Forms Center
Welcome to the Capital Health Plan Forms Center! You will find important information and downloadable forms to help direct your care as a Capital Health Plan member.
Documents for download are available in Portable Document Format (PDF). Adobe Reader (free) may be used to open these files.
Appointed Representative Form
Assign someone to represent you according to HIPPA regulations.
Coordination of Benefits Form
The process of accurately coordinating benefits between more than one insurance plan enables Capital Health Plan to ensure that claims are processed in both a timely and efficient manner. Download your Coordination of Benefits Questionnaire.
Enrollment Forms
Need to enroll in Capital Health Plan or update your address? Download your Enrollment form(s) here.
LabCorp & Pharmacy
In need of laboratory services and wish to use a LabCorp facility? Trying to locate a drug recall? Look no further.
Medicare Member Forms
Are you a Capital Health Plan Medicare member?
Privacy Forms
At times, you may wish to disclose Personal Health Information to certain individuals. Let Capital Health Plan know who you wish to share your personal health information with by downloading our privacy form(s).
Reimbursement Forms
Submit your reimbursement request to Capital Health Plan. Download your form(s) today!