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Your Medical Care Services Benefits

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The member benefits pages give you information about services and treatments covered for Medical Care Services by Community Health Plan of Washington ("Community Health Plan" or "the Plan") and by the Washington State Health Care Authority (HCA). Some health care services are not covered.

Services and treatments are covered only if medically necessary.

You will need a referral from your PCP and often an authorization from Community Health Plan before you get a service or treatment. If you get a service before you get an authorization or referral, you might have to pay for it yourself. (See About Prior Authorizations and Referrals.)

As a rule, Community Health Plan of Washington covers professional services. The Washington State Health Care Authority (HCA) covers facility services.

For more information

For information about services covered by Community Health Plan of Washington, see:

• Services Covered by Community Health Plan lists benefits covered by the Plan when they are medically necessary. The Details section tells more about each benefit, including whether it requires a referral or prior authorization.
• Services Covered by Health Care Authority or Other Programs lists services offered by HCA or other agencies and programs when they are medically necessary.
• Services at Your Local Health Department lists services offered by your local Washington State Department of Health office when they are medically necessary. You must show your ProviderOne ID card to get these services. For information, call 1-800-562-3022.
• Prescription Drug Services.
• Services Not Covered by Community Health Plan, HCA, or Other Program lists services and treatments that are not covered on your Medical Care Services program.
• Payments for Services Not Covered tells you when you might need to pay or when a a third party (such as another insurance company) must pay for your services.
• About Prior Authorizations and Referrals covers: When do I need a referral and how do I get one? What is a prior authorization? What services require a prior authorization and how do I get one?

For more information about which services are covered by the Plan:

• Contact your provider or other clinic staff.
• Phone the Community Health Plan customer service team at 1-800-440-1561, Monday through Friday from 8:00 am to 5:00 pm, or email customercare@chpw.org. If you are hearing or speech impaired, call TTY Relay: Dial 7-1-1.