Documents & Forms Center

Members

Basic Option II

PDF icon Basic Option II.pdf

Agents, Employers, Members

Blue Card Program Information

PDF icon Blue Card Program Information.pdf

Medicare, Members

Capital Health Plan - H5938 2022 Medicare Star Ratings

PDF icon 2022 Star Rating updated.pdf

Members

Capital Health Plan Large Employer Member Handbook

PDF icon 2024.22.LgMbrHb.pdf

Members

Capital Selection - No Rx

PDF icon Capital Selection No Rx 10-01-21.pdf

Members

CHP ABP Small Employer Member Handbook

PDF icon Small-Employer-Member-Handbook_Keep-Your-Health-Plan.pdf

Members

CHP High Deductible Health HMO 01.01.22

PDF icon CHP High Deductible Health HMO 01.01.22.pdf

Members

CHP HSA HDHP 1-1-2023

PDF icon CHP High Deductible Health HMO 01.01.23.pdf

Members

CHP HSA HDHP 1-1-2023

PDF icon CHP High Deductible Health HMO 01.01.23.pdf

Members

CHP Member Handbook - TMH & Medicus Select

PDF icon 2024.25.TMH-MbrHb.pdf

Members

CHP Plan Brochure - 2025

PDF icon CHP-Plan-Brochure-2025.pdf

Members

CHP Plan Brochure 2025

PDF icon CHP-Plan-Brochure-2025.pdf

Members

CHP Small Employer Member Handbook

PDF icon 2024.23.SmMbrHbACA.pdf

Agents, Employers, Members

CHPConnect Agreement

PDF icon CHPConnect Agreement.pdf

Members, Providers

Clinical Guideline - Secondary Prevention for Patients with Atherosclerotic Vascular Disease 2023

PDF icon Vascular-Clinical-Guidelines-2023.pdf

Members, Providers

Clinical Guidelines - Diabetes Care 2023

PDF icon 2023-Diabetes-Clinical-Practice-Guideline.pdf

Members

Clone of State of Florida High Deductible Health HMO Plan SBC

PDF icon sof-standard-hmo-plan-sbc.pdf

Medicare 2023, Agents, Members

Communication Directive Form

PDF icon Communication-Directive-Form.pdf

Agents, Employers, Members

Communication Directive Form Instructions

PDF icon Communication Directive 2020.pdf

Members

Consent Form for Minor Child

PDF icon Consent for Minor Child Approved 7 22 21_fillable.pdf

Members

Conversion Option A

PDF icon Conversion Option A.pdf

Members

Conversion Option C

PDF icon Conversion Option C.pdf

Members

Conversion Option C $10/$30/$50

PDF icon ConversionOptionC01-01-21.pdf

Members

Conversion Option M $15/$30/$50

PDF icon ConversionOptionM01-01-21.pdf