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).
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 1-855-492-9028, or send an email to email@example.com 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?
We offer mail order services through our partner CVS Caremark® Mail Service Pharmacy. Please visit the pharmacy section of our website to learn more. You can also call the dedicated prescription helpline that’s printed on the back of your member ID card for 24/7 assistance.
I tried calling to place an order, but I couldn't get through. Is there another way I can place an order?
We are currently experiencing extreme demand, which is impacting call center wait times, and availability of select preparedness related product categories, like hand sanitizer, wipes and cold & flu products. Our teams are making every effort to prioritize your needs with our suppliers. We sincerely apologize for any inconvenience during these unprecedented circumstances.
As a reminder, you can also can obtain over-the-counter (OTC) items directly from select CVS Pharmacy® stores or you can place an order online by visiting cvs.com/otchs/sharp. Here you can check account information, product availability and process your order.
Below are instructions on how to purchase in-store or order online.
Shop for eligible OTC products — listed in the item catalog with a blue label (pictured below) — at a participating CVS Pharmacy store near you. Once you have selected your approved items, go to any checkout register and show your Sharp Direct Advantage member ID card. Read more important details about in-store shopping here.
Step-by-step instructions for first-time online users
Create an account
- Go to cvs.com/otchs/sharp online.
- Click the “Create account” button and follow the instructions.
- You will need your Sharp Direct Advantage member ID number, date of birth, ZIP code and a current email address. As a friendly reminder, your member ID number is listed on the front of your Sharp Direct Advantage member ID card.
Note: You must use a unique email address for your account.
- You will also need to create a password.
- Save your account password for future online orders. You will need your member ID or email address and your password to sign in.
Order your OTC items online
- After you sign in to your account, your benefit amount and balance will be listed at the top of the page.
- Shop the available products and add items to your basket. Your order total will automatically deduct from your remaining balance at the top of the page.
- When you are ready to place your order, click on “Checkout.”
- At the checkout page, confirm your shipping address and make sure your order is correct.
- Place your order. That’s it!
Your order will arrive in 7–14 days. You’ll receive an email with tracking information to confirm your order is placed, when your order has shipped and another email to confirm when your order has been delivered. If an item in our order
is out of stock, you will receive an email notification.
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 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 Health Plan online 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 place your order either 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.
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 an online account
What is a Sharp Health Plan online account?
A Sharp Health Plan online account gives you access to 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.
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 your Sharp Health Plan online account 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.