Let the Postal Service do the heavy lifting. Get your medications delivered directly to your door.
Walk or Run Your Way to Better Health
At CDPHP, we take care to make sure the providers you interact with are providing the best care they can. Imagine in-network care with no paperwork, no referrals, and no surprises.
How it Works
With an EPO you do not need to select a primary care physician (PCP), although we encourage you to establish a relationship with a network PCP who will coordinate your care and refer you to network specialists as needed. You are responsible for paying a coinsurance or copayment when going for care. Please refer to the benefit materials provided to you at the time of enrollment for specifics on your out-of-pocket costs. These vary according to the plan purchased by your employer group.
Q. Do I have access to out-of-network benefits?
A. Members of the EPO only have coverage for care provided within the CDPHP. This includes access to a national network of 550,000+ providers of care.
This summary offers highlights but does not detail all benefits, limitations, or exclusions. It is not a contract and may be subject to change. For more detailed information, a Membership Certificate is available upon request.
Note: The EPO Plan is underwritten by CDPHP Universal Benefits, Inc. (CDPHP UBI). You must comply with CDPHP UBI’s managed benefits program as set forth in the contract to receive the maximum benefits for all services. Failure to do so will result in you being responsible for an additional payment of 50% of the allowed amount up to a maximum of $500 for each service otherwise payable, in addition to the applicable copayment, deductible, and/or coinsurance, unless penalty is waived by rider.
At CDPHP, we believe our most important job is to provide you access to care that helps keep you healthy. That’s why our EPO plan provides full coverage with no out-of-pocket costs for routine physicals, immunizations, well-baby/well-child care, worldwide emergency care, and more. Convenient and cost-effective, our EPO plan provides coverage with the most choices. And, unlike other managed care plans, you don’t have to select a primary care physician (PCP).
Getting great care is easy with our EPO.
Just keep these tips in mind:
Here are some tools that might be helpful to you if you have an EPO plan.
EPO Member Tip Sheet
Find tips to help you understand everything in your plan from pharmacy benefits, to what to do at the time of care.
EPO Member Handbook
Download this complete guide to your EPO coverage and all of the services available to you in this comprehensive plan.
Secure Online Site Access for Members
Find answers to many of your questions, check your claims, change your primary care provider, update your address, order new ID cards, and more – all online, 24/7.
Search the most current listing of providers in our network.
Sign up for a free wellness and fitness classes! See the line-up of classes and register online.
Find any forms you may need to complete as you use your EPO plan.
Is Your Prescription Covered?
Use a helpful drug search tool to find information on coverage, pricing, and prescription details.
Get answers to the most common questions about EPO plans.
Q. What should I do if I have an emergency when I’m out of the area?
A. A medical emergency is defined as a sudden illness or injury so severe that the average person would believe that immediate medical attention is needed to avoid serious health damage or bodily harm.
If you have an emergency outside the CDPHP service area, go to the nearest hospital emergency room. CDPHP will cover the hospital emergency room bill in full — minus your copayment. If the situation is urgent but not an emergency, such as a sore throat, sprain, or infection, contact the CDPHP Resource Coordination Department at 1-800-274-2332 for advice in obtaining the care you need. CDPHP has a national network and can frequently locate a participating provider.
Q. How do I access my out-of-network benefits?
A. Members of the EPO do not have coverage outside the CDPHP network. Please refer to the benefit materials provided to you at the time of enrollment for specifics on your out-of-pocket costs. These vary according to the plan purchased by your employer group.
Q. Do I have to choose a PCP to direct my care?
If you have EPO coverage you do not need to select a PCP. However, we still recommend that you establish yourself with a doctor who will deliver your routine services and coordinate your care with specialists. Please use Find-A-Doc to view the range of doctors available within the CDPHP network.
Q. How do I submit a claim?
A. If you’ve received a covered service and the provider of medical services requested that you pay the charge at the time of service, send a completely itemized bill to our office so that you receive the maximum available benefits. That bill should include:
Please send claim to: Capital District Physicians’ Health Plan, Inc., P.O. Box 66602, Albany, NY 12206-6602.
Note: This same process applies to claims for care you received out of the country.
Q. Can I order my prescription drugs by mail?
A. Yes. The CDPHP Mail Order Prescription service is available to members who have a prescription drug rider and who take maintenance medication.
Get the latest health news in your inbox. Sign up for our
©2013 CDPHP. All Rights Reserved.