Member resources

Get the most from your health plan

Services and information for members

Scripps Health Plan Services (SHPS) is committed to providing quality administrative health care management and customer service to all our members. Our team works with you to answer your questions, help you navigate your health plan benefits and enhance your access to health care services.

Member welcome guides

If you are a new member, we encourage you to read our welcome guide for commercial members (PDF, 210 KB) or Medicare Advantage members (PDF, 210 KB). You'll find information about:

  • Benefits
  • Specialty, emergency and urgent care services
  • Prior authorization
  • Appeals and grievances
  • Policies
  • Rights and responsibilities

Contact information

Medicare resources

If you have questions about your Medicare coverage, costs, claims or eligibility, call one of the following phone numbers:

Medicare customer service


24 hours, 7 days a week

TTY: 877-486-2048

Medicare Rights Center


Elder Care Locator


Provider directories

The provider directories below are updated on a quarterly basis. Please contact your health plan for current listings of in-network providers and facilities. 

Some hospitals and other providers do not provide one or more of the following services that may be covered under a plan contract:

  • Family planning
  • Contraceptive services, including emergency contraception
  • Sterilization, including tubal ligation at the time of labor and delivery
  • Infertility treatments
  • Abortion

Member resources

Get language translation services, access the MyScripps patient portal, learn about the California standards in place to ensure you get timely access to care and get the facts about the type of same-day care you may need for an illness or injury.

Patient Protections Against Surprise Billing

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible. Learn more about Patient Protections Against Surprise Billing (PDF, 170 KB).

Timely access to care

California has set standards for health plans and providers to ensure members have access to health care in a timely manner. Learn more about those standards in the Timely Access to Care Notice (PDF, 170 KB).

Walk-in clinics, urgent care or emergency care

Knowing where to seek treatment could save your life in a medical emergency. Learn more about the difference between walk-in clinics, urgent care and emergency care (PDF, 120 KB).

Member forms

The forms below provide members with an opportunity to release protected health information (PHI), disclose it electronically, determine who receives information about care and express desires related to end-of-life care.

Advance Health Care Directive 

An advance directive is a legal document that allows you to express your values and desires related to end-of-life care. If you are incapacitated or unable to speak for yourself, it lets your family and health care providers know what type of medical care you want to receive. 

If you would like to have an advance directive, complete the form below, have it notarized and provide a copy to your health care provider.  

Authorization for Disclosure of PHI Electronically 

Submit Authorization for Disclosure of PHI Electronically (PDF, 230 KB) to allow SHPS to email your health information to you or your designee.

Confidential Communications Request 

Complete and submit the Confidential Communications Request (PDF, 160 KB) to mandate all medical information about sensitive services and health care you receive via your health insurance be sent directly to you and not family members.

Designation of Personal Representative

The Designation of Personal Representative (DPR) (PDF, 130 KB) form designates a person to act on your behalf with respect to your PHI.

Medical management and prior authorization

SHPS collaborates with its providers to meet the needs of patients like you across the San Diego region. To ensure members get the right care at the right time, we employ management and prior authorization. Learn how we make decisions about care. 

Care management

The Care Management Program uses a collaborative approach to promote availability of appropriate care and resources while maximizing your quality of life and health care benefits. If assigned, the Case Manager works directly with you and your family/caregiver(s), and your care team to develop an Individualized Care Plan (ICP) that is focused on increasing access to resources and services that support your health needs. 

Did you know that anyone can make a referral to our Care Management Department for Scripps Coastal Medical Center and Scripps Clinic Managed Care patients? Referrals can be made via:

Out-of-area and out-of-network procedures 

In the event a member is admitted to a facility outside SHPS' service area, the Utilization Management (UM) Department will work with the out-of-area facility to assess when it’s medically appropriate for the member to be safely transferred back into the service area to assist in coordination of the transfer. The UM Department reviews admissions at out-of-network facilities by phone. UM staff facilitate transfer of the patient to a SHPS contracted hospital as soon as medically appropriate.

Utilization management statement

SHPS UM decision making is based on appropriateness of care, service and the existence of coverage.

SHPS does not:

  • Compensate practitioners or individuals for denials
  • Offer incentives to encourage denials
  • Encourage decisions that result in under utilization

SHPS ensures independence and impartiality in making referral decisions that will not influence hiring, compensation, termination, promotion and any other similar matters.

Members may request a copy of the criteria used in making referral decisions. To obtain a copy of the actual benefit provision, guideline, protocol or other similar criterion on which the decision was based, upon request and free of charge, call SHPS customer service:


TTY: 711 (for the hearing and speech impaired)

Mon - Fri

8 am - 5 pm