Medicare Retiree and Non-Medicare Spouses

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If you are a Medicare eligible retiree (age 65+ with Part A and B) and wish to enroll your non-Medicare spouse you will need to complete two forms.  The Medicare eligible retiree should complete the Sharp Direct Advantage enrollment form, and the spouse should complete the Sharp non-Medicare enrollment form.  

Both enrollment forms should be submitted at the same time and you should make a note on the top of the Sharp non-Medicare enrollment form that this form is for a non-Medicare spouse and list the name of the Medicare eligible retiree on top of the form. 

These form can be mailed, faxed (619) 431.3078 or dropped off to the SDPEBA office, 9620 Chesapeake Drive, Ste 203-B, San Diego, CA 92123.

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