Affordable personal Capital BlueCross health insurance plans can be purchased directly through this website both on and off the Exchange. We offer the lowest available rates for individual and family policies and we also research each plan so you’re provided with quality benefits that match your personal needs. Enrolling through the Pa Marketplace can be quite a challenge, so we simplify the process so that you are quickly covered both during and after the Open Enrollment period.
We always put you, the consumer, first when reviewing plans or applying for a policy. There are hundreds of options that are offered and we'll make sure you're able to view the best choices that provide the greatest value. If you are eligible for a federal tax credit/subsidy, your premium could substantially reduce.
To qualify for a policy, you must live in the 21-county service area of Central Pennsylvania and the Lehigh Valley. These counties include Fulton, Franklin, Adams, York, Lancaster, Berks, Lehigh, Northampton, Schuylkill, Northumberland, Montour, Columbia, Union, Centre, Mifflin, Juniata, Perry, Cumberland, Dauphin, Lebanon and Snyder.
If you reside in another county, you can still apply for a policy with another company through this website. Your zip code will be one factor that determines your premium. Other Blue Cross companies include Highmark and Independence Blue Cross. In neighboring Ohio. Anthem is the only BC company in the Buckeye State.
The only underwriting criteria during Open Enrollment periods in determining pricing will be your age, zip code and smoking status. This is a direct result from legislative changes from the Department Of Health And Human Services and the establishment of a State Healthcare Exchange for consumers. Typically, the enrollment period begins November 1 and ends on January 31..
Premiums will also be differentiated by your Adjusted Gross Income (AGI), which will determine the amount of tax credits you receive to reduce the rate. These credits are instantly deducted from the premium, often resulting in shockingly low rates! If you are not eligible for federal subsidies, we can help you find the most cost-effective policies that will keep premiums low while still including all required "essential health benefits."
We offer free expert unbiased advice regarding choosing and comparing Exchange coverage, determining your subsidy eligibility, and easily enrolling for coverage. There is a new Open Enrollment (see above) each year and annually, we should take the time to determine if your existing policy is properly taking advantage of all available subsidies. There is also an SEP (Special Enrollment Period) if you have one of the numerous available qualifying events.
The four previously underwritten plans (prior to 2014) were PersonalBlue PPO, PersonalBlue HSA PersonalBlue Saver and Individual Short Term. Policies were underwritten quickly and physicals were rarely required. You could keep coverage for as little as a month or until you turn age 65. US News magazine also awarded a "Five-Star" rating to five of the BC policies. Only 23 plans earned this honor, and only private plans were eligible.
However, only the "short-term" plan from that group is available (of the previously-mentioned policies). New plans have been created to satisfy the compliance and mandate requirements of Obamacare. These new plans offer richer benefits (maternity and mental illness coverage is now required) and premiums are often reduced by the federal tax credit, which is applied as an immediate subsidy.
Once you reach age 65, several Medicare Supplement plans will be available. Usually, they are less expensive than the policies you have now. You are not required to purchase any type of Medigap coverage since most of your expenses will be covered. After age 65, most of the plan choices are easy to compare, since uniform guidelines are required. A separate drug prescription plan can also be purchased (Part D). Medicare Advantage plans are also offered which provide lower premiums.
Popular Under Age 65 Capital BC Plans
Catastrophic HMO 7150/0/75 - $75 pcp office visit copay for first three visits only. $7,150 deductible with 0% coinsurance. Once deductible is met, covered expenses paid at 100%. NOTE: Must be under age 30 to apply.
Bronze HMO 7000/50/60 - $60 and $85 office visit copays with Urgent Care subject to 50% coinsurance. $7,000 deductible with maximum out-of-pocket expenses of $7,150 and 50% coinsurance. All drugs also subject to 50% coinsurance.
Silver PPO 4500/0/10 - $10 and $20 office visit copays (pcp and specialist), including $20 chiropractic copay. No charge for x-rays or lab services at independent clinical locations. $4,500 deductible with maximum out-of-pocket expenses of $7,150. Urgent Care and ER copays are $75 and $150. Prescription drug copays are $5 for generic, $25 for preferred generic, $60 for non-preferred brand, and $150 for specialty.
Silver CareConnect 3000/35/0 - $35 and $55 office visit copays (pcp and specialist), including $55 chiropractic copay. No charge for x-rays or lab services at independent clinical locations. $3,000 deductible with maximum out-of-pocket expenses of $7,150. Urgent Care and ER copays are $100 and $200. Prescription drug copays are $10 for generic, $43 for preferred generic, $65 for non-preferred brand, and $150 for specialty.
Gold PPO 1000/0/20 - $20 and $50 office visit copays, including $50 chiropractic copay. No charge for x-rays or lab services at independent clinical locations. $1,000 deductible with maximum out-of-pocket expenses of $7,150. Urgent Care and ER copays are $75 and $300. Prescription drug copays are $20 for generic, $60 for preferred generic, $100 for non-preferred brand, and $150 for specialty.
We strongly endorse the usage of HSA plans. They are a great way to lower your premiums, pay for qualified health, dental and vision expenses with tax-deductible dollars, and maintain better control over your personal health care program. We also believe selecting the 0% coinsurance is worth the small increase in premium. With this feature, other than the deductible, you pay no out-of-pocket money on covered expenses. Other higher coinsurance options are available. We also expect the State Exchange to allow HSA coverage.
Temporary Medical Plans
Individual Short-Term is designed to cover persons who need temporary medical coverage. The length of coverage runs from 30 days to 180 days and works best if you are between employers, simply uninsured, just graduated from school or waiting for a group plan to begin. Premiums are very cheap…often 50% less than conventional coverage, and preventative benefits are covered at 100%. You can often apply for coverage and be approved the next day. Deductible options are $500, $1,000, $2,500, and $5,000. Maximum out-of-pocket expenses range from $1,500 to $6,000.
The four available plans are:
Short Term 500
Short Term 1000
Short Term 2500
Short Term 5000
It is important to understand that a temporary policy does not meet many of the mandated Affordable Care Act guidelines. If you miss Open Enrollment and do not qualify for an approved Pa Obamacare plan exception, despite the 2.5% required income penalty, it is an option you should consider. Also, short-term plans are also used by persons with no major medical issues that do not want to pay for benefits they probably will never use. Generally, families with several children should not choose this type of plan, unlessno other options are offered.
The application is simplified and approval times often take less than 36 hours. Typically, pre-existing conditions are not a covered benefit. Within the last five years, if you have been treated for specific medical conditions listed on the application, you will likely be declined. We like the Capital BlueCross short-term coverage. However, since we represent all of the large companies, usually, a lower rate is available from UnitedHealthcare (Golden Rule) or other carriers. However, benefits will vary so it's important to understand differences. Also, your personal physician may not be in the UHC network.
How To Apply For A Policy:
To apply for a policy, simply contact us by phone or email. You do not have to answer any medical questions during Open Enrollment periods. You may also be eligible for substantial financial assistance that could pay some, most or all of your premium. During non-Open Enrollment periods, you can still apply for coverage by utilizing specific approved enrollment exceptions or through policies designed to cover you until the next OE period.
Please call us at (888) 513 6446 if you would like to discuss the application process, get a free quote or you would like additional specific information on any of the plans.
November 2013 - Capital BC is offering many affordable plans on the Pa Health Exchange. You can quickly view current rates and your calculated subsidy when you request a quote. Some of the most popular plans for 2014 are Health Benefits Value HMO, Healthy Benefits HMO, Keystone Blue Cross 50 and Blue Cross Value. Gold, Silver and Bronze plans are being offered as Marketplace-compliant, as they do satisfy all of the requirements needed.
May 2014 - Small business owners can continue their coverage for an additional year, even if the plan does not conform to ACA guidelines. The exception applies to small-group policies that renew between June 1st and December 31st 2014. This could save thousands of dollars in premiums bu avoiding the addition of many benefits that are now required by recent legislation. To be eligible, the company must have 50 employees (or less).
September 2014 - The PPO Silver Reserve has been eliminated from the list of available 2015 plans. If you are currently enrolled in this policy, please contact us so we can review the most suitable replacements. Open Enrollment begins in about seven weeks.
October 2014 - The laboratory list for providers has been updated. Lab Corporation Of America will no longer be considered "in-network." Individual, senior and group plans are impacted with this change. However, Health Network Labs and Quest Diagnostics will remain as approved independent labs.
Requirements and procedures for preauthorization are also changing as of January 1, 2015. Several non emergency situations have been added and policyholders will be notified in writing.
August 2015 - Telehealth is coming with 2016 plans! OK. What is"Telehealth?" By using a computer or smartphone, consumers can contact licensed physicians at any time regardless of the hour or day. It is ideal for customers that are out of town, or because of illness, can not travel to a doctor's office. Appoints can be set online, and visits with doctors can take place via video.
Physicians will be able to diagnose conditions and also prescribe medications that can conveniently be picked up locally. Two telehealth services will be utilized that will allow face-to-face meetings in less than 120 seconds.
February 2017 - Along with Highmark and Geisinger, Capital BC continues to offer coverage in the Lehigh Valley and Central Pennsylvania. Next year, as President Trump's healthcare plans are introduced, more companies are expected to offer coverage.