Forms and authorizations for Sharp Direct Advantage Medicare members

Forms and other resources

Access helpful forms and resources such as our Medicare member resource guide, prior authorization, coverage determination and reimbursement forms.

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Forms

Coverage determination
- Coverage determination (PDF)
  For best results, the form should be filled out and printed from your web browser.
- Online coverage determination form

Resources

Future formulary change file Jan. 1, 2021
Prior authorization requirements Jan. 1, 2021
Step therapy requirements Jan. 1, 2021
Other health insurance coverage questionnaire
Inspire magazine

Platinum and Gold card members

Find plan and benefit information, download forms and learn about the annual changes for our Sharp Direct Advantage individual plans.

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Forms

Plan information

Enrollment Guide including Summary of Benefits Jan. 1, 2021
Summary of Benefits Jan. 1, 2021
Drug list (formulary) Jan. 1, 2021
Provider & Pharmacy Directory Jan. 1, 2021
- Provider & Pharmacy Directory Addendum
- Dental insert
Low-Income Subsidy (LIS) premium summary chart
2021 Medicare Star Ratings flyer

en español

Guía de afiliación a Medicare incluido el Resumen de beneficios - ef. 1/1/21
Resumen de beneficios- ef. 1/1/21
Lista de medicamentos completa (formulario) - ef. 1/1/21
Directorio de proveedores y farmacias - ef. 1/1/21
- Anexo del Directorio de proveedores y farmacias
- Servicios dentales
Calificaciones por estrellas Medicare 2021

Benefit information

Delta Dental Plan (included for Platinum Card members)
Delta Dental Plan (for Gold Card members who add the plan)
Vision benefits summary (included for Platinum Card members)
Vision benefits summary (included for Gold Card members)

en español

Delta Dental Plan (included for Platinum Card members)

Delta Dental Plan (for Gold Card members who add the plan)

Annual Notice of Changes

Aviso anual de cambios - en español

Evidence of Coverage

Evidencia de cobertura - en español

Sharp HealthCare former employees

Get the details about your coverage and annual changes on our Sharp Direct Advantage plans for former Sharp HealthCare employees.

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Forms

Plan information

Enrollment Guide including Summary of Benefits Jan. 1, 2021
Drug list (formulary) Jan. 1, 2021
Provider & Pharmacy Directory Jan. 1, 2021
- Provider & Pharmacy Directory Addendum
- Dental insert
Low-income Subsidy (LIS) premium summary chart
2021 Medicare Star Ratings flyer

en español

Lista de medicamentos completa (formulario) - ef. 1/1/21
Directorio de proveedores y farmacias - ef. 1/1/21
- Anexo del Directorio de proveedores y farmacias
- Servicios dentales
Calificaciones por estrellas Medicare 2021

Benefit information

Delta Dental Plan (for Basic or Premium members who add the plan)

en español / In Spanish

Delta Dental Plan (for Basic or Premium members who add the plan)

Annual Notice of Changes

Aviso anual de cambios - en español

Evidence of Coverage

Evidencia de cobertura - en español

City of San Diego retirees (SDPEBA)

View useful information about our exclusive Sharp Direct Advantage plan for City of San Diego retirees including coverage and annual changes.

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Forms

Enrollment form
Enrollment form, in Spanish (coming soon)
Plan change form

Sharp Direct Advantage is offered by Sharp Health Plan. Sharp Health Plan is an HMO with a Medicare contract. Enrollment with Sharp Health Plan depends on contract renewal. Read the full disclaimer.

H5386_2021 Website

Page Last Updated: 1/06/2021

October – March:	7 days a week
April – September:	Mon. – Fri.

Forms, authorizations and resources

Forms and other resources

Access helpful forms and resources such as our Medicare member resource guide, prior authorization, coverage determination and reimbursement forms.

Forms

Resources

Platinum and Gold card members

Find plan and benefit information, download forms and learn about the annual changes for our Sharp Direct Advantage individual plans.

Forms

Plan information

en español

Benefit information

en español

Annual Notice of Changes

Aviso anual de cambios - en español

Evidence of Coverage

Evidencia de cobertura - en español

Sharp HealthCare former employees

Get the details about your coverage and annual changes on our Sharp Direct Advantage plans for former Sharp HealthCare employees.

Forms

Plan information

en español

Benefit information

en español / In Spanish

Annual Notice of Changes

Aviso anual de cambios - en español

Evidence of Coverage

Evidencia de cobertura - en español

City of San Diego retirees (SDPEBA)

View useful information about our exclusive Sharp Direct Advantage plan for City of San Diego retirees including coverage and annual changes.

Forms

Plan information

en español / in Spanish

Annual Notice of Changes

en español / in Spanish

Evidence of Coverage (EOC)

en español / in Spanish