Retiree Advantage - More Information & Forms

Medicare Made Easy

This brochure explains the different Medicare options. 

Download the Medicare Made Easy Brochure to explore the different Medicare options.

Forms

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) information.

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) information.

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 doctor/providers or by out-of-network doctor/providers when network doctor/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.

Privacy Notice

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

Prescription Drug Coverage

Appointment of a Representative Instructions and Form

Determinations, Grievances, and Appeals

Utilization Management

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