Frequently Asked Questions

Here are answers to some of the questions we're asked most often. If you don't find the answers you need here, please check our tips on using your health program here, contact our customer service representatives here, or call 1-800-440-1561, Monday through Friday, between 8 a.m. and 6 p.m. Pacific Time.

Q: How do I become a member of Community Health Plan?

A: If you are a member of the State's Basic Health (BH), Healthy Options, or Children's Health Insurance Program (CHIP) and you live in an area we serve, you can select Community Health Plan as your managed care health program. If you are already a BH member with another plan, you may select Community Health Plan during the open enrollment period. If you are a member Healthy Options, you have an opportunity to select a new plan each month.

If you are not enrolled in the Basic Health, Healthy Options, or Children's Health Insurance Program, you may qualify for one of these programs. To find out if you qualify, call Community Health Plan
customer service (1-800-440-1561), or call one of these state agencies:

For Basic Health call the Health Care Authority at 1-800-826-2444.
For Healthy Options and CHIP call 1-800-562-3022 or contact your local Department of Social and Health Services Community Service Office.

Q: If I am a Healthy Options member, do I need my Medicaid ID card (coupon) in addition to my Community Health Plan ID card?

A: Yes. You will need to show both your Community Health Plan ID card and your Medicaid ID card (coupon) from DSHS each time you get medical care or pick up a prescription.

Q: Is there a Community Health Plan clinic in my area?

A: We have more than 250 primary care clinics in most of the state's 39 counties. Check the Community Health Plan Provider and Pharmacy Directory to locate participating providers in your area, or call customer service at 1-800-440-1561.

Q: I'm considering joining Community Health Plan. As a member, will I be able to continue seeing my current primary care provider?

A: We contract with more than 1,000 primary health care providers and more than 6,000 medical specialists. To find out if your current provider is affiliated with Community Health Plan, call customer service at 1-800-440-1561.

Q: I have a baby. If I join Community Health Plan, who will be my baby's primary care provider?

A: Your primary care provider (PCP) will also be your baby's PCP. If you want a different provider for your baby, tell your clinic or call Community Health Plan customer service at 1-800-440-1561 and we will assign a provider to your child. Remember, the provider must be part of our service network.

Q: How can I get a free car seat for my new baby?

A: Community Health Plan members who seek the indicated care on or after January 1, 2007 would be eligible if they meet all of the program criteria

Patient must:

be a member of Community Health Plan,
see their provider for their first prenatal visit within the first trimester (or within 42 days of joining Community Health Plan and
still be seeing their provider for prenatal care in the third trimester of their pregnancy

Your primary care provider (PCP) will then submit your form to Community Health Plan. You will then receive your car seat certificate in the mail!

Once your baby is born, remember to schedule regular checkups with your PCP. During these visits, your baby will receive important immunizations (shots) and your PCP will monitor your baby's growth and development. Don't forget to ask your PCP any questions you might have as a new parent - they are interested in helping your baby grow up to be a happy, healthy child.

If you remain current with your baby's immunizations and well-child checkups, you will also receive a Healthwise handbook, thermometer, and infant grooming kit.

For questions, please contact Community Health Plan's Customer Service at 1-800-440-1561. If you are hearing-or-speech impaired, please call TTY 1-866-816-2479 (toll free) or call local 206-613-8875.

Q: How can I get a free bike helmet for my child?

A: The Children First program rewards members for getting their immunizations (shots) and well-child checks.

Community Health Plan members who seek the indicated care on or after January 1, 2007 would be eligible if they meet all of the program criteria

Patient must:

be a member of Community Health Plan,
be current on their immunizations and
be 0 to 13 years of age.

Preventing injuries and illness is one of the best ways to maintain the health of your child. During well-child exams, your primary care provider (PCP) will monitor the growth and development of your child, as well as keep his or her immunizations up to date.

Your PCP will then submit your form to Community Health Plan. You will then receive your certificate in the mail for a bike helmet, toddler cupboard locks, a booster seat or backpack!

To help make sure your child is safe when he or she uses the bike helmet, carefully read the instruction manual and follow all directions for the correct and safe use of the bike helmet. The manufacturer's warranty is the only warranty for the bike helmet, and Community Health Plan makes no additional warranties for the product.

Q: As a member of Community Health Plan, which hospital will I go to?

A: We contract with more than 85 hospitals throughout the state. Your primary care provider can help you choose one. In an emergency, always go to the nearest hospital or call 911. If you need to go to the hospital for non-emergency treatment, you must get a referral from your primary care provider first.

Q: What types of services do your clinics provide?

A: Most clinics offer a full range of services, including:

Preventive health care, including regular checkups for children and adults, routine lab tests, X-rays, and other basic medical services.
Access to medical advice by phone, even when the clinic is closed. (If a plan member in your family becomes sick when the clinic is closed, call your clinic's after-hours number for assistance.)
Referral to a medical specialist when you and your primary care provider decide you need one.
Access to hospital care, prescription medication, and other services, when deemed necessary.
Access to women's health care and family planning, including birth control drugs, devices, and counseling.

Q: How do I know if a service is covered?

A: To find out if a medical service is covered, refer to the benefits grid, call our customer service representatives at 1-800-440-1561 or contact them here. You can also check with the agency overseeing the health care program in which you are enrolled:

Basic Health (BH) members — refer to your BH Member Handbook or call 1-800-660-9840.
Healthy Options members — call Healthy Options customer service at 1-800-562-3022.
Children's Health Insurance Program

Q: What if I become ill or injured when I am far away from home?

A: When you travel, Community Health Plan covers you for emergency care and medications necessary for emergency treatment.

If you have an emergency while you are traveling, go directly to the nearest hospital emergency room. Remember that you or someone you know must call your primary care provider (PCP) within 24 hours of your emergency or as soon as is medically reasonable. Your follow-up care is covered if it is medically necessary and cannot wait until you return home, although it must first be authorized by Community Health Plan.

If you need a 30-day supply of a regular prescription before you go on vacation, please consult with your PCP before you leave. If you need more than a 30-day supply, please call Community Health Plan customer service representatives at 1-800-440-1561.

Non-emergency, out-of-state prescriptions are not covered by your plan.

Q: Where can I get my prescriptions filled?

A: At any of the 1,000 drugstores that are part of the Community Health Plan network. To find a pharmacy near you, see our current list of network pharmacies for Healthy Options and Basic Health members or the current list for GA-U members. Or call customer service at 1-800-440-1561 to locate the pharmacy nearest you. Non-emergency, out-of-state prescriptions are not covered by the plan. Please note that while our network consists of pharmacies in Washington, we also contract with selected pharmacies in Oregon and Idaho for the convenience of members who reside in bordering communities.

Q: What if I lose my Community Health Plan ID card?

A: Call Community Health Plan customer service at 1-800-440-1561 or contact us here and we'll send you a new one.

Q: What if I move?

A: First, call the state agency that oversees your insurance program and let them know your new address:

If you are a Healthy Options member, call your DSHS Community Service Office (CSO). If you do not know the number for the CSO in your area, call DSHS at 1-800-865-7801. You can also find more information about Healthy Options on the Medical Assistance Administration web site at http://www1.dshs.wa.gov.
If you are a Basic Health member, call Basic Health at 1-800-826-2444 so your records can be updated. You can also find more information about the Basic Health at the BH web site at http://www.basichealth.hca.wa.gov.

After you update your records with the appropriate agency, call our customer service representatives at 1-800-440-1561 so we can help you choose a new primary care provider, if necessary.

Q: What if I want a second opinion about my health care?

A: Tell your primary care provider (PCP) that you want a second opinion. Your PCP will refer you to a different provider within the Community Health Plan network with similar credentials, or you can choose one from our provider list. For help, call our customer service representatives at 1-800-440-1561 or e-mail them here.