calling 1-800-678-9133 or by visiting ashlink.com/ash/SharpHPpos.

You can choose an out-of-network medical provider, but costs may be higher.


Where can I find behavioral health providers?

Please visit Magellan’s online provider directory to search for a behavioral health provider. You will be prompted to select your benefit plan and can select either Tier 1 or Tier 2 from the list of options.


How can I be reimbursed for services I paid out of pocket?

You can seek reimbursement for paid services from Sharp Health Plan. Please download and complete the reimbursement form. To be reimbursed for at-home COVID-19 tests, please download and complete this form.


What if my provider is not in the Tier 1 or Tier 2 network?

If your preferred provider is not in our Tier 1 or Tier 2 network, you can access services from your preferred licensed provider using your Tier 3 out-of-network benefit level. Costs may be higher in Tier 3.  

To nominate a provider to join the Tier 2 Aetna Open Choice Network, the provider must agree to the terms and conditions of being contracted with them. Please note that a nomination does not guarantee that the provider will join the proposed network. For more information, please contact customer care at 1-858-499-8300, Monday to Friday, 8am – 6pm.  


1. In California, Magellan is doing business as Human Affairs International of California, Inc.

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