Medicare

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877-247-6512
850-523-7441
850-383-3534 (TTY)
1-800-955-8771 (TTY)

Call us seven days a week
8 a.m. - 8 p.m.

2140 Centerville Pl
1491 Governor's Square Blvd
1545 Raymond Diehl Rd
Tallahassee

Mailing address:
Post Office Box 15349
Tallahassee FL 32317-5349

Capital Health Plan is a health plan with a Medicare contract. The contract is renewed annually and the availability of coverage beyond the current year is not guaranteed.

Benefits, formulary, pharmacy, network premium and/or copayments/coinsurance may change on January 1, 2011. Please contact Capital Health Plan for details.

To ensure that beneficiaries receive appropriate care, Capital Health Plan will follow policies and procedures as directed by CMS (Centers for Medicare and Medicaid Services) in the event of an emergency situation designated by the Department of Health and Human Services.

This page was last updated on: October 29, 2009.

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Additional Copayments/Coinsurance

Below are additional medical copayments for the CHP Advantage Plus (HMO) and CHP Preferred Advantage (HMO) plans. For a complete list see the Summary of Benefits.

Service

Copayment/Coinsurance

Ambulance

 

$100 per service

 

Out-Patient/Ambulatory Surgery

 

$100 per visit

 

Diagnostic CT/MRI/PET/Thalium Scans

 

$100 per scan

 

Other Lab/X-ray

 

$0 - $100 per service

 

Home Health

 

$0

 

Durable Medical Equipment

 

20% per device

 

Radiation Therapy

 

20% of the cost

 

Hearing Testing

 

$25 per test

 

Skilled Nursing Facility

 

$0 per day - days 1-6
$75 per day - days 7-100

 

Chiropractic

 

$15 per visit

 

Podiatry

 

$15 per visit

 

Diabetic supplies

 

20% of the cost

 

$3,400 annual out-of-pocket limit. (Excludes out-patient prescription drugs)