CHP Retiree Advantage (HMO) for State of Florida Members

Capital Health Plan Retiree Advantage (HMO) is offered by the State of Florida to their Medicare-eligible retirees and Medicare-eligible dependents of retirees allowing members to continue to participate in their State of Florida-sponsored health plan after retirement and becoming Medicare eligible.  To be eligible, you must be entitled to Medicare Part A, enrolled in Medicare Part B, and live in the Capital Health Plan service.  Retiree 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 and Schedule of Copayments, attend a seminar, or call our office to talk to one of our experienced representatives to learn more.

Advanced Directives and Living Wills

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.

 

Annual Notice of Changes

The Annual Notice of Changes provides details of changes in plan benefits and coverage from one year to the next.

Download the 2018 CHP Retiree Advantage Annual Notice of Changes

Appointment of Representative Instructions and Form

Determinations, Grievances, and Appeals

Directories

Enrollment

Evidence of Coverage

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.

Download the 2018 CHP Retiree Advantage for State of Florida Members Evidence of Coverage

Extra Help from Medicare

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.

Forms

Documents on this page are available in Portable Document Format (PDF). Adobe Reader (free) may be used to open these files.

Formulary

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.

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. 

View the Medicare Complaint Form. By clicking on this link you will be leaving the Capital Health Plan Medicare Retiree Advantage (HMO) for State of Florida information. 

Medicare Event Calendar

View the Medicare Event Calendar.

Medicare Made Easy

This brochure explains the different Medicare options. 

You can download the Medicare Made Easy Brochure to explore the different Medicare options.

Out-of-Network Coverage

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.

Plan Ratings

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.

Download our Plan Ratings

Prescription Drug Coverage

Privacy Notice

  • Privacy Notice - We believe our members have the right to privacy and that their nonpublic personal, financial, and health information should be kept confidential.

Schedule of Copayments

Click on your 2018 Schedule of Copayments for copayment information:

    Service Area

    CHP Service area map graphic

    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.

    Summary of Benefits

    The Summary of Benefits provides a summary of your plan’s benefits, premium, and cost-sharing information.

    Download the 2018 State of Florida Retiree Advantage Summary of Benefits 

    The Office of the Medicare Ombudsman

    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 Retiree Advantage (HMO) for State of Florida information.

    Utilization Management

    Capital Health Plan makes health care decisions to ensure quality treatment and efficient use of resources. View more information about utilization management.