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 (PDF)

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

2020 Medicare Member Resource Guide
2020 Medicare Member Resource Guide, in Spanish
Future formulary change file Aug. 1, 2020
Prior authorization requirements Aug. 1, 2020
Step therapy requirements Aug. 1, 2020
Other health insurance coverage questionnaire
New mail order pharmacy for 2020 - FAQ
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, 2020
Summary of Benefits Jan. 1, 2020
Drug List (Formulary) Aug. 1, 2020
Provider & Pharmacy Directory June 3, 2020
- Provider & Pharmacy Directory Addendum Aug.1, 2020
Low-Income Subsidy (LIS) premium summary chart
Medicare Star Ratings flyer

en español / In Spanish

Enrollment Guide including Summary of Benefits Jan. 1, 2020
Summary of Benefits Jan. 1, 2020
Drug List (Formulary) Aug. 1, 2020
Provider & Pharmacy Directory June 3, 2020
- Provider & Pharmacy Directory Addendum Aug.1, 2020
Medicare Star Ratings flyer

Benefit information

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

en español / In Spanish

Delta Dental Plan (included for Platinum Card members) Jan. 1, 2020
Delta Dental Plan (for Gold Card members who add the plan) Jan. 1, 2020

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, 2020
Summary of Benefits Jan. 1, 2020

Drug List (Formulary) Aug. 1, 2020
Provider & Pharmacy Directory June 3, 2020
- Provider & Pharmacy Directory Addendum Aug.1, 2020
Low-income Subsidy (LIS) premium summary chart
Medicare Star Ratings flyer

en español / In Spanish

Enrollment Guide including Summary of Benefits Jan. 1, 2020
Summary of Benefits Jan. 1, 2020
Drug List (Formulary) Aug. 1, 2020
Provider & Pharmacy Directory June 3, 2020
- Provider & Pharmacy Directory Addendum Aug.1, 2020
Medicare Star Ratings flyer

Benefit information

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

en español / In Spanish

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

Annual Notice of Changes

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

en español / In Spanish

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

Evidence of Coverage

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

en español / In Spanish

Sharp Direct Advantage Basic - EOC Jan. 1, 2020
Sharp Direct Advantage Premium - EOC 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 Aug. 1, 2019
2019–20 Summary of Benefits
Drug List (Formulary) Aug. 1, 2020
2020 Provider & Pharmacy Directory June 3, 2020
- Provider & Pharmacy Directory Addendum Aug.1, 2020
Low-income Subsidy (LIS) Premium Summary Chart
Medicare Star Ratings flyer

en español / in Spanish

Enrollment Guide including Summary of Benefits Aug. 1, 2019
Drug List (Formulary) August 1, 2020
2020 Provider & Pharmacy Directory June 3, 2020
- Provider & Pharmacy Directory Addendum Aug.1, 2020
Medicare Star Ratings flyer

Annual Notice of Changes

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

en español / in Spanish

Annual Notice of Changes Aug. 1, 2019

Evidence of Coverage (EOC)

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

en español / in Spanish

Evidence of Coverage Aug. 1, 2019

2020-2021

Forms

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

Plan information

Enrollment Guide including Summary of Benefits Aug. 1, 2020
2020–21 Summary of Benefits
Drug List (Formulary) Aug. 1, 2020
Medicare Star Ratings flyer

en español / in Spanish

Enrollment Guide including Summary of Benefits Aug. 1, 2020
Medicare Star Ratings flyer

Annual Notice of Changes

Sharp Direct Advantage SDPEBA - ANOC Aug. 1, 2020

en español / in Spanish

Sharp Direct Advantage SDPEBA - ANOC Aug. 1, 2020

Evidence of Coverage (EOC)

Evidence of Coverage Aug. 1, 2020

en español / in Spanish

Evidence of Coverage Aug. 1, 2020

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: 7/31/2020

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

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 (PDF)

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 / In Spanish

Benefit information

en español / In Spanish

Annual Notice of Changes

en español / In Spanish

Evidence of Coverage

en español / In Spanish

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 / In Spanish

Benefit information

en español / In Spanish

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

2020-2021

Forms

Plan information

en español / in Spanish

Annual Notice of Changes

en español / in Spanish

Evidence of Coverage (EOC)

en español / in Spanish