You & Sharp Health Plan

Getting the best possible care.

We at Sharp Health Plan want to make sure you receive the medical information you need about your health plan, the people who provide your care, and the services available to you. Having this information helps you be an active participant in your own medical care. We also believe in your right to considerate and respectful care as well as your right to privacy.

Here are you rights and responsibilities as a Sharp Health Plan member, and information on how we work to protect your information.

Your rights and responsibilities

As a Sharp Health Plan member, you have certain rights and responsibilities to ensure that you have appropriate access to all covered benefits.

As a member, you have the right to:

Receive information about your rights and responsibilities.
Receive information about your Plan, the services your Plan offers you, and the Health Care Providers available to care for you.
Make recommendations regarding the Plan’s Member rights and responsibilities policy.
Receive information about all health care services available to you, including a clear explanation of how to obtain them and whether the Plan may impose certain limitations on those services.
Know the costs for your care, and whether your Deductible or Out-of-Pocket Maximum have been met.
Choose a Health Care Provider in your Plan’s network, and change to another doctor in your Plan’s network if you are not satisfied.
Receive timely and geographically accessible health care.
Have a timely appointment with a Health Care Provider in your Plan's network, including one with a specialist.
Have an appointment with a Health Care Provider outside of your Plan’s network when your Plan cannot provide timely access to care with an in-network Health Care Provider.
Certain accommodations for your disability, including:

Equal access to medical services, which includes accessible examination rooms and medical equipment at a Health Care Provider’s office or facility.
Full and equal access, as other members of the public, to medical facilities.
Extra time for visits if you need it.
Taking your service animal into exam rooms with you.

Purchase health insurance or determine Medi-Cal eligibility through the California Health Benefit Exchange, Covered California.
Receive considerate and courteous care and be treated with respect and dignity.
Receive culturally competent care, including but not limited to:

Trans-Inclusive Health Care, which includes all Medically Necessary services to treat gender dysphoria or intersex conditions.
To be addressed by your preferred name and pronoun.

Receive from your Health Care Provider, upon request, all appropriate information regarding your health problem or medical condition, treatment plan, and any proposed appropriate or Medically Necessary treatment alternatives. This information includes available expected outcomes information, regardless of cost or benefit coverage, so you can make an informed decision before you receive treatment.
Participate with your Health Care Providers in making decisions about your health care, including giving informed consent when you receive treatment. To the extent permitted by law, you also have the right to refuse treatment.
A discussion of appropriate or Medically Necessary treatment options for your condition, regardless of cost or benefit coverage.
Receive health care coverage even if you have a pre-existing condition.
Receive Medically Necessary Treatment of a Mental Health or Substance Use Disorder.
Receive certain preventive health services, including many without a Co-pay, Co-insurance, or Deductible.
Have no annual or lifetime dollar limits on basic health care services.
Keep eligible Dependent(s) on your Plan.
Be notified of an unreasonable rate increase or change, as applicable
Protection from illegal balance billing by a Health Care Provider.
Request from your Plan a second opinion by an Appropriately Qualified Health Care Provider.
Expect your Plan to keep your personal health information private by following its privacy policies, and state and federal laws.
Ask most Health Care Providers for information regarding who has received your personal health information.
Ask your Plan or your doctor to contact you only in certain ways or at certain locations.
Have your medical information related to sensitive services protected.
Get a copy of your records and add your own notes. You may ask your doctor or health plan to change information about you in your medical records if it is not correct or complete. Your doctor or health plan may deny your request. If this happens, you may add a statement to your file explaining the information.
Have an interpreter who speaks your language at all points of contact when you receive health care services.
Have an interpreter provided at no cost to you.
Receive written materials in your preferred language where required by law.
Have health information provided in a usable format if you are blind, deaf, or have low vision.
Request continuity of care if your Health Care Provider or medical group leaves your Plan or you are a new Plan Member.
Have an Advanced Health Care Directive.
Be fully informed about your Plan’s Grievances procedure and understand how to use it without fear of interruption to your health care.
File a complaint, Grievance, or Appeal in your preferred language about:

Your Plan or Health Care Provider.
Any care you receive, or access to care you seek.
Any covered service or benefit decision that your Plan makes.
Any improper charges or bills for care.
Any allegations of discrimination on the basis of gender identity or gender expression, or for improper denials, delays, or modifications of Trans-Inclusive Health Care, including Medically Necessary services to treat gender dysphoria or intersex conditions.
Not meeting your language needs.

Know why your Plan denies a service or treatment..
Contact the Department of Managed Health Care if you are having difficulty accessing health care services or have questions about your Plan.
To ask for an Independent Medical Review if your Plan denied, modified, or delayed a health care service.

As a plan member, you have the responsibility to:

Treat all Health Care Providers, Health Care Provider staff, and Plan staff with respect and dignity.
Share the information needed with your Plan and Health Care Providers, to the extent possible, to help you get appropriate care.
Participate in developing mutually agreed-upon treatment goals with your Health Care Providers and follow the treatment plans and instructions to the degree possible.
To the extent possible, keep all scheduled appointments, and call your Health Care Provider if you may be late or need to cancel.
Refrain from submitting false, fraudulent, or misleading claims or information to your Plan or Health Care Providers.
Notify your Plan if you have any changes to your name, address, or family members covered under your Plan.
Timely pay any Premiums, cost sharing, and charges for non-covered services.
Notify your Plan as soon as reasonably possible if you are billed inappropriately.

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Here's what to do

Notice of privacy practices

We have internal processes to protect your oral, written and electronic Protected Health Information (PHI). And we must give you this Notice that tells how we may use and share your information and what your rights are. We have the right to change the privacy practices described in this Notice. If we do make changes, the new Notice will be available upon request, in our office, and on our website.

Your information is personal and private. We receive information about you when you become eligible and enroll in our health plan. We also receive medical information from your doctors, clinics, labs, and hospitals in order to approve and pay for your health care.

Learn more about how we protect your information.

Download privacy practices

Sharp Code of Conduct

As San Diego's health care leader, Sharp HealthCare believes in leading by example and in safeguarding our reputation of integrity, honesty and doing the right thing — values upon which Sharp was built.

The Code of Conduct integrates our mission, vision and values with our policies and procedures, and the professional standards that are in place throughout the Sharp system.

The Code of Conduct provides clear directives for all employees, physicians and volunteers to follow and applies to the entire Sharp team. It is a reference guide for understanding the standards and ethical framework in making good choices.

The Code of Conduct is about each individual stepping up as a leader and a role model to help foster an ethical culture and maintain the high standards that underpin our reputation.

Public Policy Committee

Be a part of Sharp Health Plan's Public Policy Committee

Sharp Health Plan has a Public Policy Advisory Committee, also known as Member Advisory Committee, that includes members who provide input into a variety of matters, such as member satisfaction, plan benefits, and member concerns. The committee meets quarterly. Participation in this committee is one way for you to tell us how you feel about Sharp Health Plan and how we can better serve you.

If you would like more information about the Public Policy Committee or would like to participate, please call Customer Care at 1-858-499-8300 or toll-free at 1-800-359-2002, or send an email.

Nondiscrimination Notice

Sharp Health Plan complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age or disability. Sharp Health Plan does not exclude people or treat them differently because of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age or disability.

Sharp Health Plan:

Provides free aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters.
Provides reasonable modifications for individuals with disabilities, and appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternative formats, such as braille or large print, free of charge and in a timely manner, when such modifications, aids, and services are necessary to ensure accessibility and an equal opportunity to participate to individuals with disabilities.
Provides free language services to people whose primary language is not English, such as:

Qualified interpreters and language assistance services, including electronic and written translated documents and oral interpretation, free of charge and in a timely manner, when such services are a reasonable step to provide meaningful access to an individual with limited English proficiency. If you need these services, contact Customer Care at 1-800-359-2002 (TTY 711).

If you believe that Sharp Health Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age or disability, you can file a grievance with our Civil Rights Coordinator and Section 1557 Nondiscrimination Coordinator at:

Address: Sharp Health Plan Compliance Department, Attn: Director of Compliance and Regulatory Affairs Department, 8520 Tech Way, Suite 200, San Diego, CA 92123-1450
Telephone: 1-800-359-2002 (TTY: 711)
Fax: 1-619-740-8572
Email: shpcompliance@sharp.com

You can file a grievance in person or by mail or fax, or you can also complete the online Grievance / Appeal form on the plan’s website sharphealthplan.com. Please call our Customer Care team at 1-800-359-2002 if you need help filing a grievance. You can also file a discrimination complaint if there is a concern of discrimination based on race, color, national origin, age, disability or sex with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 1-800-537-7697 (TDD).

Complaint forms are available at hhs.gov/ocr/office/file/index.html.

The California Department of Managed Health Care is responsible for regulating health care service plans. If your grievance has not been satisfactorily resolved by Sharp Health Plan or your grievance has remained unresolved for more than 30 days, you may call toll-free the Department of Managed Health Care for assistance:

1-888-466-2219 Voice
1-877-688-9891 TDD

The Department of Managed Care’s website has complaint forms and instructions online: www.dmhc.ca.gov.