Frequently Asked Questions About Pregnancy

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

No authorization is required to receive maternity care from an in-network Obstetrician (OB) or certified nurse midwife. If you think you may be pregnant, schedule a visit with your Primary Care Physician (PCP), who will confirm the pregnancy and begin the process of coordinating your care. To find an in-network provider, search the CHP Network Directory or contact Member Services at (850) 383-3311.

Where should I go for lab work during pregnancy?

All pregnancy-related lab work must be done at LabCorp. Your PCP will order initial tests, and your obstetrician will handle any follow-up labs. Be sure to follow their instructions and bring any necessary paperwork when visiting LabCorp.

What maternity services are covered by CHP?

CHP covers routine and medically necessary care related to pregnancy, including prenatal visits, delivery, and complications such as miscarriage. Services must be provided within the CHP Network, unless the situation was unforeseeable before traveling. If you’re planning a home birth or delivery in a birthing center, contact Member Services for coverage details.

Will I need authorization for additional tests or referrals?

Yes, Capital Health Plan (CHP) must approve any additional referrals or tests. If you need services outside your OB’s office, such as an amniocentesis or OB ultrasound (excluding routine lab work) your OB must arrange them in advance. They will confirm that:

• The service is medically necessary
• It’s a covered benefit under your plan
• It will be performed at an approved facility

If your OB refers you to another location (e.g., Shands Hospital) or orders outpatient tests or procedures, you must contact your Primary Care Physician (PCP) as soon as possible to obtain authorization.

To check which services are covered by CHP, call Member Services at (850) 383-3311.

Who should I contact for pregnancy-related medical advice?

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/or after the baby is born, don’t forget the CHP Health Information Line at 850-383 3400, which is available 24/7, at no additional cost, to answer questions and assist you.

Are pregnancy services covered when I travel?

Routine obstetrical care, including diagnostic tests and procedures, is not covered outside 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.

How do I enroll my newborn in CHP coverage?

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 or call CHP Member Services 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.

What should I know before going to the hospital to deliver?

When you arrive at the hospital, let the staff know you’re a CHP member. Also, provide the name of your newborn’s future Primary Care Physician if you’ve already selected one. This helps ensure seamless care and billing.

My baby is here, what’s next?

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 a CHP Insurance 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.

Are breast pumps covered by my insurance?

Most CHP plans cover breast pumps at no cost to you. To check your coverage, please reach out to member services at 850-383-3311. If this benefit is available, you can collect a breast pump from the La Belle Breastfeeding Boutique.

Tallahassee Memorial HealthCare is the exclusive provider of breast pumps for Capital Health Plan members. The La Belle Breastfeeding Boutique is your one stop shop for breastfeeding-related items.

• If you are delivering at TMH, you can receive your breast pump during your delivery.
• If you are delivering at another healthcare facility, you can pick up your pump up to a month before your delivery date. There is also an option to upgrade your pump for an additional cost.

As boutique hours hours may vary, please call ahead before your visit at 850-431-4920.

Where can I find a pharmacy in CHP’s network

You can locate participating pharmacies by using our Pharmacy Directory, which lists all approved retail and specialty pharmacies within the CHP network.

Still have coverage/network questions?

For any questions regarding coverage or CHP’s network, please reach out to Capital Health Plan Member Services at 850-383-3311.