Individual & family plan details / rates

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Understanding your individual and family plan benefits

What is a summary of benefits or summary of benefits and coverage document?

Summary of benefits (SB) documents explain your benefits. They are a summary of the health benefits covered under your plan. They offer specific information about the share of costs between you and Sharp Health Plan such as copays and deductibles.

If you are covered under a Covered California plan, you must receive a summary of benefits and coverage (SBC) document. It is similar to an SB document. An SBC is also a summary, but includes more information about out-of-network costs, limitations and exceptions. Only Covered California members are required to receive an SBC document.

View a sample Summary of Benefits document.

View a sample Summary of Benefits and Coverage document.

View the uniform glossary of medical terms.


Where can I find my plan's summary of benefits or summary of benefits and coverage document?

You can find your summary of benefits (SB) or summary of benefits and coverage (SBC) documents in several ways:

1) You’ll find a hyperlink to SB's when you get a quote and recommendation for individual and family plans on our website. You’ll also see a hyperlink to an SB when you've selected a plan and finished your enrollment application for an individual and family plan.

2) When you become a Sharp Health Plan member, you'll be mailed a copy of your SB or SBC in your member welcome kit.

3) When you become a Sharp Health Plan member, you can create a Sharp Connect member portal account and view/download your SB or SBC documents.

4) You can request an SB or SBC from us at any time or download documents available below on this webpage.


How do you use summary of benefits or summary of benefits and coverage documents?

Summaries of benefits (SB) and summaries of benefits and coverage (SBC) include the name of your health plan, the name of your network, and drug information. This information is helpful when checking to see if a doctor or provider is in your network or which prescription drugs your plan covers.

If you're already a Sharp Health Plan member, you can log in to the Sharp Connect member portal to securely find your health care provider and drug information.

If you're not a member yet, you can find a doctor in our provider directory. Choose the network that matches the one in the Summary of Benefits or Summary of Benefits and Coverage you're most interested in.

Members and non-members can can also search our drug lists without a portal account. You'll need to know how you purchased or plan to purchase your coverage. For example, an individual and family plan purchased from Covered California or from Sharp Health Plan directly.


What other plan documents should I use?

Summaries of benefits and summaries of benefits and coverage are only summary documents. For complete details of your plans, members can also refer to their Member Handbook and Supplemental Coverage Rider Documents. These documents include more detailed information about:

  • What services will and won't be covered
  • Conditions you must meet to receive benefits
  • When and in what form benefits are paid
  • When you need to get approval before getting a service, i.e., pre-authorizations
  • How to file a claim

Your summaries of benefits or summaries of benefits and coverage documents, your member handbook for your plan, and your supplemental coverage rider documents comprise your complete evidence of coverage (EOC) documents.

Members can create an account or log in to the Sharp Connect member portal to view your EOC.


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2018 Summaries of Benefits

Individual Off-Exchange Non-Funded Rates (effective January 1, 2018)




2018 Summaries of Benefits for Covered California Plans

Individual On-Exchange Non-Funded Rates (effective January 1, 2018)

Page Last Updated: 1/26/2018

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