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County Health Pool - Frequently Asked Questions

Medical Summary Documents

2011 Plan A Benefit Summary
2011 Plan B500 Benefit Summary
2011 Plan B1000 Benefit Summary
2011 Plan HSA HDHP Benefit Summary

2012 Plan A Benefit Summary
2012 Plan B500 Benefit Summary
2012 Plan B1000 Benefit Summary
2012 Plan B1500 Benefit Summary
2012 Plan B2000 Benefit Summary
2012 Plan HSA HDHP Benefit Summary

Medical Plan Documents

2011 Plan A SPD
2011 Plan B500 SPD
2011 Plan B1000 SPD
2011 Plan HDHP SPD

2012 Plan A SPD
2012 Plan B500 SPD
2012 Plan B1000 SPD
2012 Plan B1500 SPD
2012 Plan B2000 SPD
2012 Plan HDHP B2500 SPD

Medical Documents & Forms

Medical Claim Form
CDL Physical Claim Form
Health Fair Claim Form
Flu Shot Claim Form

Dental &Vision Documents & Forms

2011 Dental Plan A Summary
2011 Dental Plan B Summary
2011 Dental Comparison Summary

2012 Dental Plan A Summary
2012 Dental Plan B Summary
2012 Dental Comparison Summary

2011 Dental Plan A SPD
2011 Dental Plan B SPD

2012 Dental Plan A SPD
2012 Dental Plan B SPD

2011 Vision Benefit Summary
2011 Vision Plan SPD

2012 Vision Benefit Summary
2012 Vision Plan SPD

VSP Out-Of-Network Reimbursement Form

Attending Dentist Statement Form

Dental Claim Form for Medical Procedures

Prescription Forms

Prescription Drug Claim Form
Prescription Drug Mail Order Form
Prescription Drug Mail Order Educational Flyer

Other Documents

CHP HIPAA Privacy Notice
"Who to Call" Reference Sheet