The young adult’s guide to accessing care

How to get care when you’re away from home.

We’ve got you covered, no matter where life takes you. Whether you’re at home or away, use this quick guide with important information about your health coverage to get the care you need.

When you’re home

• Use the facilities and locations in your plan medical group (PMG). This is listed on your Sharp Health Plan member ID card.
  
  ⚠️ If you get care at a location that isn’t in your PMG, you may have higher deductibles and copays, or you may not be able to access care.

When you’re away from home

• Tell your doctor about any care you receive when you’re away.
• Out-of-area services are covered only for emergency or urgent medical conditions from unexpected illness or injury, and when treatment cannot wait until you return to the
  service area.
• Telehealth services, such as video and phone visits, may be available if your doctor determines that they are medically appropriate. Contact your primary care physician (PCP) with any questions. You can find their information on your Sharp Health Plan member ID card.
  
  

  TIP: Video visits are also covered with most in-network behavioral health providers. Visit our behavioral health resource center to learn more.

• Going to school outside of San Diego? Routine health services are not covered out of the service area. Check what your school offers for routine services. We recommend purchasing supplemental health insurance for non-urgent care at school.

When you turn 26

• You can stay on your parent or guardian’s health coverage policy until you turn 26 if you meet one of the following requirements. You must:
  
  
  1. Maintain your primary residence or work in our service area, or
  2. Be a full-time student at an accredited institution, or
  3. Have coverage provided under a medical support order.
• Your primary residence is the home or address where you actually live most of the time. A residence is not considered “primary” if you move without the intent to return, or if you are absent for more than 90 days in any 12-month period and are not a full-time student.

When your doctor is a pediatrician

• Pediatricians are experts at treating children and adolescents. If your PCP is a pediatrician, check with their office and your PMG to review when you should transition your care to a doctor who treats adults.