Select Your Primary Care Physician (PCP)
- Choose a PCP for yourself and/or your dependents, Your PCP is your health care partner and central coordinator for your health care needs. Learn how easy it is to select a PCP by clicking here.
- For added convenience, you may be interested in selecting a PCP from the Physician Group of Capital Health Plan at one of our three health centers.
How To Obtain Specialty Care
- 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.
- View our Doctor/Provider Directory to locate a specialist by choosing from the Doctor or Provider Speciality drop-down menu.
How To Obtain After-Hours Care
- For after-hours care or if you physician is not available, please contact one of the Urgent Care centers in the CHP network.
- You may utilize the telehealth services available via Amwell, if it is a covered benefit.
- For emergencies, please call 911 or go to the nearest Emergency Room.
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.
CHPConnect
- Capital Health Plan (CHP) 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.
- Review your CHP benefit documents via CHPConnect for 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.
- Learn more about CHPConnect by clicking here.
About Your Care
- Learn about your care as a CHP member by clicking here.
About Your Medications
- CHP utilizes a national pharmacy network to administer our pharmacy benefits. Each covered prescription drug, when purchased from a participating pharmacy, is subject to a copayment amount. Not all plans include prescription drug coverage, so please consult your benefit documents for more information.
- Learn more about your pharmacy benefit by clicking here.
Laboratory Services
- CHP offers laboratory services through LabCorp’s national network. To find a local LabCorp click here.
Benefit Documents
- Review your CHP benefit documents via CHPConnect for 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.
- You may also find your Summary of Benefits & Coverage (SBC) CHPConnect for 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.
Submitting Claims
- Your doctor or provider will submit claims for covered services on your behalf, but you must present your CHP ID card. You can view your claim information via CHPConnect for 24/7 access or may call CHP Member Services.
Submitting a Complaint or Appeal
- To submit a complaint or appeal, please contact CHP Member Services. You may also refer to your Member Handbook for more details on the complaint, greivance and appeal process.
Your Rights & Privacy
- Understand your rights and privacy as a CHP member by clicking here.
Coordination of Benefits
- 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 your CHP coverage. You can obtain a copy of this document by contacting your benefit administrator or by calling CHP Member Services.
Language Assistance
- For any member or prospective member in need of language assistance, should contact CHP Member Services. A member services representative can connect with an interpreter to communicate by telephone.
- Members requiring language assistance at one of our three health centers should notify the receptionist upon scheduling their appointment and assistance will be provided.
Utilization Management
- To better understand how CHP makes health care decisions, along with evaluating new technology to ensure quality treatment and efficient use of resources, click here.