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 earned top ratings since NCQA began comparing health plans in 2005. Click here for more information.

2024 FEHB Benefits

Download important information about health benefits from Capital Health Plan:

• 2024 FEHB Open Enrollment Presentation
• 2024 FEHB Benefits Brochure
• 2024 FEHB Summary of Benefits (SBC) Form
• Important Member Information
• Uniform Glossary
• Enroll in Electronic EOB's

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, maintain the denial, or requesting additional information.
• If you do not agree you may ask OPM to review the request by submitting request in writing to OPM.
• OPM will review request and will send you a final decision within 60 days

For more information, please refer to page 72 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 inability to: 

• Conceive after 1 year of unprotected sex when female (or individual with female reproductive organs) is under 35 years of age, or 6 months for female (or individual with female reproductive organs) age 35 and older; 
• Conceive after a period of artificial insemination (AI for a period of time, for example 12 months). 
• Or demonstration of a disease or condition of the reproductive tract such that unprotected sex or AI would be ineffective.

For more information, please refer to page 36-37 of the FEHB Brochure.

Contraception drugs and devices:

• The contraceptive benefit at least one option in each of the HRSA-supported categories of contraception.
• Medication exception requests can be submitted by provider to CHP. Form is: 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, you can contact contraception@opm.gov.
• See FEHB Member Handbook for additional information on pages 37, and 64.

Prescription Drug Information:

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

• Drug formulary (which shows the drug tier) can be found at:  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.