Retiree Annual Open Enrollment (2012)
Information
Health Care Premiums for BCBS/CHP
Health Care Premiums for BCBS/CHP (with Rates for Overage Dependents)
CHP Schedule of Benefits
CHP Medicare Schedule of Benefits for Retiree Advantage
CHP Prescription Program (PDF)
BCBS Schedule of Benefits
BCBS Prescription Program
2012 Annual Open Enrollment for Retirees
| Change You Wish To Make | Forms Required |
|---|---|
| Changing plan from Capital Health Plan to Blue Cross Blue Shield |
CHP Status Change Form BCBS Enrollment Form |
| Changing plan from Blue Cross Blue Shield to Capital Health Plan |
BCBS Status Change Form CHP Enrollment Form |
| Changing plan from Capital Health Plan Medicare to Blue Cross Blue Shield Medicare |
CHP Status Change Form BCBS Enrollment Form |
| Changing plan from Blue Cross Blue Shield Medicare to Capital Health Plan Medicare |
BCBS Status Change Form CHP Enrollment Form CHP Medicare Enrollment Form |
Adding or Deleting dependent from |
BCBS Status Change Form |
Adding or Deleting dependent from |
CHP Status Change Form |
| Domestic Partner on Blue Cross Blue Shield/Capital Health Plan | Domestic Partnership For Retirees Affidavit |
Changing plan or decreasing coverage on |
CompBenefits Change Request Form |