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 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?
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.
How much is my over-the-counter allowance?
Over-the-counter allowances vary depending on your plan. To see which plan you’re enrolled in, check your coverage documents like your Summary of Benefits or Evidence of Coverage. Log in to your Sharp Health Plan online account at sharpmedicareadvantage.com/login to see your coverage documents.
I take aspirin every day. Can I use my allowance to buy it?
Yes, aspirin is just one of the hundreds of everyday health items available in your OTC catalog.
Can I get a physical copy of the OTC item catalog?
VIP Plan, Gold Card & Platinum Card plan members: Call OTC Health Solutions at 1-855-788-3466 (TTY: 711) to request a physical copy of the OTC item catalog. They are available on weekdays from 9 am to 8 pm, Pacific time.
Group VIP Plan, SDPEBA & Extra plan members: Call OTC Health Solutions at 1-888-628-2770 (TTY: 711) to request an OTC item catalog in the mail. They are available on weekdays from 9 am to 8 pm, Pacific time. As another option, you can also download the catalog for your plan and print it out at home.
How do I check my allowance balance?
VIP Plan, Gold Card & Platinum Card plan members: Sign in to mybenefitscenter.com with your Advantage Card number. After signing in, you’ll arrive at the “My Benefits” page, which shows your current benefits and OTC allowance balance.
Group VIP Plan, SDPEBA & Extra plan members: Sign in to cvs.com/otchs/sharp and select “My Account” to see your OTC allowance balance. Or, you can call 1‑888‑628‑2770 (TTY: 711) to find out your balance.
What if my order costs more than my allowance?
You won’t be able to place an order for an item that is above your allowance amount.
What happens if I have money left in my allowance balance at the end of the quarter? Can I add it to the allowance for the next quarter?
No, your benefit allowance does not roll over into the next quarter (three-month period). At the start of each quarter, your allowance will be reset to your quarterly spending limit.
How long does it take to get my order once I’ve placed it?
Most orders will arrive within 7 to 10 business days of placing your order.
Can I track my orders?
VIP Plan, Gold Card & Platinum Card plan members: Yes. For online orders, you will receive emails with the latest status updates as your order gets processed. Most orders will arrive in 7-10 business days. If you don’t receive you order within 14 days of placing your order, call OTC Health Solutions at 1-855-788-3466 (TTY: 711).
Group VIP Plan, SDPEBA & Extra plan members: Yes. Sign in to cvs.com/otchs/sharp, go to “My Account” and select “Order History.” If you haven’t received your order within 14 days, call 1-888-628-2770 (TTY: 711) to check the status of your order.
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.