Sharp Health Plan – CA

General Information

Criteria Information
Carrier size No answer yet
Carrier info No answer yet
Ownership / Sister Companies No answer yet
Appointment Info No answer yet
General Agent No answer yet

Service Area and Network

Criteria Information
Service Area
  • Employees must live or work within the Sharp Health Plan Service Area and provide a physical address upon *Please refer to Sharp Health Plan’s Licensed Service Area ZIP Code document to verify network eligibility.
  • Choice and Value Networks: Most ZIP codes in San Diego and southern Riverside
  • Performance and Premier Networks: Most ZIP codes in San Diego
  • Southern Riverside groups must take the Choice Network and always have the option of also taking the Value Network.
PPO Network No information yet
HMO Network No information yet
Provider Search No information yet
Formulary No information yet

Plans and Rates

Criteria Information
Overview No information yet
PPO Plan Options No information yet
HMO Plan Options No information yet
Multiple Plan Offerings Multiple plan options are available:

  • 1-5 subscribers enrolled: Two plans on one
  • 6+ subscribers enrolled: Six plans on each of two networks
Composite and Age Rating Composite rates are not available.
Formulary No information yet

Underwriting Guidelines

Criteria Information
Underwriting Guide Small Group Underwriting Guide, last updated October 2021
Small Group Definition 1-100 Employees
Employer Contribution
  • Employer must contribute a minimum of 50% of the employee-only premium.
  • Defined contribution is allowed at a minimum of $100 per employee.
Carve-Outs / Varied Offerings Class carve-outs must be underwritten by plan and accepted upon review. Requires minimum of five subscribers enrolled and 100% participation.
Participation Requirements No information yet
NPNC Groups Groups that fail to meet Sharp Health Plan’s minimum participation or contribution requirements (as noted in the Participation and Contribution sections of this document), but that satisfy the remaining eligibility criteria, will be permitted to elect coverage during a limited open enrollment period from November 15 through December 15 of each year for a January 1 effective date. Wrapping with another carrier is not permitted.
Valid Waivers No information yet
Residency Requirements No information yet
W-2 Enrollment Requirements No information yet
Owner Only Groups A group’s eligible employees cannot be only owners and their spouses.
Husband & Wife Only Groups Husband/wife-only groups are not eligible for group coverage.
One-Person Groups No information yet
Slice Business Wrapping with another carrier is available with a minimum of five enrolled subscribers. Multiple HMO plans are allowed. Wrapping alongside a private or public exchange is prohibited.
Employers Replacing Coverage No information yet
Start-Up Group Requirements No information yet
Common Ownership Guidelines No information yet
Spin-Off Groups No information yet
Employers with Union Employees No information yet
Employers Leaving a PEO No information yet

Employee Eligibility

Criteria Information
Full-Time Status Employees must work a minimum average of 30 hours.
Part-Time Eligibility Group can opt to cover part-time employees working 20-29 hours a week as defined under California Health & Safety Code Section 1357 (SB 1790) and Section 1357.500.
New-Hire Waiting Period The employer shall determine the waiting period for new hires, rehires and other eligible employees, which shall not exceed the waiting period permitted by applicable state or federal law.
1099 Workers 1099 employee must appear on the prior carrier’s bill. No more than 25% of the group may be 1099 employees. Form 1040 Schedule C and Form 1099-MISC for the prior year is required. A letter from the employer requesting coverage of 1099 employees is required. A completed 1099 Contractors Verification Form is required.
Owner Eligibility No information yet
Spouses working for same company Spouse on DE-9C can be enrolled either as an employee or as a dependent.
Domestic Partners Domestic partner coverage is available.
Ineligible Employees Retirees, part time (unless employee meets the definition of eligible employee under California Health & Safety Code Section 1357 [SB 1790] and Section 1357.500), domestic help or leased employees.

Enrollment Paperwork and Documentation

Criteria Information
Enrollment Checklist No information yet
Employer App No information yet
Employee App No information yet
Enrollment Spreadsheet No information yet
Wage & Tax Statement No information yet
Other Forms/Documentation All groups with less than five subscribers must submit a stamped and filed Statement of Information (SOI) or a complete current tax filing.
Initial Payment No information yet
Effective Date Options No information yet

More Info Coming Soon