Understanding my coverage and benefits
What is a network?
A network is a group of doctors, hospitals, pharmacies, and other medical service providers associated with your unique health plan.
What is a plan medical group (PMG)?
A plan medical group (PMG) is a designated group of physicians and hospitals associated with your network. You have access to hospitals, specialty care and urgent care centers affiliated with your PMG. It is important to keep in mind that referrals or authorizations do not transfer between PMGs, and you only have access to one PMG at a time.
With the Sharp Direct Advantage Network, you’ll find a family of providers close to where you live and spend time. Our network includes Sharp Rees-Stealy Medical Group (SRS), Sharp Community Medical Group (SCMG) and our regional partner, Greater Tri Cities Medical Group. To find out which doctors are affiliated with your PMG, refer to the Sharp Direct Advantage Network provider directory at sharpmedicareadvantage.com/findadoctor or call Customer Care at 1-855-562-8853 (TTY 711).
How do I get started with Silver&Fit?
Getting started with Silver&Fit is easy. We’ve made it simple with just three steps:
1. Visit SilverandFit.com online to find a participating Silver&Fit fitness center near you.
All you need to do is choose the type of fitness center you’d like to join, and type in your
ZIP code or city. Then click Search to find the right gym for you.
2. Contact Silver&Fit to let them know which participating fitness center you’d like to join.
You can call the Silver&Fit toll-free Customer Services hotline at 1-877-427-4788 (TTY/TDD 1-877-710-2746). Your effective date, or the date you can start using your fitness center’s facilities for free, will be the day after you call to enroll.
3. Silver&Fit will send you a fitness card to bring when you show up to the fitness center of your choice.
If you’re not able to travel to a facility or prefer exercising at home, your benefits include a free at-home fitness option. Silver&Fit offers a Home Fitness Program, where you can choose up to two Home Fitness Kits per benefit year. Each kit has a fitness theme, and will include materials such as DVDs, booklets and a quick start guide. You can enroll online or by phone, using the customer services hotline above. To learn more about Silver&Fit, please visit their website at SilverandFit.com.
The gym I’m trying to enroll in can’t verify my eligibility. What do I do?
If your local Silver&Fit facility can’t find you in their system, please call Silver&Fit toll-free Customer Services hotline at 1-877-427-4788 (TTY/TDD 1-877-710-2746). They are available to assist you Monday – Friday 5 a.m. to 6 p.m., Pacific Time. If they are unable to find you in their system, please call Sharp Health Plan Customer Care at 1-855-562-8853 (TTY 711) to report this issue. Please be sure to have your Sharp Health Plan member ID number available.
Will I get a card for my Vision Service Plan (VSP)?
No. When you access vision care, your VSP provider can verify your coverage using your Sharp Health Plan member ID number (starts with the letter S).
My eye doctor is unable to verify my eligibility. What do I do?
If your Vision Service Plan (VSP) provider can’t find you in their system, please contact VSP Member Services at 1-800-877-7195, or send an email to firstname.lastname@example.org to verify that you are in their system. They are available to assist you Monday – Friday, 5 a.m. to 8 p.m., Saturdays 7 a.m. to 8 p.m., and Sundays 7 a.m. to 7 p.m. Pacific Time. If they are unable to find you in their system, please call Sharp Health Plan Customer Care at 1-855-562-8853 (TTY 711) to report this issue. Please be sure to have your Sharp Health Plan member ID number available.
My dentist can’t verify my eligibility. What do I do?
If your dental provider can’t find you in their system, please call Delta Dental’s Customer Service Department at 1-800-390-3368 (TTY/TDD 711). They are available to assist you Monday – Friday, 5 a.m. to 5 p.m., Pacific Time. If they are unable to find you in their system, please call Sharp Health Plan Customer Care at 1-855-562-8853 (TTY 711) to report this issue. Please be sure to have your Sharp Health Plan member ID number available.
Is the Assist America® phone number on my Sharp Direct Advantage member ID card?
No. Assist America’s contact information is not shown on your member ID Card. To contact Assist America in the U.S., please call 1-800-872-1414. To contact Assist America outside of the U.S., please call 1-609-986-1234. They are available to assist you 24 hours a day, seven days a week. Please be sure to have your Sharp Health Plan member ID number available.
Accessing plan materials and correspondence
Is there a way to decrease the amount of mail I receive from Sharp Health Plan? Can I elect for email notifications instead?
Unfortunately, no. Sharp Health Plan is required by the Centers for Medicare & Medicaid Services (CMS) to communicate most plan information to members by mail. For this same reason, we are unable to offer an email notification option for member correspondence at this time.
How do I sign up for mail-order prescriptions?
To sign up for mail-order prescriptions, please visit sharpmedicareadvantage.com/mailorder. You can also call Postal Prescription Services at 1-800-552-6694. They are available to assist Monday – Friday, 6 am to 6 pm, and Saturdays 9 am to 2 pm, Pacific Time. Please note that Tier 5 medications are not available through mail order.
*Important note: We will be transitioning to a new mail order partner in January 2020. To learn more, visit Pharmacy FAQ.
Over-the-counter benefit 2020
Where can I find my Sharp Health Plan member ID number?
It can be found on the front of your health plan member ID card.
How can I find out what my benefit allowance is?
Our Sharp Direct Advantage Gold and Platinum Card individual plans in 2020 will feature a supplemental over-the-counter (OTC) benefit. Benefit allowances vary depending on your plan. Check your Evidence of Coverage (EOC) to see what plan you’re enrolled in. You can access your EOC online through your Sharp Connect account at sharphealthplan.com/login.
Where can I find an OTC benefit catalog?
You can download the OTC benefit catalog for your plan. You can also have a catalog mailed to you by calling OTC Health Solutions at 1-888-628-2770 (TTY: 711). They are available to assist you Monday through Friday, 6 am to 5 pm Pacific Time.
How do I place my order?
You can either place your order online or over the phone. To order online, visit cvs.com/otchs/sharp and log in with your Sharp Health Plan member ID number and ZIP code.
I take aspirin every day. Can I use my allowance to buy it?
Yes, aspirin is just one of the hundreds of everyday health care products available in the catalog.
Is there a shipping and handling charge?
No. There is no charge to you for shipping and/or handling.
How long does it take to get my order once I’ve placed it?
You should receive your order within 7 to 10 business days of placing your order.
Can I track my orders?
Yes. Visit cvs.com/otchs/sharp, go to My Account and click on Order History. Or you can call 1-888-628-2770 (TTY: 711) to check the status of your order.
Can I use my allowance at my local pharmacy?
No, the benefit allowance can only be used for products from the Sharp Health Plan OTC catalog and can’t be used at a pharmacy or retail store.
What if the cost of my order is less than my allowance?
Let’s say your benefit allowance per quarter is $80 and you spend only $20 on your first order. That means you have another $60 left to use as long as you place the second order before the next quarter begins. Remember, unused benefits do not roll over from one quarter to the next.
What if the cost of my order is more than my allowance?
You won’t be able to place an order for an item that is above your allowance amount.
Can I check my account balance?
Yes. Visit the Sharp Health Plan OTC website and click on My Account to see your balance. Or you can call 1-888-628-2770 (TTY: 711) to find out what your account balance is.
What if I have money left in my account at the end of the quarter? Can I add it to the allowance for the next quarter?
No, the benefit allowance does not roll over into the next quarter. At the beginning of each quarter, your allowance will be reset to your quarterly spending limit.
Can I return my order?
Yes. If you receive a damaged item, please call OTC Health Solutions within 30 days after receiving your order. An identical replacement item will be shipped to you free of charge. No other returns or exchanges are allowed.
Registering for the portal
What is Sharp Connect?
Sharp Connect is our free online member portal that connects you with important plan information 24-hours a day. It’s mobile friendly, and allows you to view your benefits, update plan information, change your primary care physician, request a new member ID card, print a temporary card, check the covered drug list and much more.
I have a Sharp Connect account, why do I have to re-register?
We’re excited to announce a portal upgrade that will offer even better functionality for our members online. As a result, we’re asking existing portal users to re-register on the portal for a brand new experience. You can do that by visiting the Sharp Medicare Advantage login page beginning January 1, 2018.
Selecting or changing my primary care physician
How do I choose a primary care physician (PCP)?
Your personal doctor, or primary care physician (PCP), is your partner in health. Whether it’s your first visit or an annual preventive care check-up, they will coordinate all of your care. They also provide referrals to other plan providers within your plan medical group. When you select a PCP, you are selecting your plan medical group. We encourage you to select a PCP who best suits your needs. If you are unable to select a PCP at the time you enroll in Sharp Health Plan, we will select one for you based on your mailing address, so that you can access care immediately.
Can I change my primary care physician (PCP)?
We know choosing the right PCP is a personal decision, which is why we make it easy for you to change your selection at any time. You can find a list of doctors online at sharpmedicareadvantage.com/findadoctor. If you wish to make a change, you can log in to Sharp Connect to use the online change PCP form, or call Customer Care at 1-855-562-8853 (TTY 711) and we will help you select a new PCP. The change will be effective on the first day of the following month. Upon making your selection, we will mail you a new member ID card.