Individual & Family Plan Member Resources
Welcome to Capital Health Plan. As one of Florida’s top-rated health plans, we are committed to providing the highest quality of care and service to our members. Understanding how to get the most out of your Individual and Family health plan can be a little confusing, which is why we offer these dedicated Individual and Family member resources to help you best utilize your health coverage and be aware of the CHP services available to you.
New Member Resources
Are you new to Capital Health Plan? Review our resource page designed for new members, where you can find a new member checklist, resource guide on available CHP services, tools, and programs, and learn about important first steps as a new CHP member.
CHPConnect
The online tools available through CHPConnect provides members with quick access to the health plan information they need.
- Search providers or choose a PCP
- Access benefit documents and claims
- Review referrals and authorizations
- Review lab results and health records
- Request ID cards
Need to Pay Your Premium?
Plan Benefits & Additional Information
CHP members can explore their plan’s specific summary of benefits, prescription coverage, and drug formulary, as well as find additional information and forms.
CHP offers four bronze-level health plans for families and individuals. These plans feature no charge preventive care, screening, and immunization, and a wide range of services to meet your healthcare needs.
CHP offers twenty-two silver-level health plans for families and individuals. These plans feature no charge preventive care, screening, and immunization, and a wide range of services to meet your healthcare needs.
CHP offers four gold-level health plans for families and individuals. These plans feature no charge preventive care, screening, and immunization, and a wide range of services to meet your healthcare needs.
CHP offers four platinum-level health plans for families and individuals. These plans feature no charge preventive care, screening, and immunization, and a wide range of services to meet your healthcare needs.
Available Health Care Services
CHP plan members have access to a variety of health care services, tools, and programs to enhance their well-being.
Pharmacies, Medications & Immunizations
Pharmacy Services
Medication Center
Immunizations
Stay Current With CHP
Serving our communities with key healthcare trends, expert medical perspective, and patient-centered events.
The Latest CHP News
Plan Ahead for Your Healthcare Wishes
Colorectal Cancer Awareness and Prevention
National Nutrition Month
Thyroid Awareness
The Latest CHP Events
Medicare Made Easy
Medicare Made Easy
NMO (3rd Quarter) – Pamela
NMO (3rd Quarter) – Pamela
More Important Information
Table of Contents
Out of Network Coverage
Learn about Capital Health Plan’s out of network coverage for CHP members who may be traveling outside of our service area.
Get Out of Network Care
Away From Home Care
Community Resources
Find information on community resources available for those who need assistance inclusive of food insecurity assistance, mental health services, transportation services, and more.
Referrals & Authorizations
Understand the difference between a referral and an authorization, and how to obtain each one from your primary care physician or specialist for certain services.
Learn About Referrals and Authorizations
Appointment of Representatives Forms & Instructions
Looking to appoint a relative, friend, advocate, attorney, or your physician to act as your representative? CHP members can find and complete a specialized form here.
Download an Appointment Representative Form
Determinations, Grievances & Appeals, and Utilization Management
You have a right to request medical care or services, payment for medical services received, exceptions and redeterminations, and file appeals or grievances, in addition to understanding how Capital Health Plan makes health care decisions.
Member Rights & Privacy Notice
CHP Members are entitled to certain rights and responsibilities. Click here learn more about member rights and responsibilities. Our CHP members have a right to privacy and confidentiality for their nonpublic personal, financial, and health records. To understand how we use your personal information and how we protect your information, please review Capital Health Plan’s Member Privacy Notice.
Health Terms Glossary
Our Health Terms Glossary was created to help you understand exactly what each service, treatment, program, diagnosis, and commonly used medical term means.
Forms
Frequently Asked Questions
CHP Members can view their plan’s Summary of Benefits & Coverage (SBC). An SBC will outline plan details and provide members with copayment and/or coinsurance amounts for services, facilities, therapy options, and testing.
Yes. The open enrollment period is generally November 1 – December 31, and plan changes will be effective on January 1 every year. Each year, CHP adjusts its plan details and premiums and members have the opportunity to change their plan during the open enrollment period.
Yes, prescription drugs are covered for all of CHP’s individual and family plans. Please refer to your specific plan for more information on covered prescription medications.
We know you can’t control when you get sick or injured, but at CHP you do have options when it comes to lowering your health care costs in forms of subsidies, preventive care services, and utilizing a primary care provider (PCP) for improvements to your overall health.
Prefer to talk to a real person?
Get your questions answered. Contact our Member Services team.