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 during COVID-19?
Getting started with Silver&Fit is easy. While many fitness centers are now closed during the current COVID-19 crisis, Silver&Fit has enhanced its at-home fitness options to help you stay active while sheltering in place. Here’s how you can get started:
- Visit SilverandFit.com online to register for an account.
- Enroll in the Home Fitness Program online. You can also enroll over the phone by calling Silver&Fit’s toll-free Customer Services hotline at 1-877-427-4788 (TTY/TDD: 1-877-710-2746).
- Silver&Fit will send your first home fitness kit to you within 10 days.
Please visit Silver&Fit to learn more.
My gym with Silver&Fit closed due to the COVID-19 crisis. What are my options to stay active?
Silver&Fit has a broad range of at-home fitness options:
- Silver&Fit Home Fitness Kits
- Silver&Fit ASHConnect™ Mobile App
- Silver&Fit Connected!™ Tool
- Silver&Fit Signature Series Classes® Exercise Videos – new!
These options are being offered at no charge to participating members. We encourage you to go to Silver&Fit to learn more.
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 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, the fastest easiest way to access your benefit 24/7 is online by visiting cvs.com/otchs/sharp. Where you can check account information, product availability
and process your order.
Below are instructions on how to create and account and place an order online.
How to place an order online:
- Create an account
- If it’s your first time placing your order online, you’ll need to create an account by visiting cvs.com/otchs/sharp.
- Then, click on the Create account button and follow the instructions.
- You will need your member ID, date of birth, zip code, and a current email address.
- You will also need to create a password.
- If you need help locating your member ID, click on Get help locating your member ID.
- Remember to save your password for future orders. You will need your member ID or email address along with your password to sign in.
- Place an order
- Once you sign in, your benefit amount and balance will be displayed at the top of the page.
- Browse through the available products and add to your basket. Your order total will automatically deduct from your remaining balance at the top of the page.
- Once you are ready to place your order, click on Checkout.
- On the checkout page, confirm your shipping address, review your order, and place your order. Your order will arrive in 7-10 days.
- You will receive an email with tracking information once your order has shipped and another once your order has been delivered.
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 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 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.
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.
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.