Sharp Health Plan
Sharp Health Plan is a California-licensed, nonprofit health insurance subsidiary of Sharp HealthCare offering individual, family, employer-group, Medicare Advantage, and government health plans (FEHB, CalPERS, SDPEBA) to members across San Diego and southern Riverside Counties.
- Company typePrivate
- Founded1992
- HeadquartersSan Diego, United States
- Headcount251–500
- GTM typeB2C
- OfferingServices
What Sharp Health Plan does
Sharp Health Plan is a California-licensed, DMHC-regulated health care service plan and subsidiary of Sharp HealthCare, headquartered at 8520 Tech Way, Suite 200, San Diego. Founded in 1992 and operating as a nonprofit insurance entity within the Sharp HealthCare integrated delivery system, the plan serves San Diego and southern Riverside Counties with individual & family HMO plans across two networks (Performance and Premier), group POS and PPO plans with Aetna Open Choice and First Health tier-2 networks, Medicare Advantage plans branded Sharp Direct Advantage, plus specialized enrollment for federal employees (FEHB), CalPERS, and City of San Diego employees and retirees (SDPEBA). The core technology is a health insurance administration platform integrated with Sharp HealthCare's provider network — Sharp Community Medical Group, Sharp Rees-Stealy Medical Group, and Rady Children's Health Network/CPMG — with members accessing benefits via an online portal that integrates with MyChart, supported by iOS and Android mobile apps.
The plan earns revenue almost entirely through recurring monthly premiums across individual, family, group, Medicare Advantage, and government program lines, with add-on modules for vision (VSP), dental, HSA-compatible high-deductible plans, and the Best Health wellness program. Pharmacy benefits are administered through CVS Caremark and CVS Specialty, behavioral health through Optum, and alternative care through American Specialty Health. Notable productized programs include opioid cumulative-dose and concurrent-use safety reviews that halt point-of-sale dispensing for pharmacist review when prescribing thresholds are exceeded. Distribution is multi-channel: direct-to-consumer via sharphealthplan.com and Covered California, licensed California brokers with broker bonus programs, and direct employer group sales including CalPERS and FEHB. Quality signals include NCQA Excellent accreditation, a 4-star Covered California rating, recognition as the highest member-rated health insurance plan in California, and a 2025 US News & World Report placement for Medicare Advantage in California.
Sharp Health Plan firmographics
Firmographics- Name
- Sharp Health Plan
- Legal name
- Sharp Health Plan
- Website
- https://sharphealthplan.com
- Company type
- Private
- Founded year
- 1992
- Operating status
- Operating
- Headcount range
- 251–500 employees
- Short description
- Sharp Health Plan is a California-licensed, nonprofit health insurance subsidiary of Sharp HealthCare offering individual, family, employer-group, Medicare Advantage, and government health plans (FEHB, CalPERS, SDPEBA) to members across San Diego and southern Riverside Counties.
- Ownership category
- akta.pro rank
Sharp Health Plan industry classification
Industry- Product category
- Health Insurance
- NAICS
- Direct Health and Medical Insurance Carriers (524114), Direct Life, Health, and Medical Insurance Carriers (52411)
- SIC
- Accident & Health Insurance (6321), Hospital & Medical Service Plans (6324), Insurance Agents, Brokers & Service (6411)
- akta.pro primary industry
- Large Group Health Insurance (Mid-Market & National Accounts) (FSAIAFAE)
- akta.pro secondary industries
- Small Group Health Insurance (2–50/100) (FSAIAFAD), Public Sector & Government Employer Group Health Plans (FSAIAFAF), Medicare Quality, Risk Adjustment & Stars Analytics/Services (FSAIAGAJ), Small Group POS Plans (HLAEAOAI)
Keywords
Where Sharp Health Plan is headquartered
LocationHeadquarters
- HQ city
- San Diego
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Sharp Health Plan business model
Business model- GTM type
- B2C
- Offering type
- Services
- Cost components
- Operations, Personnel, Technology or R&D, Marketing or Sales, Infrastructure
Revenue model
- Health Insurance Premiums - Individual and Family: Monthly premium payments from individuals and families enrolling in health insurance plans through Covered California or directly through Sharp Health Plan. Plans include various metal tiers (Bronze, Silver, Gold, Platinum) with different coverage levels and cost-sharing structures.
- Health Insurance Premiums - Group/Employer: Monthly premium payments from employer groups providing health coverage to their employees. Includes small group and large group plans with HMO, POS, and PPO options, as well as vision and dental insurance add-ons.
- Medicare Advantage Premiums: Monthly premium payments from Medicare-eligible individuals enrolling in Sharp Direct Advantage Medicare plans.
- Government Employee Health Benefits: Premium payments from federal employees (FEHB program) and City of San Diego employees and retirees (SDPEBA) enrolled in Sharp Health Plan.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | Bronze tier plans - lowest monthly premiums, highest out-of-pocket costs when accessing care |
| Subscription | Monthly | Silver tier plans - balance between monthly premiums and out-of-pocket costs |
| Subscription | Monthly | Gold tier plans - higher monthly premiums, lower costs when accessing care |
| Subscription | Monthly | Platinum tier plans - highest monthly premiums, lowest costs when accessing care |
Go-to-market motion3 records
Distribution channels6 records
Marketing channels8 records
Sharp Health Plan product offering
Product offeringCore offering
Sharp Health Plan is a nonprofit health insurance company that sells HMO, POS, and PPO health plans to individuals, families, employer groups, federal employees, and Medicare-eligible individuals in San Diego and southern Riverside Counties, California. As part of the Sharp HealthCare integrated delivery system, the plan combines health insurance administration with a coordinated provider network including Sharp HealthCare hospitals, Sharp Community Medical Group, Sharp Rees-Stealy Medical Group, and Rady Children's Health Network.
Product overview
Sharp Health Plan is a health insurance provider serving San Diego and southern Riverside Counties in California, offering individual, family, and employer-sponsored health plans. The core portfolio includes Individual & Family Plans (HMO-based with Performance and Premier networks), Group Plans (POS and PPO tiered-network options), and Medicare Advantage plans branded as Sharp Direct Advantage. Add-on modules include vision insurance through VSP, dental insurance, pharmacy benefits managed via CVS Caremark, telehealth services, and the Best Health wellness program. Members access services through the Sharp Health Plan Online Account portal, which integrates with MyChart for health record access. The company also offers specialized plans for Federal Employees (FEHB), CalPERS members, and City of San Diego employees through SDPEBA.
Differentiator
Problem solved
Functional benefit
Brands
- Sharp Direct Advantage: Medicare Advantage plans offered by Sharp Health Plan
Products and services
- Individual & Family Plans
Quantifiable outcome
- Sharp Health Plan is rated as the highest member-rated health insurance plan in California
- +1 more outcomes
Companies that use Sharp Health Plan
Customer profileNamed customers6 records
Segments6 records
Ideal customer profiles4 records
Sharp Health Plan technology and API
TechnologyTechnology focussed No
API detail
- Has API
- Yes
- API docs
- API detail
Core technology
AI maturity
App detail
Integration9 records
AI capability2 records
Feature4 records
Sharp Health Plan partnerships and signals
Strategic signalPartnerships
15 partnerships are on record, tiered core and minor.
- CVS CaremarkcorePharmacy benefit management partner providing prescription drug coverage, drug formulary management, mail order pharmacy services, and specialty pharmacy through CVS Specialty. Handles prescription prior authorizations and pharmacy claims processing.
- CVS SpecialtycoreSpecialty pharmacy partner providing specialty medications with pickup at CVS pharmacies or home delivery options. CareTeam provides ongoing clinical monitoring and support for members with complex conditions.
- CVS MinuteClinicminorUrgent care and vaccine services available at CVS MinuteClinics for Sharp Health Plan members in the service area.
- Optum Behavioral HealthcoreBehavioral health services partner providing mental health and substance use disorder services. Handles behavioral health prior authorizations and claims for out-of-network reimbursement.
- American Specialty Health (ASH)minorAcupuncture and chiropractic services network provider. Also provides 25% discount on alternative care services and 15-40% off wellness products for members without coverage or who have exhausted benefits.
- Aetna (Open Choice PPO Network)coreTier 2 network provider for Point of Service (POS) plans, allowing members to access Aetna's Open Choice PPO Network for care outside Sharp's direct network.
- First Health NetworkcoreTier 2 network provider for Preferred Provider Organization (PPO) plans, providing access to non-plan providers for PPO members.
- Sharp Community Medical Group (SCMG)coreAffiliated medical group providing primary care and specialty services to Sharp Health Plan members. Part of the Performance network. Includes SCMG Graybill North Coastal, SCMG Inland North Medical Group, and SCMG Palomar Health Medical Group.
- Sharp Rees-Stealy Medical GroupcoreAffiliated multi-specialty medical group providing integrated care services to Sharp Health Plan members. Part of the integrated Sharp HealthCare delivery system.
- Rady Children's Health Network/CPMGcorePediatric care network participating in Sharp Health Plan's Performance network for children's healthcare services.
- Marque Urgent CareminorVirtual urgent care visits available to Sharp Community Medical Group patients at the same copay as in-person urgent care.
- HearUSAminorHearing services network provider for POS plan members to access hearing exams and hearing aids.
- Vision Service Plan (VSP)minorVision services network providing eye exams, glasses, and contact lenses for members with vision coverage.
- Covered CaliforniacoreCalifornia's health insurance marketplace where individuals and families can purchase Sharp Health Plan coverage with potential eligibility for federal tax credits and state subsidies.
- CalPERScoreCalifornia Public Employees' Retirement System offering Sharp Health Plan as an HMO option for eligible public sector employees and retirees.
Scale indicators4 records
Recent moves6 records
Expansion highlights6 records
Sharp Health Plan competitors and assessment
Company assessmentDirect peers
- Kaiser Permanente: Integrated payer-provider nonprofit health plan with a dominant California footprint; competes head-to-head with Sharp Health Plan in Individual, Group, and Medicare Advantage products across San Diego.
- Blue Shield of California: California-based nonprofit health plan offering individual, family, group, and Medicare plans through Covered California and employer channels; directly comparable product mix and regulatory environment to Sharp Health Plan.
- Anthem Blue Cross of California: Largest commercial health insurer in California, offering individual, group, and Medicare Advantage plans via Covered California and employer channels; a direct scale competitor to Sharp Health Plan in San Diego.
- Health Net (Centene): California-licensed health plan offering individual, family, group, and government-sponsored coverage; competes directly with Sharp Health Plan on Covered California and in the small/mid group market.
- SCAN Health Plan: California-focused nonprofit Medicare Advantage plan; competes directly with Sharp Direct Advantage in the senior segment in Southern California.
- Molina Healthcare: Government-focused health plan offering Medicaid, Medicare Advantage, and individual Marketplace plans in California; overlaps with Sharp Health Plan on Covered California and Medicare Advantage channels.
Broad incumbents
- UnitedHealthcare: Largest U.S. health insurer with broad individual, group, and Medicare Advantage offerings; competes with Sharp Health Plan across nearly every channel, with significantly greater scale and national network leverage.
- Aetna (CVS Health): National health insurer offering group, individual, and Medicare products; competes with Sharp Health Plan in the group/employer channel in California and is also a Sharp Health Plan Tier 2 network partner (Aetna Open Choice PPO).
- Cigna Healthcare: National health insurer with significant group and individual presence; competes with Sharp Health Plan for large employer accounts and offers comparable product structures.
Regional players
- Western Health Advantage: California-licensed HMO offering individual and group plans primarily in Northern and parts of Southern California; comparable in size and structure to Sharp Health Plan, but with a different geographic footprint.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat6 records
Key risks5 records
Key highlights6 records
Customer concentration
Sharp Health Plan social profiles
Digital presenceSharp Health Plan compliance and trust
Trust signalCompliance4 records
Sharp Health Plan financial estimates
Financial estimateRevenue estimate
Valuation estimate
Sharp Health Plan leadership team
Management profileNumber of profiles
Sharp Health Plan funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Sharp Health Plan M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Sharp Health Plan
What does Sharp Health Plan do?
Sharp Health Plan is a nonprofit health insurance company that sells HMO, POS, and PPO health plans to individuals, families, employer groups, federal employees, and Medicare-eligible individuals in San Diego and southern Riverside Counties, California. As part of the Sharp HealthCare integrated delivery system, the plan combines health insurance administration with a coordinated provider network including Sharp HealthCare hospitals, Sharp Community Medical Group, Sharp Rees-Stealy Medical Group, and Rady Children's Health Network.
Is Sharp Health Plan a public or private company?
Sharp Health Plan is a private company. It is classified as nonprofit foundation owned and is currently operating.
When was Sharp Health Plan founded?
Sharp Health Plan was founded in 1992. It employs 251 to 500 people.
Where is Sharp Health Plan based?
Sharp Health Plan is headquartered in San Diego, United States, in the North America region.
How does Sharp Health Plan make money?
Four revenue lines are on record. Health Insurance Premiums - Individual and Family is the primary driver. The others are health Insurance Premiums - Group/Employer, medicare Advantage Premiums and government Employee Health Benefits.
Who are Sharp Health Plan's main competitors?
Direct peers on record are Kaiser Permanente, Blue Shield of California, Anthem Blue Cross of California, Health Net (Centene), SCAN Health Plan and Molina Healthcare. Broad incumbents are UnitedHealthcare, Aetna (CVS Health) and Cigna Healthcare. Western Health Advantage is listed as a regional player.
Does Sharp Health Plan have an API?
Yes. Sharp Health Plan offers interoperability APIs for developers. The website footer references "Interoperability APIs" as a link for developer access. Additional API-related functionality includes member health data access through their online account portal, allowing members to access and manage their health information. Developer documentation is at www.sharphealthplan.com/api-access-for-developers.
What industry is Sharp Health Plan in?
Sharp Health Plan's product category is Health Insurance. Its primary akta.pro industry code is FSAIAFAE, Large Group Health Insurance (Mid-Market & National Accounts), with a secondary code of FSAIAFAD, Small Group Health Insurance (2–50/100). Its NAICS code is 524114 and its SIC code is 6321.