Employer Group Benefit Plans

Capital Health Plan offers employer-sponsored benefit plans to both Small and Large Employer groups. Available benefit plans vary depending on the group size. Employer groups with 50 employees or less are considered to be a Small Employer Group, whereas those with 51 or more employees are considered to be a Large Employer Group.

CHP will determine which category the employer group is in based on the average number of employees the group had during the preceding calendar year. This includes full-time, part-time, and seasonal employees.

Large Employer Group Benefit Plans

For our Large Employer Groups, Capital Health Plan has developed rich benefit plan options that focus on the delivery of evidence-based medical care under the direction of primary care physicians in an effective, timely, and cost-effective manner.

Download the 2018 Large Group Comparison to review a list of available benefit plans and the Summary of Benefits for each.

Benefit DescriptionCapital Selection
15/30/50 | 15/50/100
Principal Choice
15/50/100
Quality Choice
15/50/100
Single DeductibleN/AN/AN/A
Family DeductibleN/AN/AN/A
MOOP
Single/Family
Medical & Rx Separate
$2,000/$4,500 Medical
$4,600/$8,700 Rx
$2,000/$4,500 Medical
$4,850/$9,200 Rx
$2,000/$4,500 Medical
$4,850/$9,200 Rx
Primary Care Visit$15$15$15
Specialist Visit
(all specialists including Chiropractors & OBs)
$40$50$75
Mental/Behavioral Health & Substance Abuse Disorder Visits$40$50$75
Imaging (CT/PET Scans/MRIs)$100$150$250
Tier 1 Drugs$15 | $15$15$15
Tier 2 Drugs$30 | $50$50$50
Tier 3 Drugs$50 | $100$100$100
Tier 4 Drugs (specialty)$50 | $100$100$100
ASC$100$200$250
Outpatient Hospital$250$350$500
ER (waived if admitted)$250$350$500
Ambulance$100$200$250
Urgent Care$25$50$50
Inpatient Hospital (includes Medical and MH/SH)$250$350$500
Rehabilitative Therapies (PT/OT/ST)$40$50$75
Routine Eye Exam (CHP Eye Care centers)$15$15$15
Telehealth$15$15$15

Review the Summary of Benefits for large group plans.

Small Employer Group Benefit Plans

For our Small Employer Groups, Capital Health Plan offers a choice of three benefit plans:

Benefit Description3101 - Platinum3102 - Platinum3104 - Gold
Single DeductibleN/AN/AN/A
Family DeductibleN/AN/AN/A
MOOP
Single/Family
Medical & Rx Separate
$3,500/$7,000 Medical
$3,500/$7,000 Rx
$3,500/$7,000 Medical
$3,500/$7,000 Rx
$3,500/$7,000 Medical
$3,500/$7,000 Rx
Primary Care Visit$15$15 (CHP Offices)
$25 (Affiliate Offices)
$50
Specialist Visit
(all specialists including Chiropractors & OBs)
$40$50$100
Mental/Behavioral Health & Substance Abuse Disorder Visits$40$50$100
Imaging (CT/PET Scans/MRIs)$100$100$100
Tier 1 Drugs$15$15$15
Tier 2 Drugs$30$30$50
Tier 3 Drugs$50$50$100
Tier 4 Drugs (specialty)$50$50$100
ASC$200$200$250
Outpatient Hospital$200$200$500
ER (waived if admitted)$250$350$750
Ambulance$0$100$100
Urgent Care$25$25$75
Inpatient Hospital (includes Medical and MH/SH)$250$350$750/day for first 5 days
Rehabilitative Therapies (PT/OT/ST)$40$50$100
Routine Eye Exam (CHP Eye Care centers)$15$15$35
Telehealth$15$15$15

Click here to review the Summary of Benefits for these plans. 

Review the Summary of Benefits for small group plans.

Pediatric Dental provided by Delta Dental

Do CHP's Benefits Include Pediatric Dental?
Under the Patient Protection and Affordable Care Act (PPACA), Small Employer Group benefit plans must cover Essential Health Benefits (EHBs), including comprehensive pediatric dental coverage for dependents under the age of 19.

Capital Health Plan has an alliance with Delta Dental to assist our Small Employer Groups in meeting this mandate. Please download the Delta Dental brochure that explains the dental coverage.

Small Employer Groups may choose to offer a separate stand-alone dental product in lieu of Delta Dental if the pediatric dental policy is compliant with PPACA. If a separate stand-alone product is offered, this information must be completed on the renewal package in the appropriate area, including the company name and benefit plan name that is being offered.

Please contact the Capital Health Plan Sales & Account Management Team to discuss the benefit plan options that are available to your clients.