Forms Center

Check here for important information and forms to help direct your care as a Capital Health Plan member.

If you are a Medicare member, click here for Medicare forms.

Fitness Center Reimbursement
(For more information on the reimbursement program or to see a list of facilities offering discounts to CHP members, check our Health & Fitness Section)

General Reimbursement

Protecting your privacy:

Assign someone to represent you in accordance with HIPAA regulations:

Important: These forms are for Capital Health Plan members and enrolled employer groups only. Electronic submission will not be accepted. Members must submit signed forms to their Personnel Office for processing:

Complete and mail the Coordination of Benefits Form to Capital Health Plan within the first 30 days of coverage:

CHP Mailing Address

When indicated, please mail necessary forms to:

Capital Health Plan

P.O. Box 15349

Tallahassee, FL 32317