Documents & Forms Center

Conversion Option M-1-1-22

PDF icon conversion-option-m-1-1-22.pdf

Agents, Employers, Members

Coordination of Benefits Instructions and Form

PDF icon Coordination of Benefits Instructions and Form.pdf

Covid-19 Paper Claims Form

PDF icon 3272 CHP_Rx Claim Form-508c.pdf

Members

COVID-19 Telehealth Flyer - SOF

PDF icon COVID-19 Telehealth Flyer.pdf

Members

COVID-19-PHE-Ending-Letter

PDF icon COVID-19-PHE-Ending-Letter.pdf

Delta Dental Brochure

PDF icon Delta Dental Brochure.pdf

Depression Clinical Practice Guidelines

PDF icon Depression-Clinical-Practice-Guidelines-2021.pdf

EDI Companion Guide

PDF icon Capital Health Plan 837 5010 Companion Guide.pdf

Electronic Claim Submission Form

PDF icon Electronic Claim Submission Enrollment Form.pdf

Agents, Employers, Members

Enrollment Application

PDF icon Enrollment Application 2023.87.EnrollApp.pdf

Medicare

Enrollment Checklist

PDF icon 2021 SAPPA Enrollment Checklist.pdf

Essential Selection 15.30.50 2022

PDF icon Essential Selection 15.30.50 2022.pdf

Essential Selection No Rx 2022

PDF icon Essential Selection No Rx 2022.pdf

Evidence of Coverage Advantage Plus Large Print

PDF icon 2023-EOC-Advantage-Plus - LP.pdf

Evidence of Coverage Preferred Advantage Large Print

PDF icon 2023-EOC-Preferred-Advantage - LP.pdf

Evidence of Coverage Retiree Advantage Large Print

PDF icon 2023-Retiree-Advantage-Evidence-of-Coverage - LP1.pdf

Evidence of Coverage Silver Advantage Large Print

PDF icon 2023-Silver-Advantage-EOC_LP.pdf

Evidence of Coverage State of Florida Retiree Advantage Large Print

PDF icon 2023-SOF-Retiree-Advantage-Evidence-of-Coverage- LP1.pdf

Members

Feeding Your Baby

PDF icon Feeding-Your-Baby-Final.pdf

FEHB 2022

PDF icon FEHB 2022.pdf

FEHB 2023

PDF icon FEHB-2023.pdf

FEHB 2024 OE Presentation

PDF icon FEHB 2024 Presentation.pdf

FEHB 2024 OE Presentation

PDF icon FEHB 2024 Presentation.pdf

Members

FEHB High Option SBC - 2024

PDF icon FEHBHighOption15.40.100-1-1-24.pdf