The young adult’s guide to accessing care

Getting care when you’re away from home.

Your health is our priority. That’s why we put together this quick guide with important information about your health coverage and how to get the care you need. We’ve got you covered, no matter where life takes you.

When you’re home

Use the facilities and locations in your plan medical group (PMG), which is listed on your Sharp Health Plan member ID card.

⚠️ If you try to get care at a location that is not in your PMG, you may be subject to higher deductibles and copays, or be unable to access needed care.

When you’re away from home

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.
Tell your doctor about any care you receive when you’re away.
Telehealth services like video and phone visits may be available when determined by your doctor to be medically appropriate. Contact your primary care physician (PCP) to learn more. Your PCP’s contact information is listed 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. Be sure to check what your school offers for routine services. We recommend purchasing supplemental health insurance to cover non-urgent care that you may need when you’re 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
2. Work in our service area, or
3. Be a full-time student at an accredited institution, or
4. 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 no longer considered “primary” if you move without intent to return, or if you are absent from the residence 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.