1 Sharp Health Plan only covers care you receive from doctors and facilities in your PMG, except in emergencies. Your network, PMG and PCP are listed on the front of your Sharp Health Plan member ID card. 2 Only services offered through plan providers are covered, unless prior authorization by Sharp Health Plan is obtained. 3 Members can access out-of-network urgent care centers outside of San Diego and Riverside counties. Referral/authorization is not required. However, if you access an urgent care in San Diego or Riverside counties, it must be a facility within your PMG. 4 Only services offered through plan providers are covered, unless prior authorization is obtained. Your primary care physician Your PCP is who you will see if you need a checkup or routine care, want advice about a health problem, or get sick or hurt. They provide care when you need it, listen carefully and explain things in a way that is easy to understand. Your PCP will also coordinate the care you receive from other providers, including specialists. When you choose or change your PCP, you are choosing to receive care exclusively from hospitals, specialists, urgent care centers and other providers or locations that are associated with your PCP’s PMG. Tips to Partner with Your PCP Call your PCP first for all of your health care needs. If you are a new patient, ask your previous doctor to forward a copy of your medical records to your PCP before your first appointment. Tell your PCP about your health history, current treatments, medical conditions, medications you are taking (including prescription, nonprescription and supplements) and any other doctors who are treating you. Call your PCP’s office to arrange your annual no-cost wellness exam.1 Be sure to bring the results of your Best Health Wellness Assessment (see page 18 to learn more). If you have never been seen by your PCP, make an appointment for an initial visit. If your PCP is not available or if it is after their regular business hours, leave your name and phone number with their answering service to receive a call from a physician or a qualified health care professional within 30 minutes. Choose or change your PCP in 3 easy steps It is a good idea to stay with a PCP so they can get to know your health needs and history. However, you can change to a different PCP in your plan network for any reason, at any time. In most cases, the change will be effective the first day of the following month. If you choose a PCP in a new PMG, remember to ask your new PCP for new referrals for specialty care, medical supplies or other services you may need. Visit calpers.sharphealthplan.com/findadoctor to learn more. Finding a new PCP is only a click away. Visit calpers.sharphealthplan.com/findadoctor for a full listing of doctors in your plan network. You can search for a PCP by plan network (as listed on your member ID card), language preference, gender, location, name or specialty. PCPs specialize in family medicine, general practice, internal medicine or pediatrics. Log in to your Sharp Health Plan online account at calpers.sharphealthplan.com/login to make the change. You can also contact Customer Care via email at [email protected] or by calling 1-855-995-5004. Click Search Choose 1 2 3 5
