Medicare 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 Medicare health plan can be a little confusing, which is why we offer these dedicated Medicare 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.
Get the Most Out of Your Plan
CHP Medicare members can explore their plan’s specific summary of benefits, prescription coverage, and drug formulary, as well as additional information and forms.
Capital Health Plan Silver Advantage (HMO)
Capital Health Plan Advantage Plus (HMO)
Capital Health Plan Preferred Advantage (HMO)
- Authorization to Disclose Protected Health Information Form – We require that all requests for medical records to be released must be submitted in writing using this form
- Communication Directive Form – Specify who can communicate with your health care team using the Communication Directive 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.
- These forms can be used to request an exception to your plan’s drug coverage:
- Request for Medicare Prescription Drug Coverage Determination Form is for member and healthcare doctor/provider use.
- Request for Redetermination of Medicare Prescription Drug Denial Form
- Wellness Reimbursement Form
Some Capital Health Plan Medicare members may qualify for extra help. Learn about how you may be eligible for reduced copays, premiums, and cost-sharing; and where you can verify your eligibility through trusted resources.
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
Available Health Care Services
CHP Medicare plan members have access to a variety of health care services, tools, and programs designed to enhance their well-being.
Pharmacies, Medications & Immunizations
Pharmacy Services
Medication Center
Immunizations
Member Privacy Notice
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.
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
Other Resources to Help You
Medicare Rights Center: 1(888) HMO-9050 (toll-free)
Elder Care Locator: 1 (800) 677-1116 (toll-free)
1-800-Medicare (1-800-633-4227)
TTY/TDD 1 (877) 486-2048 24 hours a day, 7 days a week
The Office of the Medicare Ombudsman – The Office of the Medicare Ombudsman (OMO) helps you with complaints, grievances, and information requests.
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
Advanced Directives & Living Wills
Obtain a copy of Five Wishes, an advanced directive document for both medical professionals and your loved ones to understand the end-of-life decisions you want in the event you’re unable to explain them due to a medical emergency. This document will help address all of your needs for advanced care planning and navigating challenging circumstances.
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.
Part D Exceptions
Need to ask us to make an exception to our Part D prescription drug coverage rules? As a CHP member you can ask us to make the following exceptions to our coverage rules such as removing a coverage restriction, limit on your drug, or step therapy requirement.
Learn About Requesting a Formulary Exception
Transition Process
Sometimes you are taking a drug that is not in our formulary and have to obtain a temporary supply of the prescribed medicine. It is in your best interest to learn about the drug transition process and next steps for obtaining your medication.
Request a Temporary Drug Supply
Termination of Coverage
CHP Medicare members have a right to disenroll in their CHP membership. Before considering this, you will need to review information on disenrollment periods, the requirements to process your disenrollment, and what Medicare choices you may be eligible to join upon disenrollment.
Learn About Terminating Your Membership
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.
Member Rights
CHP Members are entitled to certain rights and responsibilities. Click here learn more about member rights and responsibilities.
Frequently Asked Questions
Yes, you are covered for emergency care or urgent care anywhere in the world. However, if you are outside of the United States seek care if necessary. Be sure to keep your receipts for all care, including medications, as you will need to submit them for reimbursement upon your return to the U.S. to the CHP Member Services Department.
Using our online tool, you can locate your prescriptions and associated copayment.
Yes, all care services must be performed by a network physician or facility, unless a prior authorization has been completed in advance, if you are traveling and out of the service area, or in the case of an emergency.
Our compassionate care team offers comprehensive health services designed specifically for seniors, fostering physical, mental, and emotional well-being. Learn more here.
Prefer to talk to a real person?
Speak to our Medicare Member Services team directly by calling (850) 523-7441.
Capital Health Plan Silver Advantage (HMO), Advantage Plus (HMO), Preferred Advantage (HMO), and Retiree Advantage (HMO) are HMO plans with a Medicare contract. Enrollment in Capital Health Plan Silver Advantage, Advantage Plus, Preferred Advantage, and Retiree Advantage depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
If you have questions, please call Member Services at (850) 523-7441 or 1 (877) 247-6512 8:00 a.m. – 8:00 p.m., seven days a week, October 1 – March 31; 8:00 a.m. – 8:00 p.m., Monday – Friday, April 1 – September 30. State of Florida members call 1 (877) 392-1532, 7:00 a.m. – 7:00 p.m. TTY/TTD (850) 383-3534 or 1 (877) 870-8943.