CHP+ Health Insurance in Colorado

 

Child Health Plan Plus (CHP+) is a public low-cost health insurance plan for certain children. It is for people who earn too much to qualify for Health First Colorado (Colorado’s Medicaid Program), but not enough to pay for private health insurance.

Who Qualifies for CHP+?

  • Children age 18 and under and pregnant women age 19 and over.
  • Applicants with household income under 260% of the Federal Poverty Level (FPL). See CHP+ Income Chart for details.
  • Colorado Residents
  • Lawfully residing children and pregnant women with no five year waiting period
  • Applicants not eligible for Health First Colorado
  • Applicants who do not have other health insurance

CHP+ is administered by the State of Colorado’s Department of Health Care Policy and Financing. Children who are approved for CHP+ must enroll with a managed care organizations in order to access benefits of the program.

Friday Health Plans is a Managed Care Organization contracted to provide CHP+ services. Children who live in Alamosa, Baca, Bent, Chaffee, Cheyenne, Conejos, Costilla, Crowley, Custer, Fremont, Huerfano, Kiowa, Kit Carson, Las Animas, Mineral, Otero, Prowers, Rio Grande, Saguache, Washington, and Yuma counties can enroll with Friday Health Plans of Colorado as their managed care organization.

Here are some tools to help you decide if we’re the right health plan for you, and to provide support if you are already a Friday Health Plans member or acting as the Designated Client Representative for a member.

CHP+ BENEFITS Plan and Benefit Information

As a member, you are able to access and get the care you need.

CHP+ COVERS:

  • Primary Care – Doctor Visits
  • Emergency and Urgent Care
  • Hospital Services-Inpatient hospital services
  • Immunizations
  • Mental/Behavioral Health Care
  • Prescriptions
  • Specialist visits

CHP+ Member Handbook

  • The CHP+ Member Handbook is a comprehensive guide that explains how to access the services and programs available to you through Friday Health Plans of Colorado. You can find information about Getting Care, Process for Getting Covered Services, Your Friday Health Plans of Colorado Benefits and Services, and more, in the CHP+ Member Handbook.

Click here to download the CHP+ Member Handbook in PDF format. To view the CHP+ Member Handbook document, you will need to have Adobe Acrobat Reader installed on your system. Click on the following link to download Acrobat Reader. http://www.adobe.com/products/reader.html.

CHP+ Summary of Benefits

  • The CHP+ Summary of Benefits is a guide to the major categories of health services that are covered benefits under your Friday Health Plans of Colorado Plan. It also lists any financial responsibility, such as copays, coinsurance, or deductibles, you may have when receiving these services.

To view the Summary of Benefits document, you will need to have Adobe Acrobat Reader installed on your system. Click on the following link to download Acrobat Reader http://www.adobe.com/products/reader.html.

Pharmacy

At Friday Health Plans, we want to make sure you get the prescription medications you need and that you as the member know the list of medications covered by your plan. The CHP+ Formulary provides you with a list of prescription drugs that are covered. If there is not a medication on the formulary, it is not covered by your plan. Please call our customer service department at 719-589-3696 or 1-800-475-8466. (TTY: 1-800-659- 2656) if you would like a Member Handbook or Formulary mailed to you, or you can request a hard copy by email at questions@fridayhealthplans.com.

 

Become a Member

Become a Child Health Plan Plus (CHP+) offered by Friday Health Plans of Colorado Member.

Once you are approved for CHP+ you will get auto-assigned to the State Managed Care Network. You will then receive a letter from the State telling you to select an HMO. If you do not select an HMO you will get auto-assigned to an HMO. This assignment will be made based on where you live. If you don’t get assigned to Friday Health Plans and you want to be on our plan, you can change your health plan. You have to change your plan within 90 days of when you are first approved for CHP+. You will need to call 1-800-359-1991 to change your plan.

How to Find a Doctor

CHP+ Provider Directory

  • Friday Health Plans of Colorado works hard to keep information on providers updated and accurate for our Members. However due to changes throughout the Colorado provider community we cannot guarantee the accuracy of this directory. The CHP+ Provider Directory is a comprehensive listing of the providers available to you in the Friday Health Plans network. The directory includes a listing of doctors & specialists, locations, telephone numbers, additional languages some providers have available, and what specialty, if any, per provider. Friday Health Plans specializes in serving rural and underserved counties in south central Colorado and on the eastern plains. We make every effort to contract with every facility and every provider located in the communities we serve.
  • Click here to download the CHP+ Provider Directory in PDF format. To view the CHP+ Provider Directory 2020 document, you will need to have Adobe Acrobat Reader installed on your system. Click on the following link to download Acrobat Reader http://www.adobe.com/products/reader.html.
  • To look up a specific provider, find a provider close to your home, or obtain a current copy of the provider directory customized to you, please log in to your Member portal. (You must be a member of Friday Health Plans of Colorado to obtain a Member portal account).

Please call our customer service department at 719-589-3696 or 1-800-475-8466. (TTY: 1-800-659- 2656) if you would like a Member Handbook mailed to you, or you can request a hard copy by email at questions@fridayhealthplans.com.

Selecting or Changing a Primary Care Provider (PCP)

  • As a Friday Health Plans Member, you must pick a Primary Care Provider (PCP) from our PCP Provider Directory that lists our Participating PCPs. You can choose a PCP for each child enrolled. Your child’s PCP will provide medical care and help coordinate his or her care. A PCP can be one of the following types of providers:
    • Family and General Practice – usually can see the whole family
    • Internal Medicine – usually sees only adults and children 14 years or older
    • Pediatrician – sees children from newborn to age 18 or 21

You may exercise freedom of choice among network providers. If you do not choose a PCP when you join Friday Health Plans of Colorado, we will choose one for you. We will send you a letter telling you your child’s PCP’s name and address. Remember, you can request to change your child’s PCP at any time. Please call Customer Service at 719-589-3696, or 1-800-475-8466, if you want to select or change your child’s PCP.

CHP+ Member Rights

Each Member Has The Right To:

  • Receive information regarding terms and conditions of your health care benefits in a way that works for you.
  • Obtain complete information from a provider regarding your diagnosis, treatment and prognosis, in terms you can reasonably understand and appropriate to member’s condition.
  • Receive quality healthcare services in a timely manner and in a medically appropriate setting, taking into consideration the requirements for access, coverage, and coordination of medically necessary services.
  • Expect that your personal health information will be maintained in a private and confidential manner.
  • Receive information about your rights and responsibilities as a Friday Health Plans of Colorado member and to exercise those rights without any adverse effect on the way you are treated.
  • Be treated with respect and due consideration for your dignity and privacy.
  • Receive information about Friday Health Plans of Colorado, its programs, services, PCPs, and Providers.
  • Receive medically necessary covered services without regard to race, religion, age, gender, national origin, disability, sexual identity or orientation, family composition or size, medical condition or stage of illness.
  • Choose or change a primary care provider (PCP) within the Friday Health Plans of Colorado Network.
  • Make recommendations about Friday Health Plans of Colorado’s Member rights and responsibilities policies.
  • Talk with your PCP and receive information about your medical condition and the appropriate medically necessary treatment options available and any alternatives, regardless of the cost or what your benefits are. This information should be presented in a manner appropriate to the member’s condition and ability to understand.
  • Decide about your care, including the decision to stop treatment or services, stop participating in health management programs. To request or refuse treatment to the extent of the law and to know what the outcomes may be and the right to a second opinion.
  • To instruct your providers about your wishes, related to advance directives (such issues as durable power of attorney, living will or organ donation). To then receive information concerning the implementation of Advance Directives, including a clear and precise statement of limitation if the Provider cannot implement an Advance Directive on the basis of conscience.
  • Express concerns and complaints to Friday Health Plans of Colorado about the care and services provided and to have Friday Health Plans of Colorado investigate and take appropriate action without fear of reprisal.
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
  • To obtain family planning services directly from any provider, with a referral, that is duly licensed or certified to provide such services, without regard to enrollment in a Primary Care Case Management (PCCM), Managed Care Organization (MCO), or Prepaid Inpatient Health Plan (PIHP), without referral.
  • Request and receive a copy of your medical records and request that they may be amended or corrected.
  • To disenroll from Friday Health Plans of Colorado and enroll in any other HMO available in your location upon renewal of your CHP+ benefits.
  • Be free to exercise you rights, and that exercising those rights will not adversely affect the way Friday Health Plans of Colorado or its providers treat you.

Advance Medical Directive

Advance Medical Directives provide a way for members to make their wishes known regarding care and treatment decisions in case a member becomes incapacitated and is unable to do so.

Advance Medical directives:

  • Protect your right to make medical decisions and choices about your healthcare
  • Help family members make decisions if you cannot
  • Help your doctors by telling them your wishes

There are 3 kinds of Advance Medical Directives:

  • Living Will: A living will tells your doctor whether to use artificial life support if you become “terminally ill” (deathly sick). Copies of living will forms are at the healthcare facilities, doctors’ offices or office supply stores.
  • Medical Durable Power of Attorney (also called a “Health Care Proxy”): A “medical durable power of attorney” is a person you choose to make healthcare choices for you if you cannot speak for yourself.
  • Cardiopulmonary Resuscitation (CPR): Directive CPR is performed to get someone’s heart and /or breathing started again. If you have a “CPR Directive”, medical staff will not try to get your hear or breathing started.

You will get more information on advance medical directive if you are admitted to a hospital. Please understand that you are not required to have an advance directive in order to receive care, treatment or for admission to a facility. If you decide to have or change an advance medical directive, it is important to talk to your doctor, family and other people about your choices. Give copies of your Advance Medical Directive to your doctor, family members, and healthcare proxy if you have one.

If you have prepared and signed an advance directive, it will represent your wishes if you become unable to make health care decisions for yourself. These documents do not take away your right to decide what you want, if you are able to do so at the time a decision is needed.

If you have an advance directive and your doctor didn’t follow it, you can file a grievance.

  • You can file a grievance with Friday Health Plans of Colorado by calling 719-589-3696, toll free 1-800475-8466 or TTY at 1-800-659-2656. Please see the Grievances and Appeals Section VI for more information.
  • You can also write to: Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, CO 802456-1530 1-800-886-7689

Member Confidentiality

Friday Health Plans of Colorado will keep your medical information confidential. This includes any medical records, computer data, reports, or records about you or your health care. You have the right to keep your medical information and records confidential, unless you say differently. You also have the right to review, request corrections to, and receive a copy of your medical records or protected health information. Contact Customer Service at 1-800-475-8466 or 719-589-3696 for assistance.

Some of the things Friday Health Plans of Colorado does to keep your information private:

  • Friday Health Plans of Colorado Providers and their staff are required to treat your medical records and personal information with care and privacy.
  • Friday Health Plans of Colorado will only release member and eligibility information to contracted providers after that provider has given positive identification.
  • Friday Health Plans of Colorado will not reveal confidential member’s information except for member treatment, payments, or health care operations. Every precaution is taken so that information transmitted is handled in a confidential manner. Transfer of such information is allowable under current regulations.
  • Friday Health Plans of Colorado will not disclose confidential information that is not used for treatment, payment, or health care operations without your full authorization.
  • Friday Health Plans of Colorado will keep your confidential information private within Friday Health Plans of Colorado because only certain employees are permitted to have access to your confidential information.
  • You have the right to access your confidential medical information. Friday Health Plans of Colorado will provide you with access and an accounting of disclosures upon request. You also have the right to amend your confidential medical information and request restrictions on the use and disclosure of your confidential medical information
  • Friday Health Plans of Colorado takes its commitment to confidentiality seriously and has policies in place that protect your confidential information secure from oral, written, or electronic disclosure.

You have the right to report any incident that you believe results in an unauthorized disclosure of confidential information. You should report the incident to Friday Health Plans of Colorado’s Privacy Officer by calling 1-800-475-8466 or 719-589-3696.

Please refer to your HIPAA Notice of Privacy Practices included in your Welcome Packet for further information regarding Friday Health Plans of Colorado’s Privacy Practices, or call Customer Service at 1-800-475-8466 or 719-589-3696 for a copy of the HIPAA Notice of Privacy Practice.

Grievances and Appeals

Please let us know if you are not happy with Friday Health Plans of Colorado, your providers, your services, or any decisions that are made about your treatment.

  • You have the right to express a concern (grievance) about anything you are not happy with.
  • You also have a right to appeal. This means you can ask for a review of a Friday Health Plans of Colorado CHP+ action or decision about what services you get.
  • Call our Grievance and Appeal Department at 719-589-3696, toll free 1-800-475-8466 or TTY for the deaf or hard of hearing at 1-800-659-2656.

You will not lose your Friday Health Plans of Colorado CHP+ benefits if you express a concern, file a grievance or an appeal. It is the law.

Grievances

If you are not happy with something, other than a medical service decision, you can file a grievance (an oral or written expression of dissatisfaction about any matter other than an Adverse Benefit Determination, including but not limited to qualify of care or services provided and aspects of interpersonal relationships such as rudeness of provider or employee, or failure to respect eh Member’s rights) with Friday Health Plans of Colorado. A grievance can be about anything other than a decision by Friday Health Plans of Colorado CHP+ to deny, limit or change a service that you or your provider requested. This is your right. You do not need to worry that you will be treated badly for filing a grievance. We want to make sure that you are treated fairly and receive the best serve possible. This is one way you can stand up for yourself and your rights. It also helps us make our programs and services better for you and others.

Examples of Grievances might include:

  • The receptionist was rude to you.
  • Your provider would not let you look at your health records.
  • You could not get an appointment when you needed one.

How do I file a grievance?

  • You or your DCR can call or write Friday Health Plans of Colorado CHP+ Customer Service Department. You should do this within 30 days from when the problem happened. Be sure to include your name, Member ID number, State identification (ID) number, address, and phone number.

Friday Health Plans of Colorado Grievance and Appeals Department 700 Main Street, Suite 100 Alamosa, Colorado 81101 Phone: 719-589-3696, toll free 1-800-475-8466, TTY 1-800-659-2656

Appeals

You have the right to file an appeal with Friday Health Plans of Colorado. An appeal is a request for review of an Adverse Benefit Determination. If Friday Health Plans of Colorado CHP+ takes an action, you and your provider will get a Notice of Action (Adverse Benefit Determination) letter that tells you why. This Notice of Action Letter (Adverse Benefit Determination will explain how to appeal if you want to.

How do I File an Appeal?

You have the right to file an appeal with Friday Health Plans of Friday Health Plans of Colorado. You or your DCR can call or write Friday Health Plans of Colorado CHP+ Customer Service Department. You should do this within 60 days from when the problem happened. Be sure to include your name, Member ID number, State identification (ID) number, address, and phone number.

Friday Health Plans of Colorado
Grievance and Appeals Department
700 Main Street, Suite 100
Alamosa, Colorado 81101
Phone: (719) 589-3696, toll free 1-800-475-8466, TTY 1-800-659-2656

For a more in-depth review of the grievances and appeals process, please review Section VI. Of the Member Handbook.

Resources

Forms and Additional Resources

Additional Resources

  • CHP+ Customer Service: 1-800-359-1991
  • CHP+ website: www.cchp.org
  • Health Colorado: 303-839-2120 or 1-888-367-6557 (selecting an HMO)

Frequently Asked Questions

Who do I contact if I have questions about my eligibility for the CHP+ program?

  • Call CHP+ Customer Service at 1-800-359-1991
  • Visit CHP+ website @ www.cchp.org

Who do I call if I have questions about my CHP+ benefits?

  • Contact Friday Health Plans of Colorado at 719-589-3696, if calling from within the San Luis Valley, or 1-800-475-8466, if calling from outside the valley, so we can help you understand the programs and services available to you as a Friday Health Plans member.

What if I need a new member identification card?

  • Contact Friday Health Plans of Colorado at 719-589-3696 if calling within the San Luis Valley, or 1-800-475-8466, if calling from outside the valley, so we can send you a new member ID card.

How do I select a PCP?

  • Please call Customer Service at 719-589-3696, if calling from within the San Luis Valley, or 1-800-475-8466, if calling from outside the valley.

What if I get a bill from the doctor?

  • Contact Friday Health Plans of Colorado at 719-589-3696 if calling from within the San Luis Valley, or 1-800-475-8466, if calling from outside the valley, so we can help you determine benefits and understand your medical claims

Who do I call if I want to choose a different managed care organization?

  • Contact Health Colorado at 1-800-359-1991

How to Contact Us:

  • Telephone: 719-589-3696 or 1-800-475-8466
  • TTY: 1-800-659-2656
  • Fax: 719-589-4901
  • Address: 700 Main Street, Suite 100 Alamosa, CO 81101
  • Hours: 8:00 a.m. – 5:00 p.m., Monday through Friday Translation services are available by contacting Customer Service. Servicios de tradducion están disponibles contactando a servicio al cliente.

Speak to a Health Plan Expert.

or give us a call at: 800-475-8466
Friday Health Plans is open Monday - Friday 8am - 5pm MST and will respond within 24 hours.