CHP Retiree Advantage (HMO) State of Florida
Prescription Drug Coverage
Sometimes you are taking a drug that is not on our formulary, and if that is the circumstance please review the 2021 Prime Medicare Transition Policy for additional information. During the time when you are receiving a temporary supply of a drug, you should talk with your provider to decide what to do when your temporary supply runs out.
Enrollment
To enroll in CHP State of Florida Retiree Advantage, you will need to download and complete the 2020 CHP Retiree Advantage Enrollment Application. Please return the completed enrollment application directly to CHP. You may enroll anytime within 90 days before the effective date of coverage. Additionally, you can also download the Enrollment Checklist as a guide.
Forms
Documents on this page are available in Portable Document Format (PDF). Adobe Reader (free) may be used to open these files.
Appointment of Representative Instructions & Form
Advanced Directives and Living Wills
An advanced directive ensures that both medical professionals and your loved ones understand the end-of-life decisions you want in the event you’re unable to explain them due to a medical emergency. An advanced directive is simply a statement, made while you are competent, about the medical treatment you want if you can’t make those decisions later. Decisions made early and communicated plainly may have tremendous value for you and your family.
Determinations, Grievances & Appeals
For instructions on how to use the form to appoint a representative, visit Appointment of Representative Form Instructions.
Privacy Notice
Privacy Notice - We believe our members have the right to privacy and that their nonpublic personal, financial, and health information should be kept confidential.
Utilization Management
Capital Health Plan makes health care decisions to ensure quality treatment and efficient use of resources. View more information about utilization management.
Extra Help & LIS Chart
You may be able to get Extra Help to pay for your prescription drug premiums and costs. The amount of Extra Help that you can get depends on your income and resources. If you qualify, you will get help paying for your Medicare drug plan's monthly premium and prescription copayments or coinsurance. Your premium generally will be lower if you receive Extra Help from Medicare.
Learn more about Medicare's Extra Help program.