Medicare

This section gives information on what to do if you need to ask us to make an exception to our Part D prescription drug coverage rules.

**You cannot request coverage for a prescription drug that does not meet the definition of a Part D drug. There are a few specific drugs that your Medicare plan cannot cover.**

You may appoint a relative, friend, advocate, attorney, or your physician to act as your representative. A representative who is appointed by the court or who is active in accordance with State law may also file an appeal or grievance for you. To appoint a representative you must complete an Appointment of Representative Form.

This section describes your rights to request coverage of medical care or services, or payment for medical services that you already have received. You also may make a complaint about your medical benefits and coverage.

Don’t worry, you’re covered with Capital Health Plan! Out of network coverage consists of the services Capital Health Plan (CHP) covers when you are outside of our service area or network of care for a medical emergency, urgently needed care, renal dialysis (while you are temporarily out of the service area), and/or care that we have approved in advance.