Capital Health Plan Preferred Advantage (HMO) is a Medicare Advantage plan that is available to individuals who are entitled to Medicare Part A, enrolled in Medicare Part B, live in the Capital Health Plan service area, and do not have End Stage Renal Disease. Capital Health Plan Preferred Advantage will provide all of your Medicare benefits and services including prescription drug coverage (Medicare Parts A, B, and D). Review the Summary of Benefits, attend a seminar, or call our office to talk to one of our experienced representatives to find the plan that is right for you.
CHP Preferred Advantage (HMO)
An advanced directive ensures that both medical professionals and your loved ones understand the end-of-life decisions you want in the event you’re unable to explain them due to a medical emergency. An advanced directive is simply a statement, made while you are competent, about the medical treatment you want if you can’t make those decisions later. Decisions made early and communicated plainly may have tremendous value for you and your family.
To obtain a copy of Five Wishes, an advanced directive document that addresses all of an individual's needs (medical, personal, emotional, and spiritual), call Capital Health Plan's Health Information Line at (850) 383-3400.
Through the Planning Early About Care at the End (PEACE) program, Big Bend Hospice offers individualized assistance in completing the Five Wishes Advanced Directive. To schedule an appointment with a PEACE facilitator, contact Big Bend Hospice at (850) 878-5310 or visit the Big Bend Hospice website.
The Annual Notice of Changes provides details of changes in plan benefits and coverage from one year to the next.
- Medical Care & Services
- Prescription Drug Coverage
- Request for Medicare Prescription Drug Coverage Redetermination
- Download the Request for Medicare Prescription Drug Coverage Determination Form to request an exception.
- Download the Request for Redetermination of Medicare Prescription Drug Denial Form to request a redetermination.
- Appointment of Representative Form
- For instructions on how to use the form to appoint a representative, visit Appointment of Representative Form Instructions.
Your Evidence of Coverage provides details about your Medicare health and prescription drug coverage, explains how to get the care you need, and includes plan conditions and limitations.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. The amount of Extra Help that you can get depends on your income and resources. If you qualify, you will get help paying for your Medicare drug plan's monthly premium and prescription copayments or coinsurance. Your premium generally will be lower if you receive Extra Help from Medicare.
Learn more about Medicare's Extra Help program.
Documents on this page are available in Portable Document Format (PDF). Adobe Reader (free) may be used to open these files.
- Advanced Directives - Information on Advanced Directives including the Living Will and Health Care Surrogate
- Appointment of Representative Form - Assign someone to represent you in accordance with HIPAA regulations using an Appointment of Representative form.
- Appointment of Representative Form Instructions
- Authorization to Disclose Protected Health Information
- Communication Directive Form - Specify who can communicate with your health care team using the Communication Directive Form.
- Request for Medicare Prescription Drug Coverage Determination Form is for member and health care provider use.
- Request for Redetermination of Medicare Prescription Drug Denial Form
- Enrollment Application - 2018 Capital Health Plan Advantage Plus and Capital Health Plan Preferred Advantage.
- Health and Fitness Reimbursement Form
- Medicare Complaint Form - You are now able to submit feedback about your Medicare health plan or other non-urgent issues directly to Medicare using the Medicare Complaint Form.
- The Office of the Medicare Ombudsman - The Office of the Medicare Ombudsman (OMO) helps you with complaints, grievances, and information requests.
A formulary is a list of covered drugs believed to be a necessary part of a quality treatment program. The formulary is selected by Capital Health Plan in consultation with a team of health care providers.
If you get Extra Help from Medicare for your Medicare prescription drug plan costs, your monthly plan premium will be reduced. The amount of Extra Help determines your total monthly plan premium. This table shows you what your monthly plan premium will be if you get Extra Help.
You can access and explore the low-income subsidy chart any time.
You are now able to submit feedback about your Medicare health plan or other non-urgent issues directly to Medicare using the Medicare Complaint Form.
View the Medicare Complaint Form. By clicking on this link you will be leaving the Capital Health Plan Medicare Preferred Advantage (HMO) information.
View the Medicare Event Calendar.
This brochure explains the different Medicare options.
Download the Medicare Made Easy Brochure to explore the different Medicare options.
The services we cover when you are outside our service area or network are care for a medical emergency, urgently needed care, renal dialysis, and care that Capital Health Plan has approved in advance.
A "medical emergency" is when you, or a prudent layperson with an average knowledge of health and medicine, believe that you have medical symptoms that require immediate medical attention to prevent loss of life, loss of a limb, or loss of function of a limb. The medical symptoms may be an illness, injury, severe pain, or a medical condition that is quickly getting worse. Members are covered for medical emergencies anywhere in the world.
If you have a medical emergency:
- Get help as quickly as possible. Call 911 for help or go to the nearest emergency room or hospital. Call for an ambulance if you need it. You do not need to get approval or a referral first from your PCP.
- As soon as possible, make sure that our plan has been notified about your emergency. We need to follow up on your emergency care. You or someone else should call to tell us about your emergency care, usually within 48 hours. Member Services can assist you if you call the number located on your plan membership card.
"Urgently needed care" is a non-emergency, unforeseen medical illness, injury, or condition that requires immediate medical care. Urgently needed care may be furnished by in-network providers or by out-of-network providers when network providers are temporarily unavailable or inaccessible. The unforseen condition could, for example, be an unforeseen flare-up of a known condition that you have. Members are covered for urgently needed care anywhere in the world.
Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.
- Medication Therapy Management Program
- Prescription Drug Transition Process
Sometimes you are taking a drug that is not on our formulary. Please click the link to review the 2018 Prime Medicare Transition Policy. During the time when you are getting a temporary supply of a drug, you should talk with your provider to decide what to do when your temporary supply runs out. You can either switch to a different drug covered by the plan or ask the plan to make an exception for you and cover your current drug. To ask for a temporary supply, call Member Services.
- Part D Exceptions
- Pharmacy Search Tool
- Formulary Search Tool
Privacy Notice - We believe our members have the right to privacy and that their nonpublic personal, financial, and health information should be kept confidential.
For more than thirty-five years, Capital Health Plan has provided comprehensive and affordable health care to our members in our service area. We proudly serve Calhoun, Franklin, Gadsden, Jefferson, Leon, Liberty, and Wakulla counties in Florida.
The Summary of Benefits provides a summary of your plan’s benefits, premium, copayments, and coinsurance information.
- The Office of the Medicare Ombudsman - The Office of the Medicare Ombudsman (OMO) helps you with complaints, grievances, and information requests. By clicking on this link you will be leaving the Capital Health Plan Medicare Preferred Advantage (HMO) information.
Capital Health Plan makes health care decisions to ensure quality treatment and efficient use of resources. View more information about utilization management.