Frequently Asked Questions, and Answers, About CHP
General Questions
Q. How does Capital Health Plan work?
A. Capital Health Plan is a health maintenance organization (HMO). We not only insure you against the high cost of medical care, we actually provide medical care through our broad network of physicians and service providers for a small copayment. Members should never see a claim form. We handle all the paperwork and details. Your primary care physician is continuously involved in managing and coordinating your health care.
Q. What benefits are included?
A. Our coverage for you includes preventive care, diagnostic and lab tests, hospital and surgical care, and inpatient and outpatient treatment and emergency care. For details, please go to Benefits or refer to your Capital Health Plan Member Handbook.
Q. How much paperwork and claim forms are involved?
A. Practically none. There are no claim forms. Also, our Member Services representatives are just a phone call away at 383-3311, to answer any questions you may have concerning Capital Health Plan's benefits and policies.
Q. If I have a medical need at a time other than routine office hours, will I have access to a physician?
A. Yes. Your primary care physician (PCP) is either on-call, or has another physician on-call, 24 hours a day, 7 days a week. Also, CHP offers its members an Urgent Care Center. After hours, you call your PCP's office for guidance about the problem. He or she may want you to go to CHP's Urgent Care Center, which is located in the Centerville Road health center. The Urgent Care Center is open weekdays noon-ll p.m., and weekends, 9 a.m. - 8 p.m. (Members whose PCPs are affiliated with Patients First will go to Patients First for after-hours care.)
Q. Am I covered for medical emergencies?
A. Yes. A medical emergency is an accidental injury or the sudden and unexpected onset of a condition requiring immediate medical or surgical care. Some problems are emergencies because if not treated promptly, they might become more serious; examples include deep cuts and broken bones.
Q. How do I handle emergency situations?
A. When a medical emergency occurs inside or outside the service area, go to the nearest medical facility for treatment or call 911. Then contact your primary care physician's office as soon as possible. Capital Health Plan should be notified within two working days. Your PCP will authorize medically necessary hospitalizations and provide or arrange any needed follow-up care within the CHP network.
Q. Does Capital Health Plan provide coverage when a member is living away from home?
A. You are covered for emergency care (as defined above) 24 hours a day, every day, anywhere in the world.
Also, CHP's popular Away from Home Care® Program allows any commercial employer group member to have coverage when living temporarily outside of our service area for at least 90 consecutive days (a covered dependent going to college, for example). These CHP members may become guest members of any participating HMO in the BluesCONNECT® network. This network is the nation's largest, including health plans in over 200 cities.