Frequently Asked Questions By Individual and Family Plan Members

Who needs individual and family health insurance?

Individual health insurance is typically for individuals and families that do not have access to an employer-sponsored health plan or qualify for Medicaid. Examples of people who may consider purchasing an individual and family health plan include:

• Individuals who work part-time and don’t qualify for employer-sponsored health coverage.
• Entrepreneurs, freelancers, gig workers, consultants, or contractors who need an affordable healthcare solution.
• Early retirees who need coverage before they become Medicare-eligible.
• College students and recent graduates who may have a gap in coverage due to age or employment.

How do I know if I’m eligible?

You may be eligible for a CHP health plan if you’ve recently had a qualifying event, such as:

• Lost your Medicaid or employer coverage.
• Moved to Florida or a new county within CHP’s service area.
• Had a baby or adopted a child.
• Have a household income below a certain level.
• Many other life events may also qualify.

Whether you’re uninsured or looking to change your health plan, a dedicated CHP agent can check if you’re eligible, share which life events qualify you for a Special Enrollment Period, and walk you through your options with CHP.

When can I enroll?

Open Enrollment starts November 1 each year and typically ends January 15. However, you may qualify for a Special Enrollment Period if you need coverage outside of that enrollment window. Request to speak with a dedicated CHP agent to check if you’re eligible, share which life events qualify you for a Special Enrollment Period, and walk through your options with CHP.

How do I pick the right plan?

When it comes to picking the right plan, everyone has different preferences and shopping for health insurance is easier when you have answers to these questions:

1. Who do you need health care coverage for?
   Is it just you? Do you have a spouse and/or children who need coverage, too?
2. What is your monthly budget?
   What are you currently paying for health insurance? Do you qualify for a subsidy?
3. What is important to you in a health plan?
   Determine what benefits and coverage is best for your health needs.

How do I know what health services are covered?

CHP Members can view their plan’s Summary of Benefits & Coverage (SBC). An SBC will outline plan details and provide members with copayment and/or coinsurance amounts for services, facilities, therapy options, and testing.

When I enroll, will I be able to change plans?

Yes. The open enrollment period is generally November 1 – December 31, and plan changes will be effective on January 1 every year. Each year, CHP adjusts its plan details and premiums and members have the opportunity to change their plan during the open enrollment period.

Are prescription drugs covered?

Yes, prescription drugs are covered for all of CHP’s individual and family plans. Please refer to your specific plan for more information on covered prescription medications.

How do I save money on health insurance?

We know you can’t control when you get sick or injured, but at CHP you do have options when it comes to lowering your health care costs in forms of subsidies, preventive care services, and utilizing a primary care provider (PCP) for improvements to your overall health.

How do I access my health information online?

CHP makes it easy to access your health information with our mobile app, CHPConnect. Once you have registered, you will receive a code in the mail for you to log in for the first time or you may call Member Services to be given the code over the phone.

How is the prescription drug reimbursement processed? How much will I be reimbursed?

You must submit an itemized paid receipt and a completed Non-Medicare Prescription Drug Reimbursement Form within 90 days of purchase. Please note that if your reimbursement is approved, the reimbursement will be made minus any applicable copayments for only the prescription drug(s) listed on the Formulary (list of covered prescription drugs). You may also contact CHP Member Services for more information.

What services are offered by the Physician Group of CHP (PGCHP)?

The Physician Group of Capital Health Plan provides comprehensive health care exclusively for Capital Health Plan members. Their goal is to promote disease prevention and healthy living, so in addition to diagnosing and treating illnesses, they also provide preventive care, health risk assessments, immunizations, screening tests, comprehensive management of chronic conditions, and education on maintaining a healthy lifestyle. You can learn more about the Physician Group of Capital Health Plan at any time.