Capital Health Plan
Capital Health Plan is a not-for-profit HMO founded in 1982 that serves 135,000+ members across nine Florida Big Bend counties through Medicare Advantage, employer group, and Individual & Family plans, operating three member-exclusive health centers as a BCBS licensee.
- Company typePrivate
- Founded1982
- HeadquartersAtlanta, United States
- Headcount251–500
- GTM typeB2B and B2C
- OfferingServices
What Capital Health Plan does
Capital Health Plan (CHP) is a not-for-profit Health Maintenance Organization founded on June 1, 1982, and headquartered in Tallahassee, Florida, where it serves more than 135,000 members across nine counties in the Florida Big Bend region as an independent licensee of the Blue Cross and Blue Shield Association. The company operates three integrated product lines: Medicare Advantage HMO plans (Silver Advantage, Advantage Plus, Preferred Advantage, Giveback Advantage, and Retiree Advantage, including a State of Florida retiree variant), employer-sponsored group plans for small and large businesses, and Individual & Family plans offered through the Federally Facilitated Healthcare Exchange in Bronze, Silver, Gold, and Platinum tiers.
CHP runs a vertically integrated delivery model anchored by three member-exclusive health centers (Centerville Place, Governor's Square, and Metropolitan) that provide primary care, urgent care, imaging, laboratory services, infusion therapy, wound care, eye care, and the Nancy Van Vessem, M.D. Center for Healthy Aging, supported by CHP Physicians Group providers certified as a Patient-Centered Medical Home. The technology stack combines third-party platforms including NextGen (patient portal and EMR), Amwell (24/7 telehealth at $15 per visit), Prime Therapeutics/MyPrime (pharmacy benefits administration), LabCorp (laboratory services), Healthwise (health education knowledgebase), Luma Health (scheduling), and an in-house CHP*Connect member portal; electronic medical records were implemented in the CHP Physician Practice in 2005.
Revenue is generated primarily through recurring monthly health insurance premiums across the Medicare, employer group, and individual segments, supplemented by member cost-sharing, with Medicare Advantage likely the largest single revenue contributor given CHP's 5-star CMS rating and senior-focused care infrastructure. Distribution combines direct sales teams, an appointed agent and broker network, Healthcare.gov marketplace listings, community events such as Walk With a Doc and Medicare education seminars, and digital channels including social media and the Healthline newsletter. John Hogan serves as President and CEO.
Capital Health Plan firmographics
Firmographics- Name
- Capital Health Plan
- Legal name
- Capital Health Plan
- Website
- https://capitalhealth.com
- Company type
- Private
- Founded year
- 1982
- Operating status
- Operating
- Headcount range
- 251–500 employees
- Short description
- Capital Health Plan is a not-for-profit HMO founded in 1982 that serves 135,000+ members across nine Florida Big Bend counties through Medicare Advantage, employer group, and Individual & Family plans, operating three member-exclusive health centers as a BCBS licensee.
- Ownership category
- akta.pro rank
Capital Health Plan industry classification
Industry- Product category
- Managed Care
- NAICS
- Direct Health and Medical Insurance Carriers (524114), HMO Medical Centers (621491)
- SIC
- Hospital & Medical Service Plans (6324), Services-Health Services (8000)
- akta.pro primary industry
- Medicare Advantage HMOs (HMO/HMO-POS) (HLAEAMAH)
- akta.pro secondary industries
- Group HMO Plans (FSAIAFAK), MA HMO Plans (HLAEACAA), Network-Model HMOs (HLAEAMAC)
Keywords
Where Capital Health Plan is headquartered
LocationHeadquarters
- HQ city
- Atlanta
- HQ country
- United States
- HQ region
- North America
Offices5 records
Markets served
Capital Health Plan business model
Business model- GTM type
- B2B and B2C
- Offering type
- Services
- Cost components
- Personnel, Operations
Revenue model
- Health Insurance Premiums - Medicare Advantage Plans: Medicare Advantage HMO plans including Silver Advantage, Advantage Plus, Preferred Advantage, Giveback Advantage, and Retiree Advantage for Medicare-eligible individuals. Revenue generated from Medicare premiums and member cost-sharing.
- Health Insurance Premiums - Employer Group Plans: Employer-sponsored health benefit plans for large and small businesses in the CHP service area. Revenue from employer group premium payments based on employee enrollment.
- Health Insurance Premiums - Individual/Family Plans: Individual and family health plans offered through the Federally Facilitated Healthcare Exchange (ACA marketplace) including Bronze, Silver, Gold, and Platinum tier plans. Revenue from individual premium payments.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | Medicare Advantage HMO plans with various benefit structures and Part B premium reduction options |
| Subscription | Monthly | Bronze, Silver, Gold, and Platinum tier individual/family plans with varying deductibles and copays |
| Subscription | Monthly | Small and large employer group health benefit plans |
| Unit Pricing | Pay-as-you-go | Telehealth video visits via Amwell platform |
Go-to-market motion3 records
Distribution channels5 records
Marketing channels9 records
Capital Health Plan product offering
Product offeringCore offering
Capital Health Plan is a not-for-profit HMO founded in 1982 that provides managed health care coverage to over 135,000 members across 9 counties in Florida's Big Bend region. The organization offers Medicare Advantage, employer group, and individual/family health plans, and operates three member-exclusive health centers that deliver integrated primary care to its members.
Product overview
Capital Health Plan is a not-for-profit HMO providing comprehensive health insurance and healthcare services across three product lines: Medicare Advantage plans (Silver Advantage, Advantage Plus, Preferred Advantage, Giveback Advantage, and Retiree Advantage HMOs), Employer Group Benefit Plans for small and large businesses, and Individual & Family Plans offered through the Healthcare Exchange in Bronze, Silver, Gold, and Platinum tiers. The company operates a unique integrated delivery system featuring three member-exclusive CHP Health Centers (Centerville Place, Governor's Square, and Metropolitan) providing access to CHP-only physicians, laboratory, imaging, urgent care, eye care, wound care, infusion services, and specialized senior care through the Nancy Van Vessem Center for Healthy Aging. Digital services include member portal (CHP*Connect*), NextGen Patient Portal, and Amwell Telehealth. Pharmacy benefits are administered through Prime Therapeutics/MyPrime with access to 5,000+ pharmacies. The company serves over 135,000 members across 9 counties in Florida's Big Bend region.
Differentiator
Problem solved
Functional benefit
Brands
- CHP Physicians Group: The Capital Health Plan Physicians Group provides evidence-based, comprehensive health care exclusively for Capital Health Plan members at CHP's three member-exclusive Health Centers.
- CHP Health Centers
- Nancy Van Vessem, M.D., Center for Healthy Aging
- CHP Urgent Care
- CHP*Connect*
Products and services
- Medicare Advantage Plans Medicare Advantage health insurance plans offered to Medicare-eligible seniors living in Capital Health Plan's 9-county service area in Florida's Big Bend region, providing comprehensive medical, hospital, and prescription drug coverage.
- Employer Group Plans Group health insurance plans offered to employers in the Big Bend region, including community-rated pricing options, large group pricing, and administrative services only (ASO) arrangements for businesses providing health benefits to employees.
- Individual and Family Plans Health insurance plans purchased directly by individuals and families in Capital Health Plan's service area, with tiered coverage options (Bronze, Silver, Gold, Platinum levels) and access to the integrated provider network.
- Member Health Centers Three member-exclusive health center locations providing integrated primary care services exclusively to Capital Health Plan members, supporting the HMO's coordinated care delivery model.
Quantifiable outcome
- Ranked #1 Medicare Plan and #4 Commercial Plan in the nation by NCQA (2006)
- +4 more outcomes
Companies that use Capital Health Plan
Customer profileSegments4 records
Ideal customer profiles3 records
Capital Health Plan technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Integration10 records
Feature4 records
Capital Health Plan partnerships and signals
Strategic signalPartnerships
Eight partnerships are on record, tiered minor and core.
- Florida State University (FSU Health)minorCHP participates in FSU Health's Clinical Catalyst grant program, funding collaborative healthcare research projects between FSU researchers and local clinical providers to advance patient care innovation.
- Amwell (American Well)coreAmwell provides telehealth video visit services for CHP members, enabling 24/7 access to board-certified physicians via computer or smartphone. CHP members pay $15 per visit (or $0 for State of Florida members). Clinical services provided by Online Care Group, the nation's first and largest primary care group devoted to telehealth.
- LabCorpcoreCHP contracts with LabCorp for laboratory testing services. LabCorp testing centers are conveniently located at CHP's Centerville Health Center, Governor's Square Health Center (Temporarily Closed), and Metropolitan Health Center locations.
- Prime TherapeuticscorePrime Therapeutics administers CHP's pharmacy benefits. Members can register at MyPrime.com to check drug coverage, look up prices, search pharmacies, and view claim history.
- Blue Cross and Blue Shield AssociationcoreCapital Health Plan is an independent licensee of the Blue Cross and Blue Shield Association, operating under the BCBSA brand and network agreements while maintaining local governance.
- John A. Hartford Foundation and Institute for Healthcare ImprovementminorCollaborative partnership for Age-Friendly Health System recognition and delivery of evidence-based care grounded in the 4Ms Framework for older adults.
- Center for Orthopedic and Sports Physical Therapy (COSPT)minorCHP partnered with COSPT to provide physical therapy services located in each CHP clinical site, available for same-day walk-in appointments for in-center patients.
- Tallahassee Memorial HealthcarecoreCHP partners with Tallahassee Memorial Healthcare for hospital affiliations, referrals for specialty care, and family medicine residency program collaboration. TMH is one of the primary hospital affiliations in CHP's network.
Scale indicators6 records
Recent moves20 records
Expansion highlights5 records
Capital Health Plan competitors and assessment
Company assessmentDirect peers
- Florida Blue (Blue Cross and Blue Shield of Florida): Florida Blue is the largest health insurer in Florida and is also a BCBSA licensee, directly competing with CHP across commercial, Medicare Advantage, and individual segments in overlapping Florida geographies. Its massive scale, broad network, and brand recognition make it the most relevant direct peer.
- AvMed: AvMed is a Florida-based not-for-profit health plan offering commercial, Medicare Advantage, and individual coverage. Comparable not-for-profit HMO structure with Florida regional focus and similar product mix to CHP, including Medicare Advantage HMO plans.
- Geisinger Health Plan: Geisinger Health Plan is a not-for-profit regional health plan with an integrated delivery system serving Pennsylvania. Comparable community-rooted not-for-profit HMO model with member-exclusive provider network and strong NCQA quality ratings, mirroring CHP's structural approach.
Broad incumbents
- Humana: Humana is the second-largest Medicare Advantage carrier nationally and a major player in Florida MA, offering competing HMO and PPO Medicare plans in many of CHP's counties. Comparable Medicare Advantage product structure and senior-focused care model.
- UnitedHealthcare: UnitedHealthcare is the largest U.S. health insurer with a substantial Medicare Advantage footprint in Florida. Competes with CHP on individual, employer group, and Medicare Advantage products with significantly broader networks and national scale.
- Aetna (CVS Health): Aetna, part of CVS Health, is a major national health insurer with Medicare Advantage, employer, and individual plan offerings in Florida. Competes with CHP on MA HMO plans and individual marketplace products, with the additional vertical integration advantage of CVS pharmacy and MinuteClinic assets.
- Kaiser Permanente: Kaiser Permanente is the prototypical integrated not-for-profit HMO combining insurer and provider functions, with member-exclusive medical centers. Highly comparable integrated care delivery and member-exclusivity model that mirrors CHP's three member-exclusive health centers.
- Centene Corporation: Centene is a large managed care company with significant Medicare Advantage and individual marketplace presence in Florida through subsidiaries like Wellcare. Competes with CHP on individual marketplace plans and Medicare Advantage HMO products, with substantial scale advantages.
Regional players
- Health First Health Plans: Health First Health Plans is a Florida-based regional health plan offering Medicare Advantage and commercial plans primarily in Brevard County and surrounding areas. Comparable integrated delivery model with health system affiliation and regional HMO focus.
Emerging players
- Molina Healthcare: Molina Healthcare is a managed care company with significant Medicare Advantage and dual-eligible plan presence, including in Florida. Comparable HMO operating model with a focus on government-sponsored health programs overlapping CHP's Medicare Advantage focus.
Market position
Strengths4 records
Weaknesses4 records
Competitive moat5 records
Key risks6 records
Key highlights7 records
Customer concentration
Capital Health Plan social profiles
Digital presenceCapital Health Plan compliance and trust
Trust signalCompliance8 records
Capital Health Plan financial estimates
Financial estimateRevenue estimate
Valuation estimate
Capital Health Plan leadership team
Management profileNumber of profiles
Profiles1 record
Capital Health Plan funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Capital Health Plan M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Capital Health Plan
What does Capital Health Plan do?
Capital Health Plan is a not-for-profit HMO founded in 1982 that provides managed health care coverage to over 135,000 members across 9 counties in Florida's Big Bend region. The organization offers Medicare Advantage, employer group, and individual/family health plans, and operates three member-exclusive health centers that deliver integrated primary care to its members.
Is Capital Health Plan a public or private company?
Capital Health Plan is a private company. It is classified as nonprofit foundation owned and is currently operating.
When was Capital Health Plan founded?
Capital Health Plan was founded in 1982. It employs 251 to 500 people.
Where is Capital Health Plan based?
Capital Health Plan is headquartered in Atlanta, United States, in the North America region.
How does Capital Health Plan make money?
Three revenue lines are on record. Health Insurance Premiums - Medicare Advantage Plans are the primary driver. The others are health Insurance Premiums - Employer Group Plans and health Insurance Premiums - Individual/Family Plans.
Who are Capital Health Plan's main competitors?
Direct peers on record are Florida Blue (Blue Cross and Blue Shield of Florida), AvMed and Geisinger Health Plan. Broad incumbents are Humana, UnitedHealthcare, Aetna (CVS Health), Kaiser Permanente and Centene Corporation. Health First Health Plans is listed as a regional player. Molina Healthcare is listed as an emerging player.
Does Capital Health Plan have an API?
No public API is recorded for Capital Health Plan.
What industry is Capital Health Plan in?
Capital Health Plan's product category is Managed Care. Its primary akta.pro industry code is HLAEAMAH, Medicare Advantage HMOs (HMO/HMO-POS), with a secondary code of FSAIAFAK, Group HMO Plans. Its NAICS code is 524114 and its SIC code is 6324.