Employee eligibility

Here’s the information you need to determine if an employee or dependent is eligible to become a member.

Employees
Dependents

Eligibility criteria for new, rehired and formerly ineligible employees

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New employees

To be eligible to enroll as a member with Sharp Health Plan, an employee must meet the following requirements.

Be an active employee and satisfy the minimum hours per week requirement, as defined in the group agreement.
Have completed the waiting period defined by your group.
Work or reside within the service area of San Diego County and southern Riverside County.
Satisfy all eligibility requirements as defined in your group agreement.
Elect health care coverage through Sharp Health Plan by submitting eligibility details through a form approved by Sharp Health Plan within thirty-one (31) days of the eligibility effective date.
Never have had coverage terminated for cause by Sharp Health Plan.

Enrollment kits are available for employers. Please contact your account manager for a supply of these kits.

Important reminder

Be sure to send new enrollment notifications as they occur. Timely notification of enrollment changes will help us serve members in the following ways:

Member eligibility will be visible to providers.
Members will be able to access care on their effective dates.
Members will receive their member ID card in a timely manner.
Billing adjustments will be processed and appear sooner.

Formerly ineligible employees

Eligibility changes can only be made for qualifying events, such as marriage or a birth or adoption. The employee becomes eligible for coverage on the first day of the month following the qualifying event.

Rehired employees

Employees who have been rehired will be subject to the rehire waiting period as defined by the employer.

Eligibility criteria for an employee's spouse and dependents

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A dependent’s eligibility for enrollment is contingent upon the subscriber’s eligibility for membership in Sharp Health Plan. Eligible dependents include:

The spouse or domestic partner of an enrolled employee
The dependent child of an enrolled employee or the enrolled employee’s spouse, who is either
- Under age 26
- Who at the time of attaining age 26 is incapable of self-sustaining employment by reason of a physically or mentally disabling injury, illness, or condition and is chiefly dependent upon the enrolled employee for support and maintenance. Proof of incapacity and dependence must be furnished to Sharp Health Plan by the enrolled employee as outlined in the group agreement.
- Any other person under age 26 for whom the enrolled employee or the enrolled employee’s spouse is (or was before the person's 18th birthday) the court-appointed guardian. We may require the eligible employee to furnish evidence, on a periodic basis, of the IRS status, residency or guardianship of such person.

Please note: an adult dependent child enrolled in a grandfathered plan is only eligible for coverage as a dependent with Sharp Health Plan if the adult child is not eligible for his or her own employer-sponsored coverage. A grandfathered plan is a health benefit plan that was in existence on March 23, 2010, and continuously covered someone in that same plan since that date.