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Important information about your Sharp Health Plan Click here to search for a Vision provider. Click here to search for a Dental provider. Click here for important information about Performance Network. Click here for important information about Premier Network. Out-of-Area Information Out-of-Area means services received while a Member is outside the Service Area. Out-of-Area coverage includes Urgent or Emergent services for the sudden onset of symptoms of sufficient severity to require immediate medical attention to prevent serious deterioration of a Member’s health resulting from unforeseen illness or injury or complication of an existing condition, including pregnancy, for which treatment cannot be delayed until the Member returns to the Service Area. Out-of-Area medical services will be covered to meet your immediate medical needs. Applicable follow-up for the Urgent or Emergent service must be Authorized by Sharp Health Plan and will be covered until it is prudent to transfer your care into the Plan’s Service Area. Exclusions and Limitations Information 1. Not Medically Necessary; 2. Not specifically described as covered in the Member Handbook or supplemental benefit materials; 3. In excess of the limits described in the Member Handbook or described in the Health Plan Benefits and Coverage Matrix; 4. Specified as excluded in the Member Handbook; 5. Not provided by Plan Providers (except for Emergency Services or Out-of-Area Urgent Care Services); 6. Not prescribed by a Plan Physician and, if required, Authorized in advance by your Primary Care Physician, your Plan Medical Group or the Plan (Note: Emergency Services do not require Authorization); 7. Part of a treatment plan for noncovered services; or 8. Received prior to the Member’s effective date of coverage or after the Member’s termination from coverage under this Plan FOR APPLICANTS 30 YEARS OLD AND OVER: You may be eligible for a Minimum Coverage plan if you are over the age of 30 and are able to provide a certification that you are without affordable coverage or are experiencing financial hardship. If so, please contact Sharp Health Plan for more information.
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