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2016–2017 Sharp AdvantagePlan Information KitExclusively for City of San Diego Medicare-eligibleretirees and their dependentsThis plan is sponsored by MEA for all City of San Diego retirees
San Diegans chooseSharp Health PlanDear City of San Diego retiree,You’ve earned your Medicare benefits and we want to help you get the mostout of them. At Sharp Health Plan, we know that Medicare can be confusing.We’re here to simplify it.We designed this guide to give you a summary of the Sharp Advantage MedicarePlan and make it easier to understand. We’ve included helpful tips, an overviewof how Medicare works and details of our benefits.Our personal health care assistants are standing by ready to provide you withanswers to any additional questions.We hope this guide brings you the peace of mind that comes from having ahigh-quality, affordable health plan behind you.Sincerely,Melissa Hayden CookPresident & CEO, Sharp Health Plan1sharp-advantage.com
Table of ContentsThe Sharp Health Plan difference3About Medicare4Frequently asked questions5We’ve got you covered, San Diego7Before you shop, compare9Get started with Sharp Advantage11More benefits, more access, more convenience13Best Health wellness program15Preventive care172016—2017 Summary of Benefits18Multi-language Interpreter Services282
The Sharp Health Plan differenceAward-winning careYou’ll receive award-winning care from ournationally recognized doctors, medical groups and hospitalsand direct access to The Sharp Experience.Local focusAs the county’s only locally based, not-for-profit commercialhealth plan, we not only serve the people of San Diego—we are thepeople of San Diego. When you join Sharp Health Plan, you’ll have accessto providers and hospitals throughout San Diego County.Health care, personalizedYou are our top priority. When you call Sharp Health Plan,you’ll talk to a fellow San Diegan. And because we know health concernscan arise at any time, the convenience of Sharp Health Plan extendsbeyond Greater San Diego and standard business hours.3sharp-advantage.com
About MedicareHave questions? We have answers! It’s common for people to be confused about exactly what Medicare is andhow they can benefit from it. Simply put, Medicare is a federal health insurance program available to you onceyou turn 65 or if you have certain disabilities. There are four parts to Medicare coverage. Learn more below orgive us a call toll-free at 1-855-820-2112, Monday through Friday, 8 a.m. – 6 p.m. TTY users call 711.Part AHospital InsuranceOnce you turn 65 or otherwise become eligible for Medicare,you are eligible to automatically receive Medicare Part A hospitalinsurance. For most people, Part A has no cost.Part BMedical InsurancePart B covers certain doctor services, outpatient care,medical supplies and preventive care. Part B has a monthlypremium. Together, Part A and Part B are knownas Original Medicare.Part CMedicare AdvantageMedicare Advantage plans are offered through private insurersand combine Part A, Part B, and often Part D into one plan withmore benefits than Original Medicare. Sharp Advantage is aPart C plan, also known as a Medicare Advantage plan.Part DPrescription Drug CoveragePrescription drug coverage is Medicare Part D. Sharp Advantageincludes prescription drug coverage as part of its MedicareAdvantage plan.4
Frequently asked questionsWill doctors or hospitals accept my plan?Sharp Advantage is an HMO (Health MaintenanceOrganization) that gives you access to a broadnetwork of local doctors and hospitals. YourPrimary Care Physician (PCP) oversees your careand, in general, you will need prior authorizationto see a specialist.How do I find a doctor? Is my doctorin the network?Your Primary Care Physician (PCP) will be yourmain doctor and point of contact who is mostfamiliar with your health history and coordinatesyour health care. We have several physician groupsfrom which you choose your doctor. You receivespecialty care and access to hospitals and urgentcare centers from the providers affiliated withyour Plan Medical Group (PMG). PCPs usuallyspecialize in family practice, internal medicine,general practice or pediatrics. To find a PCP orto see if your PCP is in the Sharp Advantagenetwork, visit sharphealthplan.com/findadoctor.Select the Sharp Advantage Network, then searchfor a doctor by medical group, specialty, language,gender, location or last name. Once you selecta doctor, notify Sharp Health Plan and call thedoctor’s office directly to schedule a visit.*Are emergency or urgentlyneeded services covered?Yes, you have worldwide coverage for urgent andemergency health services.5sharp-advantage.comWhat do I pay for covered doctor orhospital services?You only have to pay your plan copayment orcoinsurance for visits to an in-network doctoror hospital. If you choose to go to a doctor outsideof our network, you must pay for these servicesyourself. Neither the plan nor Original Medicarewill pay for these services except in limitedsituations (for example, urgent or emergency care).Is there a limit to my totalout-of-pocket spending for the year?Yes, 1,500 is the maximum you will have to payout-of-pocket for covered medical benefits for thebenefit year. Part D prescription drug costs are notincluded in this maximum.Are my prescriptions covered?Prescription drug coverage* is included inSharp Advantage to help cover the cost of themedications that your doctor prescribes.You may obtain covered outpatient prescriptiondrugs from Sharp Advantage-contractedpharmacies located throughout San Diego Countyand the U.S.You also have the option of using our mail orderpharmacy, Postal Prescription Solutions(ppsrx.com) for maintenance medications.At sharp-advantage.com, you can use ourPharmacy Directory to find a pharmacy near you,learn more about specialty medications that maybe available, and find out if a specific drug is onour drug list.
Where can I get my prescriptionsfilled if I join this plan?You can fill prescriptions for any covered PartD drugs, some of which may be subject to priorauthorization, at any of the network pharmacies.*How can I learn if my prescription is covered?Visit sharp-advantage.com and click “San DiegoMunicipal Employees Association”, then select2016 or 2017 “Comprehensive Plan Formulary”to view our list of covered drugs.*Can I use this plan with the MedicareSupplement Plan I already have?No. Your Medicare Supplement Plan, alsoknown as a Medigap policy, can’t be used to payyour Medicare Advantage Plan copayments,deductibles, or premiums and it can’t be used whileenrolled in your Medicare Advantage plan. If youwant to cancel your Medicare Supplement Plan,contact your insurance company. This is not aMedicare Supplement Plan. You will need to keepyour Medicare Part A and B and must continueto pay your Medicare Part B premium, if you haveone, and it is not paid by Medicaid or anotherthird party. You can only be in one MedicareAdvantage or prescription drug plan at a time.Your enrollment in this plan will automatically endyour enrollment in another Medicare Advantageor prescription drug plan.* The Formulary, pharmacy network and/orprovider network may change at any time.You will receive notice when necessary.6
We’ve got you covered, San DiegoAs part of Sharp HealthCare, San Diego’s health care leader, and through our connection to regional partners,you’ll find a family of providers close to where you live and spend time. No matter where you are in San DiegoCounty, from Chula Vista to El Cajon to Oceanside, we’ve got you covered.7Save moneyBetter benefitsIf you’re Medicare-eligible, there’s agood chance you could save moneyand get better coverage by choosingSharp Advantage. This plan providesenhanced benefits, comprehensiveprescription drug coverageand much more.Our Sharp Advantage plan includes all ofthe benefits below, and much more!*sharp-advantage.com All of your Original Medicare benefits(Part A and Part B). Medicare Part D prescription drugcoverage to help cover the cost ofthe medications that your doctorprescribes. You may obtain coveredoutpatient prescription drugs fromSharp Health Plan-contractedpharmacies located throughout SanDiego County. You also have theoption of using mail order pharmacyservices for maintenance medications. Vision benefits, including routine eyeexams and an allowance for glasses orcontacts. A free gym membership throughSilver&Fit that allows you to choosefrom many different facilitiesthroughout San Diego County. A hearing aid allowance of 1,000every three years. Expanded chiropractic benefits.
76ValleyCenterVista78Mira CostaTwin OaksOceansideOcean HillsSan MarcosCarlsbadValleyViewH78EscondidoLeucadiaRancho Santa FeEncinitasAward-winning careWith Sharp Advantage, you’ll haveaccess to award-winning doctors,hospitals and medical groupsacross San Diego County.Plus, through our unique integrationwith Sharp HealthCare, San Diego’shealth care leader, we offer a directconnection to The Sharp Experience.Rancho BernardoHSolana Beach1,000 Physicians and Specialists 8 Hospitals 27 Urgent Care Centers 500 Pharmacies 500 Vision Providers 300 ChiropractorsCarmelMountain56North City67Del MarSabre SpringsDel Mar HeightsMira MesaMiramarLa Jolla5252Santee67Sharp Advantage Network PowayHH ity HeightsLemon GroveHCoronado54National City* This information is not a complete description of benefits.Contact the plan for more information. Limitations,copayments and restrictions may apply. Benefits, premiumsand/or copayments/coinsurance may change each year.GrossmontLa Mesa94SpringValleyEncanto125BonitaChula VistaH8
Before you shop, compareWhen you enroll, you will need to select your doctor. Search our provider directory to pick the doctor whoworks best for you. Then view the Sharp Advantage benefit highlight table on the following page and theSummary of Benefits that starts on page 18.Sharp Advantage DoctorsSharp Advantage offers several ways to look fora doctor, specialist or chiropractor. Access theSharp Advantage Provider Directory via ouronline search tool or as a downloadable file.Online ProviderSearch ToolDownloadable DirectoryYou can access our Provider Directory*on our website. Simply visitsharp-advantage.com,click on “San Diego MunicipalEmployees Association” and thendownload the 2016 or 2017Provider and Pharmacy Directory.You can search the directory byprovider name using “CTRL-F”on your PC keyboard(or -F on a Mac).*The Formulary, pharmacy network and/or providernetwork may change at any time. You will receivenotice when necessary.9sharp-advantage.comYou can use the online searchtool on our website atsharphealthplan.com/findadoctor.Be sure to select “Sharp Advantage” asthe network in the drop down menu.If you are looking for an AmericanSpecialty Health chiropractor, visitsharphealthplan.com/chiro.
Sharp Advantagebenefit highlightsSharp Advantage (HMO)City of San Diego Retiree PlanMonthly Plan Premium 179DeductibleNoneAnnual Out-of-Pocket Maximum 1,500Preventive Care 0Primary Care Physician Visit 10Specialist Physician Visit 10Lab Services 0Diagnostic Radiology (e.g., MRIs) 0X-ray 0Urgently Needed Services 10Emergency Room 50Ambulance 0HospitalizationOutpatient SurgerySkilled Nursing Facility 0 per day 50 0 per dayDurable Medical Equipment 0Chiropractic Spinal Subluxation Treatment* 10Chiropractic Expanded BenefitsRoutine Eye Exam 10, limit 30 visits per year 20Hearing Aids 1,000 allowanceevery 36 months30-day Retail Prescription DrugsPreferred Generic / Non-Preferred GenericPreferred Brand / Non-Preferred Brand / Specialty 10 / 10 20 / 20 / 25%90-day Mail Order Prescription DrugsPreferred Generic / Non-Preferred GenericPreferred Brand / Non-Preferred Brand / Specialty 20 / 20 40 / 40 / Not offered* Manipulation of the spine to correct a subluxation (when one or more of the bones of yourspine move out of position).This information is not a complete description of benefits. Contact the plan for moreinformation. Benefits, premiums and/or copayments/coinsurance may change each year.You must continue to pay your Medicare Part B premium.10
Get started with Sharp AdvantageSharp Advantage is sponsored by the Municipal Employees Association, but all Medicare-eligible City ofSan Diego retirees are welcome to enroll. If you are a City of San Diego retiree and/or an eligible spouse ordependent, here are some tips to help you begin:1Check your Medicare eligibilityYou must be age 65 or otherwise be eligible for Medicare,have Medicare Part A and be eligible for Part B.2Enroll in Medicare Part BIf you have not already enrolled, you can enroll online atsocialsecurity.gov. You can also visit your local Social Security office orcall 1-800-772-1213. TTY users call 1-800-325-0778. If you are alreadyreceiving Social Security benefits or if you are receiving Railroad RetirementBoard benefits, you will be automatically enrolled in Medicare.3Join Sharp AdvantageOpen Enrollment for City of San Diego retirees occurs fromJune 6–June 30, 2016. All eligible retirees can enroll during this period.If you are a new retiree you can enroll at the time of your retirement.Call the Municipal Employees Association at 1-888-217-9175 or visitwww.sdmea.org or sharp-advantage.com for an enrollment form.11sharp-advantage.com
Enrollment checklistEnrolling is easy! Here’s a checklist with the information you’ll need to enroll:The Medicare claim number and effective dates from your red, white and blue Medicare ID card. e name of your Sharp Advantage Network Primary Care Physician (PCP). If you don’t have a PCP, we willThassign one for you. You may change your PCP at any time by contacting Customer Care at 1-855-820-2112.(TTY users should call 711.) Hours are 8 a.m. to 6 p.m. Pacific Time, Monday to Friday.You must be enrolled in Medicare Part B and continueto pay your Part B premium.Sharp Advantage is offered by Sharp Health Plan.Sharp Advantage is an HMO plan with a Medicarecontract. Enrollment in Sharp Advantage depends oncontract renewal.Sharp Advantage (HMO) es un plan de salud HMOque tiene un contrato con Medicare. La inscripción enSharp Advantage depende de la renovación del contrato.Find a doctorVisit sharphealthplan.com/findadoctorto find a doctor. You’ll need to list yourdoctor when you enroll.12
More benefits, more access,more convenienceWe believe San Diegans deserve more. That’s why our Sharp Advantage plan includes theseadditional member benefits:Silver&Fit gym membershipAssist America We offer a free gym membership to Sharp Advantagemembers. Choose from 24 Hour Fitness, Curves,LA Fitness, Jazzercise and many other facilitiesthroughout San Diego County. And enjoy theflexibility to change facilities monthly with nohassles. If you prefer to exercise at home,at-home fitness options are available as well.See SilverandFit.com to find participating clubsin your area.When faced with a medical emergency whiletraveling 100 miles or more away from homeor in another country, Assist America connectsSharp Health Plan members to doctors, hospitals,pharmacies and other services. A global network of pre-qualifiedmedical providersMinuteClinic insideCVS/pharmacy Experienced crisis management professionals Air and ground ambulance service providersMinuteClinic is the walk-in medical clinic locatedinside select CVS/pharmacy stores. MinuteClinicprovides convenient access to quality routine carewithout an appointment. They are open seven daysa week, including evenings and weekends.No appointment necessary.For a list of MinuteClinic locations nationwide,visit MinuteClinic.com/locations or call1-866-389-2727. Your copay for MinuteClinicis the same as your Urgent Care copay.Sharp Health Plan services atMinuteClinic include: Diagnosis and treatment for common illnesses Flu vaccinations Treatment of minor wounds, skin conditionsand more13sharp-advantage.comOne simple call puts you in touch with:While abroad, you can access the followingmedical services through Assist America: Medical evaluation and referral Emergency medical transportation Critical care monitoring Prescription assistance Emergency trauma counseling Lost luggage or document assistance Interpreter and legal referrals
Vision CareSharp Nurse Connection We believe that it’s never too late to make visionhealth a priority. That’s why we are proud topartner with Vision Service Plan (VSP) to offeran innovative vision plan: VSP Elements. VSPElements is included in Sharp Advantage, somembers have access to the highest-quality eye careservices. These benefits include routine eye examsand an annual allowance for glasses or contacts.When you have a health question or concernafter regular business hours, a single phone call toSharp Nurse Connection puts you in touch witha registered nurse. Sharp Nurse Connection isavailable from 5 p.m. to 8 a.m., Monday throughFriday and 24 hours a day on weekends by calling(858) 499-8300 (TTY users call 711), and selectingthe option to speak with a nurse.As a long-time partner to Sharp Health Plan,VSP has more than 500 providers throughoutSan Diego County to ensure that you can findcare close to home.Through Sharp Nurse Connection you can: Talk to a registered nurse if you’re feeling ill or ifyou get injured outside of your doctor’s regularbusiness hours.Hearing Aid Coverage Get advice on when and where to seek care. Understand self-care options until you cansee your doctor.Members receive a 1,000 allowance (per 36months) toward medically necessary hearing aids.To get started with accessing this benefit, membersshould contact their PCP.Expanded ChiropracticCoverage Like all Medicare Advantage plans,Sharp Advantage offers chiropractic benefits forspinal subluxation treatment. This is providedthrough your medical group by referral fromyour PCP at your specialist visit copay. In addition, Sharp Advantage has asupplemental chiropractic benefit. This meansyou can self-refer to any chiropractor in theAmerican Specialty Health Network for anymedically necessary chiropractic need. Up to 30 visits per year for a 10 copayare covered. Search for participating chiropractors atsharphealthplan.com/chiro.14
Best Health wellness program&H E A LT H PRMOTIONW ELLNESOSBest Health, our comprehensive wellness program, is available to all Sharp Advantage members at no extra cost.Being healthy and reaching your best has never been easier or more fun!A C C R E D I TAT I O NWITHPERFORMANCE REPORTINGNationallyaccreditedBest Health, Sharp Health Plan’swellness program, is one of only10 health plan wellness programsnationally to be accreditedby the NCQA.15sharp-advantage.com
Health coachingExercise videos and trackersWant personalized support? Our telephone-based,private health coaching is tailored to your wellnessgoals and scheduled at times that are convenientfor you.Ready to get in shape and feel great with fun fitnessroutines, interactive exercise trackers and easy-touse logs? Get fit and stay fit. Track your steps, milesand calories burned — your way.Health LibraryWellness workshopsWant all the health and wellness information youneed in one spot? We’re here for you, ready to helpwith a library of resources and support.Want 24/7 support? Look no further than ourself-guided online workshops with interactivevideos, articles, tips, quizzes, meal and activityplanners, and more.Get your wellness scoreThe Personal Health Assessment (PHA) is aconfidential online questionnaire that evaluatesyour current health with a wellness score between1 and 100. The PHA asks questions about yourwell-being and lifestyle to provide you with anat-a-glance profile of your health, along withpersonalized recommendations for improvement.Best Health mobile appWant all the perks of Best Health while you’reon the move? The HealthyNow mobile app,available for Apple and Android devices, puts yourfavorite Best Health trackers and toolsright in your pocket.Meal plansWant to find the right meal plan for you, trackcalories, print recipes and grocery lists, and get aclear sense of your daily nutritional needs?Best Health has everything you need in oneconvenient place.16
Preventive careYour health is our top priority. That’s why we encourage you to take advantage of the many preventive careservices that are available to our members at no additional charge when scheduled with an in-network providerand separate from an appointment for other care or treatment. The following are examples of coveredpreventive care benefits: Annual wellness visit, Medicare-covered immunizations and related laboratory services Routine gynecological exams and related laboratory services Screenings for:ǼǼ Breast cancerǼǼ HypertensionǼǼ CholesterolǼǼ ObesityǼǼ Cervical cancerǼǼ Prostate cancerǼǼ Colorectal cancerǼǼ Sexually transmitted infectionsǼǼ DepressionǼǼ Tobacco and alcohol use/misuseǼǼ Diabetes17sharp-advantage.com
2016—2017 Summary of BenefitsAugust 1, 2016 – July 31, 2017This is a summary of what we cover and what you pay. It doesn’t list every service that we cover or list everylimitation or exclusion. To get a complete list of services we cover, call us and ask for the “Evidence of Coverage.”You have choices about how toget your Medicare benefitsOne choice is to get your Medicare benefits throughOriginal Medicare (fee-for-service Medicare).Original Medicare is run directly by the federalgovernment. Another choice is to get yourMedicare benefits by joining a Medicare health plansuch as Sharp Advantage (HMO) for Cityof San Diego retirees.Tips for comparing yourMedicare choicesThis Summary of Benefits booklet gives you asummary of what the Sharp Advantage (HMO)plan covers and what you can expect to pay. If youwant to compare our plan with other Medicarehealth plans, ask the other plans for their Summaryof Benefits booklets. Or, use the Medicare Plan Finderon medicare.gov.If you want to know more about the coverage andcosts of Original Medicare, look in your current“Medicare & You” handbook. View it online athttp://www.medicare.gov or get a copy by calling1-800-MEDICARE (1-800-633-4227), 24 hoursa day, 7 days a week. TTY users should call1-877-486-2048.Sections in this booklet Things to Know About the Sharp Advantage(HMO) plan Monthly Premium, Deductible and Limits onHow Much You Pay for Covered Services Covered Medical and Hospital Benefits Prescription Drug BenefitsThis information is not a complete description ofbenefits. Contact the plan for more information.Limitations, copayments and restrictions may apply.Benefits, premiums and/or copayments/coinsurancemay change each year. The formulary, pharmacynetwork and/or provider network may change at anytime. You will receive notice when necessary.Sharp Advantage is offered by Sharp Health Plan.Sharp Advantage is an HMO plan with a Medicarecontract. Enrollment in Sharp Advantage depends oncontract renewal. This document is available in otherformats such as large print.This document may be available in a non-Englishlanguage. For additional information, call us at1-855-820-2112 (TTY users should call 711).This information is available for free in otherlanguages. Please call our Customer Care numberat 1-855-820-2112 for additional information.(TTY users should call 711.) Hours are 8:00 a.m.to 6:00 p.m. Pacific Time, Mondaythrough Friday. Customer Care also has freelanguage interpreter services available for nonEnglish speakers.Esta información puede obtenerse sin cargo enotros idiomas. Si desea más información, llame anuestro servicio de atención a los miembros al1-855-820-2112 (los usuarios de TTY deben llamaral 711). El horario es de 8:00 de la mañana a 6:00de la tarde (horario del Pacífico) de lunes a viernes.Alguien que hable español le podrá ayudar. Este es unservicio gratuito.18
Things to know aboutSharp Advantage (HMO)Hours of OperationThe Customer Care hours are 8:00 a.m. to 6:00 p.m.Pacific Time, Monday through Friday. Customer Carealso has free language interpreter services available fornon-English speakers.Sharp Advantage (HMO)Phone Numbers and WebsiteIf you are a member of this plan, call toll-free1-855-820-2112. TTY users should call 711.If you are not a member of this plan, call toll-free1-855-820-2112. TTY users should call 711.Our website: sharp-advantage.com.Who can join?To join a Sharp Advantage (HMO) plan, you must beentitled to Medicare Part A, be enrolled in MedicarePart B, meet the eligibility requirements establishedby the employer/union group sponsor’s employmentbased health coverage and live in our service area.Our service area includes the following county inCalifornia: San Diego.19sharp-advantage.comWhich doctors, hospitals andpharmacies can I use?Sharp Advantage (HMO) has a network of doctors,hospitals, pharmacies and other providers. If you usethe providers that are not in our network, the planmay not pay for these services. You must generally use network pharmacies to fillyour prescriptions for covered Part D drugs. You can see our plan’s provider andpharmacy directory at our website,sharp-advantage.com. Or, call us and we will send you a copy of theprovider and pharmacy directories.
What do we cover?Like all Medicare Advantage health plans, we covereverything that Original Medicare covers—and more. Our plan members get all of the benefitscovered by Original Medicare. For some ofthese benefits, you may pay more in our planthan you would in Original Medicare.For others, you may pay less. Our plan members also get more than what iscovered by Original Medicare. Some of the extrabenefits are outlined in this booklet. We cover Part D drugs. In addition, we coverPart B drugs such as chemotherapy and somedrugs administered by your provider. You can see the complete plan formulary(list of Part D prescription drugs) andany restrictions on our website atsharp-advantage.com. Or, call us andwe will send you a copy of the formulary.How will I determine my drug costs?Our plan groups each medication into one of five“tiers.” You will need to use your formulary to locatewhat tier your drug is on to determine how much itwill cost you. The amount you pay depends on thedrug’s tier and what stage of the benefit you havereached. Later in this document we discuss the benefitstages that occur: Initial Coverage, Coverage Gapand Catastrophic Coverage.20
Summary of BenefitsSharp Advantage is offered by Sharp Health Plan. Sharp Advantage is an HMO plan with a Medicare contract.Enrollment in Sharp Advantage depends on contract renewal.Monthly Premium, Deductible and Limits on How Much You Pay for Covered ServicesBenefitHow much is themonthly premium?How much is the deductible?Sharp Advantage (HMO) 179 per month.In addition, you must keep paying your Medicare Part B premium.This plan does not have a deductible.Yes. Like all Medicare health plans, our plan protects you by havingyearly limits on your out-of-pocket costs for medical and hospital care.Is there any limit onhow much I will pay for mycovered services?Your yearly limit in these plans: 1,500 for services you receive from in-network providers.If you reach the limit on out-of-pocket costs, you keep getting coveredhospital and medical services and we will pay the full cost for the rest ofthe year.Please note that you will still need to pay your monthly premiums andcost-sharing for your Part D prescription drugs.Is there a limit on how muchthe plan will pay?No. There are no limits on how much our plan will pay.Covered Medical and Hospital BenefitsOutpatient Careand Services21Sharp Advantage(HMO)AcupunctureNot coveredAmbulance1 0 copayNote: Services with a 1 may require prior authorization. Services with a 2 may requirea referral from your doctor.
Outpatient Careand ServicesChiropractic Care2Dental Services1Sharp Advantage (HMO)Manipulation of the spine to correct a subluxation (when 1 or moreof the bones of your spine move out of position): 10 copaySupplemental Chiropractic through American Specialty Health: 10 copay, maximum 30 office visits per year.Limited dental services (this does not include services in connectionwith care, treatment, filling, removal, or replacement of teeth): 10 copayDiabetes monitoring supplies: 0Diabetes Suppliesand Services1,2Diabetes self-management training: 0Therapeutic shoes or inserts: 0Diagnostic Tests, Lab andRadiology Services, andX-Rays (costs for theseservices may vary basedon place of service)1,2Doctor's Office VisitsDurable Medical Equipment(wheelchairs, oxygen, etc.)1Emergency CareFoot Care(podiatry services)2Diagnostic radiology services (such as MRIs, CT scans): 0Diagnostic tests and procedures: 0Lab services: 0Outpatient X-rays: 0Therapeutic radiology services (such as radiation treatment for cancer): 0Primary care physician visit: 10 copaySpecialist visit: 10 copay 0 50 copayIf you are admitted to the hospital within 24 hours, you do not haveto pay your share of the cost for emergency care. See the “InpatientHospital Care” section of this booklet for other costs.Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions: 10 copay22
Outpatient Careand ServicesSharp Advantage (HMO)Exam to diagnose and treat hearing and balance issues: 10 copayHearing Services1Hearing aid fitting/evaluations: 10 copayHearing aid: Our plan pays up to 1,000 every three years.Home Health Care1Mental Health Care1,2 0Inpatient visit: Our plan covers an unlimited number of days foran inpatient hospital stay. 0 copay per dayOutpatient group therapy visit: 10 copayOutpatient individual therapy visit: 10 copayCardiac (heart) rehab services (for a maximum of 2 one-hour sessionsper day for up to 36 sessions up to 36 weeks): 10 copayOutpatient Rehabilitation1Occupational therapy visit: 10 copayPhysical therapy and speech and language therapy visit: 10 copayOutpatient Substance Abuse1Outpatient Surgery1Over-the-Counter ItemsProsthetic Devices(braces, artificial limbs,etc.)123Group therapy visit: 10 copayIndividual therapy visit: 10 copayAmbulatory surgical ce
Award-winning care With Sharp Advantage, you'll have access to award-winning doctors, hospitals and medical groups across San Diego County. Plus, through our unique integration with Sharp HealthCare, San Diego's health care leader, we offer a direct connection to The Sharp Experience. Sharp Advantage Network 1,000 Physicians and .
