Forms, authorizations, resources for Sharp Direct Advantage Medicare

Sharp Direct Advantage individual plans

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 effective Jan. 1, 2020
Summary of Benefits effective Jan. 1, 2020
Comprehensive Drug List effective Feb. 1, 2020
Provider & Pharmacy Directory effective Jan. 1, 2020
Provider & Pharmacy Directory addendum effective Feb. 1, 2020
Low-Income Subsidy (LIS) premium summary chart
Medicare Star Ratings flyer

en español / In Spanish

Enrollment Guide including Summary of Benefits effective Jan. 1, 2020
Summary of Benefits effective Jan. 1, 2020
Comprehensive Drug List effective Feb. 1, 2020
Provider & Pharmacy Directory effective Jan. 1, 2020
Provider & Pharmacy Directory addendum effective Feb. 1, 2020
Medicare Star Ratings flyer

Benefit information

Dental insert effective Jan. 1, 2020
Delta Dental Plan (included for Platinum Card members) effective Jan. 1, 2020
Delta Dental Plan (for Gold Card members, Basic members or Premium members who add the plan) effective Jan. 1, 2020
Vision benefits summary (included for Platinum Card members) effective Jan. 1, 2020
Vision benefits summary (included for Gold Card members) effective Jan. 1, 2020

Former Sharp HealthCare 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 effective Jan. 1, 2020
Summary of Benefits effective Jan. 1, 2020

Comprehensive Drug List effective Feb. 1, 2020
Provider & Pharmacy Directory effective Jan. 1, 2020
Provider & Pharmacy Directory addendum effective Feb. 1, 2020
Low-income Subsidy (LIS) premium summary chart
Medicare Star Ratings flyer

en español / In Spanish

Enrollment Guide including Summary of Benefits effective Jan. 1, 2020
Summary of Benefits effective Jan. 1, 2020
Comprehensive Drug List effective Feb. 1, 2020
Provider & Pharmacy Directory effective Jan. 1, 2020
Provider & Pharmacy Directory addendum effective Feb. 1, 2020
Medicare Star Ratings flyer

Benefit information

Dental insert effective Jan. 1, 2020
Delta Dental Plan (for Gold Card members, Basic members or Premium members who add the plan) effective Jan. 1, 2020

Annual Notice of Changes

Sharp Direct Advantage Basic - ANOC effective Jan. 1, 2020
Sharp Direct Advantage Premium - ANOC effective Jan. 1, 2020

en español / In Spanish

Sharp Direct Advantage Basic - ANOC effective Jan. 1, 2020
Sharp Direct Advantage Premium - ANOC effective Jan. 1, 2020

Evidence of Coverage

Sharp Direct Advantage Basic - EOC effective Jan. 1, 2020
Sharp Direct Advantage Premium - EOC effective Jan. 1, 2020

en español / In Spanish

Sharp Direct Advantage Basic - EOC effective Jan. 1, 2020
Sharp Direct Advantage Premium - EOC effective Jan. 1, 2020

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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2019-2020

Forms

Plan information

Enrollment Guide including Summary of Benefits effective Aug. 1, 2019
2019–20 Summary of Benefits
Comprehensive Drug List effective Dec. 1, 2019
2020 Provider & Pharmacy Directory effective Jan. 1, 2020
2020 Provider & Pharmacy Directory addendum effective Feb. 1, 2020
Low-income Subsidy (LIS) Premium Summary Chart
Star ratings flyer

en español / In Spanish

Enrollment Guide including Summary of Benefits effective Aug. 1, 2019
Comprehensive Drug List effective Dec. 1, 2019
2020 Provider & Pharmacy Directory effective Jan. 1, 2020
2020 Provider & Pharmacy Directory addendum effective Feb. 1, 2020
Star ratings flyer

Annual Notice of Changes

Annual Notice of Changes effective Aug. 1, 2019
Annual Notice of Changes & Evidence of Coverage addendum effective Jan. 1, 2020

en español / In Spanish

Annual Notice of Changes effective Aug. 1, 2019

Evidence of Coverage (EOC)

Evidence of Coverage effective Aug. 1, 2019
Annual Notice of Changes & Evidence of Coverage addendum effective Jan. 1, 2020

en español / In Spanish

Evidence of Coverage effective Aug. 1, 2019

Additional member forms and resources

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

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Forms (PDF)

Coverage determination

For best results, the form should be filled out and printed from your web browser.

Request for redetermination
Prior authorization request
Part C member reimbursement request
Part D prescription reimbursement claim
Part D late enrollment penalty (LEP) reconsideration request
Appointment of representative
Authorization for use or disclosure of protected health information (PHI)
Bank withdrawal pre-authorization form

Resources

2020 Medicare Member Resource Guide
2020 Medicare Member Resource Guide, in Spanish
Future formulary change file effective Jan. 1, 2020
Prior authorization requirements effective Feb. 1, 2020
Step therapy requirements effective Feb. 1, 2020
Other health insurance coverage questionnaire
New mail order pharmacy for 2020 - FAQ
Inspire magazine

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_2020 website

Page Last Updated: 2/13/2020

Forms, authorizations and resources

Sharp Direct Advantage individual plans

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 / In Spanish

Benefit information

Annual Notice of Changes

en español / In Spanish

Evidence of Coverage

en español / In Spanish

Former Sharp HealthCare 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 / In Spanish

Benefit information

Annual Notice of Changes

en español / In Spanish

Evidence of Coverage

en español / In Spanish

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.

2019-2020

Forms

Plan information

en español / In Spanish

Annual Notice of Changes

en español / In Spanish

Evidence of Coverage (EOC)

en español / In Spanish

Additional member forms and resources

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

Forms (PDF)

Resources