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You and
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 your 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.


You have the right to:

  • Be treated with dignity and respect.
  • Have your privacy and confidentiality maintained.
  • Review your medical treatment and record with your health care provider.
  • Be provided with explanations about tests and medical procedures.
  • Have your questions answered about your care.
  • Have a candid discussion with your health care provider about appropriate or medically necessary treatment options, regardless of cost.
  • Participate in planning and decisions about your health care.
  • Agree to, or refuse, any care or treatment.
  • Voice complaints or appeals about Sharp Health Plan or the services you receive as a Sharp Health Plan member.
  • Receive information about Sharp Health Plan, our services and providers, and member rights and responsibilities.
  • Make recommendations about these rights and responsibilities.

You have the responsibility to:

  • Provide information that Sharp Health Plan and your doctors and other providers need to offer you the best care.
  • Understand your health problems and participate in developing treatment goals.
  • Ask questions if you do not understand explanations and instructions.
  • Respect provider office policies and ask questions if you do not understand them.
  • Follow advice and instructions agreed-upon with your provider.
  • Report any changes in your health.  Keep all appointments and arrive on time.
  • If you are unable to keep an appointment, cancel 24 hours in advance, if possible.
  • Notify Sharp Health Plan of any changes in your address or telephone number.
  • Let your health care provider or Sharp Health Plan know if you have any suggestions, compliments or complaints.
  • Notify Sharp Health Plan of any changes that affect your eligibility, such as no longer residing in the Plan’s Service Area.

What if you suspect fraud, abuse or waste?

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 771).

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:

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

Access for the vision-impaired

 

The Member Handbook and other important plan materials will be made available in alternate formats for the vision impaired, such as on a computer disk where text can be enlarged or in Braille. For more information about alternative formats or for direct help in reading the Member Handbook or other materials, please call Customer Care at at 1-858-499-8300 or toll-free at 1-800-359-2002.

Covered California premium disclosure

The federal Affordable Care Act requires all health plans offered through Covered California, the state’s health benefit exchange, to include costs for non-Hyde abortion services as a portion of members’ total monthly premium. As a result, Sharp Health Plan is legally required to collect a $1 fee from members to cover the cost of these services. If you purchased a health plan through Covered California, this fee is included in your monthly premium.

Your rights and protections against surprise medical bills

When you get emergency care or gettreated by an out-of-network provider for authorized care at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

For POS members: Balance billing notice

For non-POS members: Balance billing notice

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