Preferred Provider Organization (PPO) plan

Get the care you need, with the flexibility you want.

Sharp Health Plan’s PPO plan is designed to give you the freedom to receive care the way you want. In our three-tier employer group plan, you can choose to receive care from Sharp HealthCare’s integrated care delivery system, the First Health® Network or any out-of-network providers of your choice. Behavioral health services, including mental health and substance use disorder services, are provided by Magellan Healthcare, Inc.1

Choose any network anytime you need to get care.

Tier 1

Sharp Health Plan Premier Network

You have regional access to Sharp Health Plan’s award-winning care.

  • No primary care physician assigned
  • No referrals necessary
  • Lower out-of-pocket costs
  • Certain services may require precertification or approval from Sharp Health Plan
  • Behavioral health care through Magellan (within California)
Find a Tier 1 medical provider
Find a behavioral health provider ➜

Tier 2

First Health Network

You have nationwide access to care through the First Health Network.

  • No primary care physician assigned
  • No referrals necessary
  • Lower out-of-pocket costs
  • 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

You have the freedom to access care with any licensed provider in the U.S.

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

Benefits of our PPO plan

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Freedom of choice

Our PPO plan offers a large network of providers, so you can choose doctors, specialists and other providers at any time on your terms.

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Freedom from referrals

Choose to see a specialist at any time. You have the flexibility to see your preferred specialist without needing a referral from a primary care physician.

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Out-of-network availability

We recommend getting care from a provider within your network, but you can choose to go outside your network to receive care. Higher out-of-pocket costs may apply when you receive care from out-of-network providers.

PPO Concierge benefits

The PPO Concierge Program is a free resource that gives you access to these benefits:

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

Meet our PPO Concierge

Our PPO Concierge, Yvonne Mascareno, is our members' guide to understanding how their PPO 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

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


Questions?

What is a PPO plan?

A Preferred Provider Organization (PPO) plan is a plan that allows members to choose from a network of preferred providers. Members do not select a primary care physician and do not need referrals to see other plan providers in the network.

Your plan allows you to receive care from your plan providers within Sharp HealthCare’s integrated care delivery system (Tier 1). You can also receive care from non-plan providers in the First Health® Network (Tier 2), or any out-of-network 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 Sharp Health Plan Premier Network.
  • Tier 2: Please visit the First Health Network directory.
    • Please note, do not use the following services in this directory: acupuncturists, chiropractors, vision, dental, hearing, or mental health services. You may have access to other programs for these services.

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


Where can I find behavioral health providers?

Visit sharphealthplan.com/mentalhealthprovider to search for a Tier 1 or Tier 2 behavioral health provider and filter by specialty, location and more to find the best fit for you. In Tier 3, you can choose an out-of-network behavioral health provider, but costs may be higher.


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.


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