New Member Checklist
Welcome to Capital Health Plan (CHP). We are proud to offer you comprehensive health care services and access to the highest quality of treatment from our extensive provider and facility network. Below you will find important steps for new CHP members to take to maximize the use of their health plan. You can print this webpage to make a physical checklist.
Sign Up For CHPConnect
- Capital Health Plan offers our members the opportunity to access their CHP medical history, review and download benefit documents, request new ID cards, and to select a new PCP.
- After signing up for CHPConnect, you will be able to view your CHP benefit documents via CHPConnect with 24/7 access. You may also contact your benefit administrator or by calling CHP Member Services to request your documents to be mailed to you.
Member ID Issuance
You should receive your Member ID card within 10 business days of CHP’s receipt of a complete and accurate enrollment application.
You may print a temporary Member ID card from the CHPConnect portal or contact CHP Member Services to request your Member ID number to receive care prior to the arrival of your Member ID card in the mail. Additionally, you can provide your name and date of birth to your Provider and they can contact CHP to verify eligibility and copayment information on your behalf.
If you lose your Member ID card, you can request a new ID card via the CHPConnect portal or call (850) 383-3311 to speak to CHP’s Member Services Team.
Select Your Primary Care Physician
Choose a Primary Care Physician (PCP) for yourself and/or your dependents, Your PCP is your health care partner and central coordinator for your health care needs.
On the capitalhealth.com website, you will select the Find a Provider/Facility tool, this will bring you to the provider directory where you can see in-network providers. Follow the below steps:
- View our Doctor/Provider Directory.
- On the Doctor/Provider Directory, use the drop-down menu in the category labeled Accepting New Patients and select Yes.
- Next, use the drop-down menu in the category labeled Primary Care Physicians and select Yes.
- Click on the green Apply button.
- Review the list of PCPs accepting new patients and choose the one you would like to have as your primary care physician.
For added convenience, you may be interested in selecting a CHP member-exclusive PCP from the Physician Group of Capital Health Plan. These providers provide comprehensive care from one of our three health centers.
You can also call CHP’s Member Services Team at (850) 383-3311 to see if the doctor you are seeking information on is accepting new patients. In some cases, a doctor may not be taking new patients, and you may have to make another choice.
You can also request a hard copy of our provider directory from our Member Services Team.
Transferring Your Medical Records
If you are selecting a new physician for yourself and/or your dependents, you will need to transfer all records to your new physician’s office. Please check with your previous physician’s office to obtain their policies and procedures on how to transfer your medical records to your new physician.
How to Obtain Specialty Care
CHP members have direct access to a network of specialists for office visits and consultations. Your PCP should be able to assist you for other services that may require a referral or prior authorization such as cardiology or behavior health.
View our Doctor/Provider Directory to locate a specialist or specialty practitioner in the CHP network.
How to Obtain After-Hours Care
- For after-hours care or if your physician is not available, please contact one of the Urgent Care centers in the CHP network.
- View our Facility Directory to find an Urgent Care location. Use the facility type drop-down menu and select Urgent Care to find the nearest urgent care facility to you.
- You may utilize the telehealth services available via Amwell.
- You may call CHP’s 24/7 Health Information Line for non-emergency situations.
- For emergencies, please call 911 or go to the nearest Emergency Room.
Coordination of Benefits Document
The process of accurately coordinating benefits between more than one insurance plan enables CHP to ensure that claims are processed in both a timely and efficient manner. We ask that you please complete the Coordination of Benefits Questionnaire within the first 30 days of receiving your CHP coverage. You can obtain a copy of this document by contacting your benefit administrator or by calling CHP Member Services.
Seeking Language Assistance?
For any member in need of language assistance, please contact CHP Member Services. A member services representative can connect you with a no-cost contracted translation interpreter to communicate by telephone, known as our Language Services program. Members requiring language assistance at one of our three health centers should notify the receptionist upon scheduling their appointment and assistance will be provided.
Understanding Copayments, Deductibles, and Coinsurance
Copayments
A copayment is a set amount you must pay when you get certain covered services. There are different types of copayments, and here’s how they work:
- If the allowed amount or the provider’s actual charge for a covered service is less than your copayment, you will pay the lower amount.
- Copayments must be paid at the time you receive the services, apply before any payment will be made by us, apply regardless of the reason for the service, and usually apply to all services rendered during the visit. However, there are exceptions to this rule, so be sure to check your Schedule of Benefits and the brief explanations below.
Example:
Anne goes to see her PCP because she feels dizzy when she works out. To see her doctor, she needs to pay a $25 copay. When Anne gets to the office, she hands the receptionist the $25. After her visit, her doctor sends her to a heart specialist. When Anne sees the cardiologist, she will have to pay her specialist copayment which is a $40 copay for that appointment, according to her insurance plan.
You can check your CHP member ID card for a list of copays for different types of visits.
Deductible
A deductible is the amount of money you owe for covered health care services before your CHP health insurance begins to pay for healthcare services. Throughout the year of your plan, your payments add up until you reach your deductible.
Example:
David has a High Deductible plan with a deductible of $1,000, meaning CHP won’t pay anything until he spends that amount on covered health care. He recently visited a specialist and had some tests that cost him $612. Now, he only needs to spend $388 more to meet his deductible.
Coinsurance
Coinsurance is the part of the cost you pay for a covered health care service. It is usually a percentage of the total amount allowed for that service.
Example:
Beth’s CHP plan requires a 20% coinsurance for non-admission Emergency Room visits.
Reminder: You can access your CHP benefit documents anytime, by scanning the QR code found on the back of your CHP ID card or through CHPConnect.
To learn more about these topics or if you have questions about your benefits and coverage, contact Capital Health Plan Member Services at 1 (850) 383-3311 from 8:00 a.m. – 5:00 p.m., Monday – Friday.
Medicare members can call 1 (850) 523-7441 or 1 (877) 247-6512 from 8:00 a.m. – 8:00 p.m., seven days a week.
State of Florida members can call 1 (877) 392-1532 from 7:00 a.m. – 7:00 p.m., Monday – Friday.