Tier 1

Your HMO level benefits and care.

When accessing health services through this tier, you get the care you need from doctors and hospitals in Sharp Health Plan’s Choice Network. You’ll be able to choose your own personal doctor — primary care physician, or PCP — who will coordinate all of your care, including referrals to specialists. Any specialists you see will need to be in the same plan medical group as your PCP.


View Choice Hospitals  Find a doctor


Here’s what to remember about Tier 1:

  • Your PCP is your main point of contact for all of your health care needs. They’ll handle your care, coordinate any treatments, refer you to a specialist if you need one, and more.
  • Preventive care services are offered at no extra cost.
  • Copays or coinsurance costs apply for most other care visits and services.

Tier 2

Your out-of-network level benefits and care.

With Tier 2, you can get care from the Aetna Open Choice PPO provider network, as well as out-of-network providers — with no referral needed. It’s important to remember that when you choose to get care from the Aetna Open Choice PPO provider network or out-of-network providers, your out-of-pocket costs will be higher. Out-of-network providers include any U.S. licensed health care professionals and facilities.

Use the tool below to search for an Aetna provider. Be sure to select the Open Choice PPO plan. 


Find an Aetna provider


Here's what to remember about Tier 2:

  • You can make appointments directly with providers in the Aetna Open Choice PPO network, or with any licensed health care providers in the U.S.
  • 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 most out-of-network services.

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.


Download the form

Directly through Sharp Health Plan

Follow these simple steps to get the most out of your new health plan. You can also use this checklist if you applied for health coverage through Covered California.

checkbox Carry your member ID card
Your member ID card is your key to accessing care. You will need it whenever you seek medical services, such as visiting your doctor or filling a prescription. Your member ID card also contains important benefit information, like which networks of doctors you have access to.
  • If you or a member of your family has not received an ID card, log in to Sharp Connect to request an ID card or print a temporary card.

checkbox Activate your member account
Visit sharphealthplan.com/login to register for our all-access, secure member portal. You can view your unique plan information, see what you can expect to pay for office visits and more. Everything you need to manage your plan, and your health, is at your fingertips.
  • Most plan medical groups offer a patient portal that lets you manage appointments, health records and more. Sharp Rees-Stealy and Sharp Community Medical Group members can log in or register for FollowMyHealth. If your doctor isn't a part of these medical groups, please visit sharphealthplan.com/your-patient-portal for more information.

checkbox Set up automatic payments
We offer convenient options to pay your premium bill online. Set up automatic payments or view your payment history through our secure online portal. Register or log in at sharphealthplan.com/payment.

checkbox Transfer your prescriptions
Under your health plan, there’s a lot of pharmacies to choose from. Use this helpful online tool to search for a pharmacy that is close by and works for you and your family. Just let your new pharmacy know that you need your prescriptions transferred from your old pharmacy. Also, let your primary care physician (PCP) know of any existing special authorizations for prescriptions that may need to be re-authorized.
  • Mail order is an easy and affordable way to get the medications you and your family need, along with the convenience of home delivery. Sign up here. 

checkbox Transfer any existing referrals and medical records
If you have existing referrals to see a specialist, ask your new PCP to re-authorize the referral with your new coverage. For medical records, please contact your previous doctor for assistance to transfer your protected health information to your new doctor.

checkbox Get care
We’re here to help you get the right care at the right time. Here are a few different ways you can get the care you need in any situation:
  • Get to know your PCP by setting up your first appointment. If you would like to switch doctors, fill out this form.
  • Receive after-hours and weekend medical advice in a single phone call to our specially trained registered nurses with Sharp Nurse Connection®. Just call 1-800-359-2002.
  • Our nationally-accredited wellness program provides free meal plans, exercise routines, and health coaching to keep you feeling your best. Get your free wellness score by registering for Best Health.

checkbox Manage your plan
Need a little more guidance on how best to manage your health plan? Take this shortcut to the most popular member actions on our website, from adding dependents to changing your primary care physician.

Through your employer

Follow these simple steps to get the most out of your new health plan.

checkbox Carry your member ID card
Your member ID card is your key to accessing care. You will need it whenever you seek medical services, such as visiting your doctor or filling a prescription. Your member ID card also contains important benefit information, like which networks of doctors you have access to.
  • If you or a member of your family has not received an ID card, log in to Sharp Connect to request an ID card or print a temporary card.

checkbox Activate your member account
Visit sharphealthplan.com/login to register for our all-access, secure member portal. You can view your unique plan information, see what you can expect to pay for office visits and more. Everything you need to manage your plan, and your health, is at your fingertips.
  • Most plan medical groups offer a patient portal that lets you manage appointments, health records, and more. Sharp Rees-Stealy and Sharp Community Medical Group members can log in or register for FollowMyHealth. If you doctor isn't a part of these medical groups, please visit sharphealthplan.com/your-patient-portal for more information.

checkbox Transfer your prescriptions
Under your health plan, there’s a lot of pharmacies to choose from. Use this helpful online tool to search for a pharmacy close by and works for you and your family. Just let your new pharmacy know that you need your prescriptions transferred from your old pharmacy. Also, let your PCP know of any existing special authorizations for prescriptions that may need to be re-authorized.
  • Mail order is an easy and affordable way to get the medications you and your family need, along with the convenience of home delivery. Sign up here. 

checkbox Transfer any existing referrals and medical records
If you have existing referrals to see a specialist, ask your new PCP to re-authorize the referral with your new coverage. For medical records, please contact your previous doctor for assistance to transfer your protected health information to your new doctor.

checkbox Get care
We’re here to help you get the right care at the right time. Here are a few different ways you can get the care you need in any situation:
  • Get to know your PCP by setting up your first appointment. If you would like to switch doctors, fill out this form.
  • Receive after-hours and weekend medical advice in a single phone call to our specially trained registered nurses with Sharp Nurse Connection®. Just call 1-800-359-2002.
  • Our nationally-accredited wellness program provides free meal plans, exercise routines, and health coaching to keep you feeling your best. Get your free wellness score by registering for Best Health.

checkbox Manage your plan
Need a little more guidance on how to best manage your health plan? Your HR department is your best resource for the most popular members actions, such as adding and removing dependents.
We offer eight different plans for individuals and families. Each one’s designed to give you the flexibility you need, at a price you like.
Healthy employees are happy, productive employees. Explore our plan options designed to meet the needs of your employees and their families.
If you're eligible for Medicare or would like to learn more about our Medicare Advantage plans, visit our dedicated website.      

Our Plans

Not sure where to start? We can recommend a plan that provides the right coverage and the most value based on your needs and preferences.
Get a quote and plan recommendation

Enter your zip code to get started.

.
NEXT
Browse and compare plans

Compare Options

Add or remove someone on your plan

When a life event occurs that requires you to update the dependents on your plan, there’s a few things you should know. Find out when changes can be made and which forms are required.

WHAT YOU NEED TO KNOW ➜

Get a new member ID or temporary card

Getting a new member ID card is simple. Sign in to your Sharp Connect account, request a replacement, and a new card will be mailed within seven to ten days. In the meantime, you can view and print a temporary ID card.

LOG IN TO MY ACCOUNT
ourplans-groupplans-indivpreexisting

Health Care Reform and your health

By law, your coverage can’t be dropped or denied if you have a pre-existing medical condition or if you get sick. Because of the Health Care Reform, you can get health insurance regardless of the current state of your health, and you can’t be charged more because of your existing health or medical condition. When you get care for your pre-existing condition or a new health condition, you’ll still need to pay any deductibles, copayments, and coinsurance your plan requires.

LEARN MORE

Quick and easy out-of-state care with CVS MinuteClinic

If you’re traveling and run into a minor illness or injury stop by a CVS/pharmacy® store. Their MinuteClinics are equipped to care for you, and you’ll only need to provide a $40 copayment anywhere in the the United States.

Looking for a dentist nearby? You have options

Premier Access Dental plan members have access to a broad network of care providers. Visit their site to find a dentist, just select “Dental HMO (Health Maintenance Organization)” under “State Exchange Plans” to begin your search, no login needed. If you are still having trouble, call Premier Access member services at 877.702.8800.

Find a Dentist

The best of San Diego is in your network.

Get-the-most-from-your-health-plan-DM-Medical-iStock000023109033-555x311

Featured article

Get the most health from your health plan

Sharp Health Plan’s Chief Medical Officer Dr. Cary Shames is quoted in this article on how to get the most out of your health plan. For the new year, members should take advantage of all the preventive health benefits available to them without a copay.

Find out how
Checking child's temperature

Featured article

Staying healthy when others are sick

First one person in your home gets sick with a cold or flu — perhaps your school-aged child, partner or roommate. Then you start feeling that slight tickle at the back of your throat or mild ache near your temples, and you sense that you’re next in line for the illness.

Read Article

Better health with better benefits

Best Health is a wellness program designed club caviar monogram metropolitan stockmarket luxury sheer. Impresario butler wine panoramic brokerage. Diamond club polo wishlist salon saphire career rare de-jour. Gilded dynasty gold.

Special kicker that wraps multiple lines.

This is a sentence that explains what the body content looks like inside a "kicker" module. You'll be able to call yourself CMS certified when you can explain to someone why you need to create content before adding a module to a page.

Here are some bullets and this text is bold:

  • You just got your wellness score
  • You had a new kitten
  • You just moved from another planet
  • You recently changed your hair color

Click this button

Test

Test

Test

  • 1
  • 2
  • 3
  1. One
  2. Two
  3. Three

Indent

Test

  • 1
  • 2
  • 3

Test

Test

TestTest

TestTest