Other General Frequently Asked Questions

How can I get Language Assistance or translation services?

Members or prospective members in need of language assistance should contact CHP Member Services. A member service representative can connect with an interpreter to communicate by telephone. Members requiring language assistance at one of our Health Centers should notify the receptionist upon scheduling their appointment and assistance will be provided. Capital Health Plan does offer translation services in many different languages. Contact CHP Member Services if you are in need of translation services.

Can I receive my benefit documents or other correspondence in an alternative format?

Capital Health Plan can provide benefit documents and/or other correspondence in alternate formats such as Braille and large print upon request. Please contact CHP Member Services.

Where can I find benefits and claim information for my dependent(s)?

You can find benefits and claim information on CHPConnect or by calling CHP Member Services.

Where can I find information on the Away from Home Care program?

CHP Members traveling out of the CHP service area can find several programs inclusive of Away from Home Care, the BlueCard program, and out of network service.

What areas are covered with Away From Home Care®?

Below is a list of states that do not participate in Away From Home Care® (AFHC®).

States not covered on AFHC® include, but are not limited to:
Alabama, Alaska, Idaho, Iowa, Kansas, Mississippi, Montana, Tennessee, Nebraska, North Dakota, Oregon, Puerto Rico, Rhode Island, South Carolina, South Dakota, Utah, Vermont, Washington, West Virginia, and Wyoming.

For states that are covered, please contact CHP Member Services to confirm there is coverage in that state’s specific county.

Once enrolled in Away From Home Care® how long can an individual stay enrolled? Does enrollment in Away From Home Care need to be renewed and if so, how often?

Subscriber Away From Home Care® (AFHC®) policies will end after six months. Dependent AFHC® policies automatically end after one year. Capital Health Plan will mail a letter and renewal form prior to the termination date. If you want to renew the policy, you must complete and return the form as directed.

How long can my child(ren) remain covered by my policy?

Your dependent children can remain on your policy through the end of the year in which they turn 26. If you have a dependent child over 26 but under 30, they can remain on your plan for an additional monthly premium*. Please refer to your Member Handbook for more details, or you may call CHP Member Services.

*Subject to certain requirements

How long can a child be covered by my policy if he/she has disabilities?

If a child attains the limiting age for a Covered Dependent, coverage will not terminate while that child is, and continues to be, both:

Incapable of self-sustaining employment by reason of mental retardation or physical handicap; and
Chiefly dependent on the Subscriber for support and maintenance.

Please refer to your Member Handbook for more details, or you may call CHP Member Services.

How does the Delta Dental benefit and claim system work for my pediatric dental coverage?

Your pediatric dental coverage is administered exclusively by Delta Dental. For questions or more information, please contact Delta Dental at 1 (800) 471-0236.

How do I add eligible dependents to my policy?

To add an eligible dependent, you should submit the Member Status Change Request Form to your benefit administrator during the enrollment period. Please refer to your Member Handbook for special enrollment criteria, or you may call CHP Member Services.

How do I cancel my Away From Home Care® policy?

To cancel your Away From Home Care® policy, call CHP Member Services.

How do I obtain coverage for my newly adopted child?

For a newborn adopted child: You should submit the Member Status Change Form along with a copy of your placement papers to your benefit administrator 60 days prior to the date of birth or during the 60-day period immediately following the date of birth. The effective date of coverage would be from the date of birth for the newborn, provided a written agreement to adopt the child has been entered into prior to the birth of the child. If not, then the effective date of coverage would be the date of placement.

For adopted child(ren): You should submit the Member Status Change Form along with a copy of your placement papers to your benefit administrator 30 days immediately following the date of placement. The effective date of coverage would be the date of placement.

How do I remove dependents from my policy?

To remove a dependent, you should submit the Member Status Change Form to your benefit administrator.

How can I protect myself from health care fraud?

Learn about Fraud, Waste and Abuse compliance policies and trainings here.

What are my rights as a member?

View your member rights and responsibilities here.

Am I covered for emergency care or urgent care? Am I covered for emergencies if I am out of the CHP service area? What should I do if I am outside of the U.S. and need emergency care or urgent care?

Yes. Members are covered for emergencies and urgently needed care anywhere in the world. In addition, members have access to our national Pharmacy Network and national LabCorp Network. If you are outside of the U.S. seek care, if necessary. Upon your return to the U.S., you will need to submit a request for reimbursement for Covered Services. You must submit proof of payment and a completed General Reimbursement Form. Please note that if the reimbursement is approved, it will be made minus any applicable copayments.

What is the difference between urgent care and emergency care?

The Emergency Room (ER) should be used to treat emergency medical conditions. Urgent Care should be used for an illness, injury, or condition serious enough to seek care right away, but not so severe as to require ER care.

What types of conditions are treated at an Urgent Care facility versus an Emergency Room?

Review the chart below:

Condition	Urgent Care	Emergency Room
Allergies
Chest Pain
Cough
Cut/Laceration
Earache
Headache
Insect/Animal Bite
Minor Burns
Nausea/Vomiting/Diarrhea
Numbness in Limbs
Rash/Skin Infection
Severe Abdominal Pain
Severe Burns
Severe Head Injury
Shortness of Breath
Sinus
Sprain/Strain
Stitches
Upper Respiratory Symptoms

What should I do in an emergency?

If necessary, you should seek Emergency Care immediately. Contact your Primary Care Physician as soon as possible.

What type of benefit plans do you offer?

Capital Health Plan offers employer-based coverage for those who live or work in our service area, Individual and Family plans for those under 65 who are self-employed, out of work, or between jobs, and Medicare Advantage plans for individuals with Medicare.

What happens to my coverage if I move out of the CHP service area?

If you relocate outside of the CHP service area, you are no longer eligible for CHP coverage.

Where can I find more information on my medical claims?

You can view your claim information on CHPConnect or you may call CHP Member Services.

Where can I find my Summary of Benefits & Coverage (SBC)?

Non-Medicare members who are Employer Group members can request their SBC from their benefits administrator. Individual and Family plan members can contact Member Services for their SBC information. Additionally, members can also access their SBC via CHPConnect. For Medicare Advantage members, Summary of Benefits are detailed on their specific plan detail page.

Where can I find my benefit documents electronically?

For Non-Medicare members, your benefit documents are available on CHPConnect.

For Medicare Advantage members, your benefit documents are listed by your plan type:

How do I find CHP Patient Access API Member Educational Resources Regarding Privacy and Security documents?

View our CHP Patient Access API Member Educational Resource here.

What is CHP’s Wellness Reimbursement Program?

Capital Health Plan members can receive up to $150 per calendar year for membership at a qualified health and fitness center during that year.

Where can I find the Wellness Reimbursement form?

Find the Wellness Reimbursement form here and in the Document Center.

When will I receive my Wellness reimbursement?

Please allow 30 days from receipt of your Wellness Reimbursement Form for reimbursements to be made.

What is CHP’s eyeglass reimbursement program for Medicare members?

CHP’s Medicare Advantage members can be reimbursed up to $150 for eyeglasses (lenses and frames) or contact lenses every two years. Consult your plan’s Evidence of Coverage for more information.

I am a Medicare Advantage member and want to take advantage of my eyeglass reimbursement. Where can I find the reimbursement form?

Medicare Advantage members may use the General Reimbursement Request Form when requesting reimbursement for eyeglasses.

I am new to CHP. What do I need to know?

Welcome to Capital Health Plan! View our New Member section for some information and resources we’ve put together to help you get started with our plan.

I am a new member. When will I receive my ID card?

You should receive your Member ID card within 10 business days of CHP’s receipt of a complete and accurate enrollment application.

I am a new member. Can I receive care before I get my ID card?

Yes. You may print a temporary Member ID card on CHPConnect or contact CHP Member Services to request your Member ID number. Additionally, you can provide your name and date of birth to your Provider and they can contact CHP to verify eligibility and copayment information.

What is a primary care physician (PCP)?

A PCP is a physician you select to serve as your primary physician to maintain your needs. They handle a variety of health-related problems, keep a medical history and medical records, and can help coordinate care with a specialist or other health care professional.

What if I need to see a specialist?

Members have direct access to a network of specialists for office visits and consultations. Your primary care physician should be able to assist you for other services that may require a referral or prior authorization.

Where can I go for lab work?

Members can utilize LabCorp’s nationwide lab network. Find a participating lab.

Does CHP cover flu vaccinations, and where can I get one?

Yes. Flu vaccines can be obtained by calling your primary care physician’s office, visiting your local health department within our Service Area, or at retail pharmacies in our network if you have a prescription benefit.

Retail pharmacy vaccination programs apply to adults 18 years of age and older. Patients under the age of 18 should see their primary care physician for the flu vaccine.

How do I see a physician after hours or when my primary care physician (PCP) is not available?

For after-hours care or if your physician is not available, please contact CHP Urgent Care. Additionally, you may utilize the telehealth services available via Amwell. For emergencies, please call 911 or go to the nearest Emergency Room.

When can I use CHP Urgent Care?

Urgent medical conditions that might be treated include:

Upper respiratory infections (e.g. colds, ear infections, and sore throats)
Minor trauma (e.g. ankle sprains or cuts)
Abnormal symptoms (e.g. fevers, nausea, vomiting)
Urinary tract infections

View CHP Urgent Care’s hours of operation and telephone number.

How do I submit a complaint?

To submit a complaint, please contact CHP Member Services. You may also refer to your Member Handbook or Evidence of Coverage for more details on the complaint, grievance, and appeal process.

What is Amwell?

Amwell is a faster, easier way to see a doctor. You can have video visits with a doctor anytime. It’s easy to use, private, and secure. It’s free to enroll and the copays are currently being waived.

What does Amwell offer?

Amwell offers:

Your choice of trusted, U.S. board-certified doctors
Video visits using the web or mobile app
Consultation, diagnosis – even prescriptions (when appropriate)

Amwell can be used any time, day or night. It’s perfect when your doctor’s office is closed, you’re too sick or busy to see someone in person, or even when you’re traveling.

How do I sign up for Amwell?

There are 3 easy ways to sign up for Amwell:

Download the iOS or Android App by searching “Amwell”
Sign-up on the Amwell website
Sign-up by phone: call 1 (855) 818-DOCS

What can doctors treat on Amwell?

On Amwell, you can be seen by a provider to take care of the most common issues like:

Colds
Flu
Fever
Rash
Abdominal pain
Sinusitis
Pinkeye
Ear infection
Migraines

What is the cost of using Amwell?

Copays are dependent on your plan’s specific details.

When would I use Amwell?

You can use Amwell when you believe the following:

I should probably see a doctor, but can’t fit it into my schedule
My doctor’s office is closed
I feel too sick to drive
I have children at home and don’t want to bring them with me
It’s difficult for me to get a doctor’s appointment
I’m on business travel and stuck in a hotel room

Can I use Amwell when I’m traveling?

Yes. Amwell is great when you’re on the road for vacation or work. Telehealth is available in all 50 states.

Who are the doctors on Amwell?

Clinical services on Amwell are provided by Online Care Group – the nation’s first and largest primary care group devoted to telehealth. Doctors on Amwell:

Average 15 years experience in primary and urgent care
Are U.S. Board Certified, licensed and credentialed
Have profiles, so you can see their education and practice experience
Are rated by other patients, so you can review and select the doctor that meets your needs

How do I add my spouse to my Amwell account?

Your spouse should create a separate account to enroll.

How do I add a child to my Amwell account?

Parents and guardians can add their children who are under age 18 to their account and have doctor visits on their behalf. Enroll yourself first and then add your child or dependent to your account.

What do I do if I have a child over 18 who is still on my health insurance but needs to use Amwell?

They should enroll as an adult and create their own separate account.

Who do I contact if I have questions about Amwell?

If you have any other questions, please call or email our support team at 1 (855) 818-DOCS (1 (855) 818-3627) or email [email protected].

Do I need an authorization to receive services from an obstetrician or midwife?

When you believe you may be pregnant, you should schedule an appointment with your Primary Care Physician, who will confirm your pregnancy and order your initial lab work. At that time you may wish to discuss your choice of obstetrical care provider with your PCP. An authorization is not necessary, if you use an in-area network health care professional to provide your maternity care. To determine which providers are covered by CHP, you may search the Network Directory or you may call the Member Services Department, at (850) 383-3311, for assistance.

I’m pregnant. Where should I get my lab work done?

All laboratory work must be done at LabCorp. Your primary care physician (PCP) will order all of your initial lab work to be done at LabCorp and forwarded to your obstetrician (OB). Additional lab work ordered by your OB must also be done at LabCorp. Your doctors will give you instructions and the appropriate lab orders.

What pregnancy-related expenses are covered by CHP?

CHP covers hospital and obstetrical services for normal pregnancy, delivery, miscarriage or pregnancy complications within the CHP service area unless the need for such services was not, and could not reasonably have been anticipated, before leaving the service area. If you plan to deliver your baby outside of the hospital setting, please call Member Services at (850) 383-3311 for more information. CHP provides coverage for maternity care according to Florida Statute 641.31 (18).

I’m pregnant. What if I need further tests or referrals?

CHP must authorize any additional referrals and tests. Any services (besides lab work) done outside your OB’s office — amniocentesis, OB ultrasound, etc. — must be pre-arranged by your OB, who will verify that the service is medically necessary, that it is a covered benefit, and that the services are performed at a covered facility. If your OB refers you to any other facility, such as Shands Hospital, or orders outpatient tests or procedures, contact your PCP as soon as possible for authorization. To find out what services are covered by Capital Health Plan, call Member Services at (850) 383-3311.

I’m pregnant. Who do I call to get medical information?

We encourage you to keep in touch with both your Primary Care Physician and your Obstetrician during your pregnancy. Your Obstetrician will manage your pregnancy. Your Primary Care Physician will continue to manage any non-pregnancy related medical care. If you have general questions both before and after the baby is born, don’t forget the CHP Health Information Line, which is available 24/7, at no additional cost, to answer questions and assist you.

I’m pregnant. What is covered if I have to travel?

Routine obstetrical care, including diagnostic tests and procedures, is not covered out of the Capital Health Plan service area. CHP recommends that you limit your out-of-town travel during your pregnancy. After 37 weeks gestation, out-of-area travel deliveries would be anticipated and therefore not covered.

I’m pregnant. How do I secure coverage for my newborn?

The expense of your newborn will be covered for medically necessary hospitalization and newborn care only if you secure proper coverage for your baby. It is your responsibility to add your child to your policy. This should be done through the subscriber’s human resources office within 30 days of the birth of your child. If you would like to pre-enroll your baby, check with the subscriber’s human resources office to see if this is an option for you. Coverage for your baby will be denied — even if you have family coverage — until the next open enrollment if CHP does not receive notice from the employer within 60 days of the birth of the child. Early in your eighth month of pregnancy, call Member Services to request a list of primary care physicians so you can select one for your newborn. If you have questions about this enrollment process, please contact Member Services at (850) 383-3311.

I’m pregnant. The big day is here. What do I need to know?

When you arrive at the hospital to deliver, it is important to identify yourself to labor and delivery personnel as a CHP member. You will also need to tell them whether your baby will have CHP coverage and the name of the doctor who will care for the baby. This doctor will be the baby’s Primary Care Physician.

My baby is here. Now what?

If your baby is already enrolled through the subscriber’s human resources office, you will need to call Member Services as soon as possible with the baby’s name. We will record the information in your child’s membership and issue an identification card. If the baby is not yet enrolled, it is your responsibility to add your child to your policy. This should be done through the subscriber’s human resources office within 30 days of the birth of your child. Coverage for your baby will be denied — even if you have family coverage — until the next open enrollment if CHP does not receive notice from the employer within 60 days of the birth of the child.

What do I need to know about feeding my newborn?

Breast milk is the best source of nutrition for growing babies. Breast milk contains all the right nutrients in the right amounts. In addition to the nutritional benefits, breast fed babies receive antibodies through breast milk and are better equipped to fight infection. One of the most important and unique benefits of breast feeding is the lasting emotional bond that is formed between mother and child.

How can I find out if a medication is covered by CHP?

Find medication online using our formularies page to locate your prescriptions and associated copayment.

How can I find a pharmacy within CHP’s network?

Locate a pharmacy within CHP’s network.

How can I review my list of covered prescription drugs?

CHP utilizes a list of covered prescription drugs known as a Formulary.

What is the difference between generic and brand-name drugs, and how does it affect my benefits?

A generic drug is approved by the FDA as having the same active ingredient as the brand name drug.

What if my drug is not on the list of covered prescription drugs?

You, your authorized representative, or your prescribing physician can request an exception to prescription drug coverage restrictions or quantity limits. For example, certain drugs on CHP’s formulary have quantity limits. If your drug has a quantity limit, you can ask CHP to cover a quantity over the stated limit. You may need to meet certain clinical criteria to receive an approval for the higher quantity.

Where can I find the latest drug recall information from the Food and Drug Administration (FDA)?

For up-to-date information on drug recalls, market withdrawals, and safety alerts, visit the U.S. Food and Drug Administration’s (FDA) website.

How do I renew/refill a prescription?

CHP Members can call their primary care physician’s office, request a prescription refill through the NextGen Patient Portal, or call their preferred pharmacy for a refill.

How do I ask questions for my Care Team to answer?

You can call your primary care physician’s office, or ask your question through the NextGen Patient Portal.

How do I request a copy of my medical records?

You can complete the Authorization to Disclose Protected Health Information form and then submit the authorization to your primary care physician’s office. If you need assistance, contact Capital Health Plan’s Medical Records Department at 850-383-3485.

Why do I need to arrive early for an appointment?

You may be asked to arrive a few minutes early for first-time visits or visits requiring that you fill out patient information forms. We ask that you arrive 15 minutes before your appointment to complete any paperwork.

What do I need to bring to my appointment?

Bring all your medications including prescriptions, non-prescriptions, and any vitamins you take regularly or use as needed. In addition, you will need to bring your government-issued picture ID, and the copayment amount for your visit.

How can I utilize the CHP Document Center?

CHP Members can view, print, and complete forms available in our Document Center prior to their patient visit. Additional forms are available in our Document Center that can assist with medication coverage requests, filing a claim, appointing a representative, completing a living wills, and much more.

What is CHPConnect?

CHPConnect is our secure online portal where CHP Members have the ability to:

Review/download benefit documents
Choose a Primary Care Physician (PCP)
Review lab results
Request ID cards
Review referrals and authorizations
Enroll in electronic EOBs
Review medical claims information

Providers have the ability to:

View member eligibility
Review referrals and authorizations
Review claim status

Employers have the ability to:

Review billing statements
Enroll members
Terminate members
Change member information

Agents have the ability to:

Review commission statements
Review/download group renewals