Forms
Documents on this page are available in Portable Document Format (PDF). Adobe Reader (free) may be used to open these files.
CHP Retiree Advantage (HMO)
Determinations, Grievances & Appeals
For instructions on how to use the form to appoint a representative, visit Appointment of Representative Form Instructions.
Appointment of Representative Instructions & Form
Formulary
A formulary is a list of covered drugs believed to be a necessary part of a quality treatment program. The CHP Retiree Advantage Formulary was selected by CHP in consultation with a team of health care providers. You can also use our online formulary search tool.
Evidence of Coverage
Your 2025 CHP Retiree Advantage (HMO) Evidence of Coverage provides details about your Medicare health and prescription drug coverage, explains how to get the care you need, and includes plan conditions and limitations.
Annual Notice of Changes
The 2025 Retiree Advantage Annual Notice of Changes (ANOC) provides details of changed in plan benefits and coverage from one year to the next.
Enrollment
To enroll in CHP Retiree Advantage, you will need to download and complete the CHP Retiree Advantage Enrollment Application. Please return the completed enrollment application to your employer or former employer’s benefits department, unless you are with the State of Florida. State of Florida retirees should send their enrollment application directly to Capital Health Plan.
Enroll anytime within 90 days before the effective date.
Summary of Benefits
The Retiree Advantage Summary of Benefits provides a summary of your plan’s benefits, premium, copayments, and coinsurance information.
Prescription Drug Coverage
Sometimes you are taking a drug that is not on our formulary, and if that is the circumstance please review the Medicare Transition Policy for additional information. During the time when you are receiving a temporary supply of a drug, you should talk with your provider to decide what to do when your temporary supply runs out.
Utilization Management
Capital Health Plan makes health care decisions to ensure quality treatment and efficient use of resources. View more information about utilization management.