FEHB Members

For federal employees in our coverage area, we offer high-quality plans that provide comprehensive coverage and meet the requirements for Federal Employees Health Benefits (FEHB) plans. Both our Medicare and commercial plans consistently earn top ratings, and they have a full range of benefits, including a large, stable pool of in-network providers and access to urgent and away-from-home care.

Each year the National Committee for Quality Assurance (NCQA) rates health plans across the country, and Capital Health Plan (CHP) has continued earning top ratings since NCQA began comparing health plans in 2005. Click here for more information.

2025 FEHB Benefits

Download important information about health benefits from Capital Health Plan:

• 2025 FEHB Benefits Brochure
• 2025 FEHB Summary of Benefits (SBC) Form
• Important Member Information
• Uniform Glossary
• Enroll in Electronic EOBs

FEHB OPM Open Season Website:

• http://www.opm.gov/insure

Choosing Your Physician:

• For the most accurate list of physicians accepting new patients:
  • Search for a Physician or Provider

Urgent Care:

• Amwell: Telehealth
• Urgent Care Information

Dependent Information:

• Away From Home Care

Disputed Claims Process:

• Submit in writing a request to reconsider initial decision to CHP.
• Post-service claims have 30 days from the date we receive your request to respond - by either paying the claim, maintaining the denial, or requesting additional information.
• If you do not agree, you may ask OPM to review the request by submitting a written request to OPM.
• OPM will review the request and send you a final decision within 60 days.

For more information, please refer to page 75 of the FEHB Brochure.

Fertility

CHP’s Federal Drug List (formulary) currently covers fertility drugs associated with artificial insemination procedures when medically necessary, and the cost of IVF-related drugs for three cycles annually.

Infertility is defined as the inability to:

• Conceive after one year of unprotected sex when the female (or individual with female reproductive organs) is under 35 years of age, or six months for those aged 35 and older.
• Conceive after a period of artificial insemination (AI), for example, 12 months.
• Demonstrate a disease or condition of the reproductive tract such that unprotected sex or AI would be ineffective.

For more information, please refer to pages 38-39 of the FEHB Brochure.

Contraception Drugs and Devices:

• The contraceptive benefit covers at least one option in each of the HRSA-supported categories of contraception.
• Medication exception requests can be submitted by providers to CHP using the following form: https://www.myprime.com/content/dam/prime/memberportal/WebDocs/Other/UM/Commercial/Choice_CE_FE_HD.pdf
• If you have difficulty accessing contraceptive coverage or other reproductive healthcare, contact contraception@opm.gov.
• See the FEHB Member Handbook for additional information on pages 37 and 64.

Prescription Drug Information:

Members and prospective members can access the drug formulary using the following links:

• Drug formulary (which shows the drug tier): https://www.myprime.com/en/forms.html
• To view the cost of drugs: https://www.myprime.com/en/medicines.html#find-medicine

This is a summary of the features of Capital Health Plan. Before making a final decision, please read the plan's federal brochure RI 73-197. All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.