Affordable personal Capital Blue Cross health insurance plans can be purchased directly through this website and through the Pennie 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. Group plans are available to small and large employers. 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. Senior Medigap plans are also reviewed and compared, including Advantage, Part D, and Supplement options.
We always put you, the consumer, first when reviewing Capital Advantage Assurance Company 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. You may also purchase non-Obamacare coverage. Updated rewards and resources include health assessment (confidentially track your health goals and receive personalized reports) and digital health tools (articles, recipes, how-to guides, and free interactive programs).
Additional free programs include Blue365 (health and wellness deals and offers), Capital Blue Cross Loop (money-saving tips sent to your mobile device), MyCare Finder (Easily find network physicians, specialists, medical facilities and hospitals), Virtual Care (Online physician visits which include diagnosis and treatment for many conditions), Healthy Blue Rewards ($100 gift reward cards for completing wellness activities), and hearing aid discounts (up to 60% off retail price).
Capital Blue Cross Connect provides medical care in six locations. They are located in York (Apple Hill Medical Center on 25 Monument Road), Allentown (1221 Hamilton Street), Chambersburg (12 St. Paul Drive), Enola (4500 Marketplace Way), and Saucon Valley (2845 Center Valley Parkway).
Service Area
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. PPO Choice is only offered in Lancaster County, Valley Advantage EPO is only offered in Lehigh and Northampton Counties, and Capital Advantage EPO is offered in Cumberland, Dauphin, and Perry Counties.
Prescription drug benefits are widely available through The Broad Network. 65,000 pharmacies are available, including Wal-Mart, CVS, and Rite Aid. “90DayMyWay” provides mail-order service with substantial discounts. Medication synchronization (two or more medications) and a value formulary (no-cost preventative medications) are also offered.
Open Enrollment
The only underwriting criteria during 2024 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 15th. Senior Open Enrollment begins on October 15th and ends on December 7th.
Premiums for Under-65 plans 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 (no longer offered) 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.
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. Note: Temporary coverage is offered through a partner carrier of CBC. UnitedHealthcare also provides affordable temporary plans.
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.
Individual Under Age-65 Capital BC Plans
Catastrophic Tier
Catastrophic HMO 9450/0/0 – $0 pcp office visit copay for first four visits only. $9,450 deductible with 0% coinsurance. Once deductible is met, covered expenses paid at 100%. NOTE: Must be under age 30 to apply.
Catastrophic HMO 9100/0/0 – $0 pcp office visit copay for first four visits only. $9,450 deductible with 0% coinsurance. Once deductible is met, covered expenses paid at 100%. NOTE: Must be under age 30 to apply.
Bronze Tier
Bronze HMO 7450/0/50 – $50 and $85 office visit copays. $7,450 deductible with maximum out-of-pocket expenses of $9,450 and 0% coinsurance. $25 copay for blood work at independent clinical labs ($75 copay at facility-owned labs). $100 Urgent Care copay. Preferred and non-preferred drug copays are $10 and $25 ($30 and $75 mail order).
Bronze PPO 7450/0/50 – $50 and $85 office visit copays. $7,450 deductible with maximum out-of-pocket expenses of $9,450 and 0% coinsurance. $25 copay for blood work at independent clinical labs ($75 copay at facility-owned labs). $100 Urgent Care copay. Preferred and non-preferred drug copays are $10 and $25 ($30 and $75 mail order).
Bronze Valley Advantage EPO 7450/0/50 – $50 and $85 office visit copays. $7,450 deductible with maximum out-of-pocket expenses of $9,450 and 0% coinsurance. $25 copay for blood work at independent clinical labs ($75 copay at facility-owned labs). $100 Urgent Care copay. Preferred and non-preferred drug copays are $10 and $25 ($30 and $75 mail order).
Bronze PPO Choice Select 7100/0/50 – $50 and $85 office visit copays. $7,100 deductible with maximum out-of-pocket expenses of $9,450 and 0% coinsurance. $100 Urgent Care copay. Preferred and non-preferred drug copays are $10 and $25 ($30 and $75 mail order).
Bronze QHDHP PPO 6400/0/50 – $50 and $85 office visit copays (after deductible). $6,400 deductible with maximum out-of-pocket expenses of $7,450 and 0% coinsurance. HSA-eligible.$100 Urgent Care copay (after deductible).
Silver Tier
Silver Valley Advantage EPO 6000/20/30 – $30 and $60 office visit copays (pcp and specialist) with $100 Urgent Care copay. $6,000 deductible with maximum out-of-pocket expenses of $9,100 and 20% coinsurance. $25 copay for blood work at independent clinical labs. Preferred generic, preferred brand, and non-preferred brand drug copays are $10, $50, and $100 ($25, $125, and $250 for mail order).
Silver PPO 6000/20/30 – $30 and $60 office visit copays (pcp and specialist) with $100 Urgent Care copay. $6,000 deductible with maximum out-of-pocket expenses of $9,100 and 20% coinsurance. $25 copay for blood work at independent clinical labs. Preferred generic, preferred brand, and non-preferred brand drug copays are $10, $50, and $100 ($25, $125, and $250 for mail order).
Silver QHDHP PPO 2900/10/40 – $40 and $85 office visit copays (after deductible). $2,900 deductible with maximum out-of-pocket expenses of $7,450 and 10% coinsurance. HSA-eligible.
Silver QHDHP PPO Choice 3000/10/35 – $35/$60 and $65/$85 office visit copays (after deductible). $3,000 or $6,000 deductible with maximum out-of-pocket expenses of $7,450 and 10% or 30% coinsurance. HSA-eligible.
Silver PPO 5950/20/30 – $30 and $60 office visit copays (pcp and specialist) with $100 Urgent Care copay. $5,950 deductible with maximum out-of-pocket expenses of $9,100 and 20% coinsurance. $25 copay for blood work at independent clinical labs. Preferred generic, preferred brand, and non-preferred brand drug copays are $10, $50, and $100 ($25, $125, and $250 for mail order).
Silver Valley Advantage EPO 5950/20/30 – $30 and $60 office visit copays (pcp and specialist) with $100 Urgent Care copay. $5,950 deductible with maximum out-of-pocket expenses of $9,100 and 20% coinsurance. Preferred generic, preferred brand, and non-preferred brand drug copays are $10, $50, and $100 ($25, $125, and $250 for mail order).
Silver PPO Choice 4450/20/35 – $35 and $60 office visit copays (pcp and specialist) with $100 Urgent Care copay. $4,450 deductible with maximum out-of-pocket expenses of $9,450 and 20% coinsurance. Preferred generic, non-preferred generic, preferred brand, and non-preferred brand drug copays are $10, 25%, $50, and $100 ($25, 25%, $125, and $250 for mail order).
Silver Performance PPO 4450/20/35 – $35 and $65 or $60 and $85 office visit copays (pcp and specialist) with $100 Urgent Care copay. $4,450 deductible with maximum out-of-pocket expenses of $9,450 and 20% coinsurance. Preferred generic, non-preferred generic, preferred brand, and non-preferred brand drug copays are $10, 25%, $50, and $100 ($25, 25%, $125, and $250 for mail order).
Silver PPO Choice Select 4450/20/35 – $35 and $65 or $60 and $85 office visit copays (pcp and specialist) with $100 Urgent Care copay. $4,450 deductible with maximum out-of-pocket expenses of $9,450 and 20% coinsurance. Preferred generic, non-preferred generic, preferred brand, and non-preferred brand drug copays are $10, 25%, $50, and $100 ($25, 25%, $125, and $250 for mail order).
Silver PPO Choice 4500/20/35 – $35 and $65 office visit copays (pcp and specialist) with $100 Urgent Care copay. $4,500 deductible with maximum out-of-pocket expenses of $9,450 and 20% coinsurance. Preferred generic, non-preferred generic, preferred brand, and non-preferred brand drug copays are $10, 25%, $50, and $100 ($25, 25%, $125, and $250 for mail order).
Silver PPO Choice Select 4500/20/35 – $35 and $65 or $60 and $85 office visit copays (pcp and specialist) with $100 Urgent Care copay. $4,500 deductible with maximum out-of-pocket expenses of $9,450 and 20% coinsurance. Preferred generic, non-preferred generic, preferred brand, and non-preferred brand drug copays are $10, 25%, $50, and $100 ($25, 25%, $125, and $250 for mail order).
Silver PPO 6000/20/30 – $30 and $60 office visit copays (pcp and specialist) with $100 Urgent Care copay. $6,000 deductible with maximum out-of-pocket expenses of $9,100 and 20% coinsurance. $25 copay for blood work at independent clinical labs. Preferred generic, preferred brand, and non-preferred brand drug copays are $10, $50, and $100 ($25, $125, and $250 for mail order).
Gold Tier
Gold PPO 2650/10/20 – $20 and $45 office visit copays, including $25 copay for diagnostic lab services at independent clinical locations. $2,650 deductible with maximum out-of-pocket expenses of $8,550. Urgent Care and ER copays are $75 and $350. Prescription drug copays are $10 for generic, 25% for preferred generic, $25 for preferred brand, and $75 for non-preferred brand ($25, 25%, $63, and $188 mail order).
Gold PPO 1800/10/20 – $20 and $45 office visit copays, including $25 copay for diagnostic lab services at independent clinical locations. $1,800 deductible with maximum out-of-pocket expenses of $8,550. Urgent Care and ER copays are $75 and $300. Prescription drug copays are $10 for generic, 25% for preferred generic, $25 for preferred brand, and $75 for non-preferred brand ($25, 25%, $63, and $188 mail order).
Gold Simple PPO – $25 and $50 office visit copays, including $25 copay for diagnostic lab services at independent clinical locations. $0 deductible with maximum out-of-pocket expenses of $8,550. Urgent Care and ER copays are $50 and $200. Prescription drug copays are $4 for generic, $15 for preferred generic, $45 for preferred brand, and $70 for non-preferred brand ($10, $38, $113, and $175 mail order).
Gold PPO Choice 2000/0/30 – $30 and $50 office visit copays. $2,000 deductible with maximum out-of-pocket expenses of $8,550. Urgent Care and ER copays are $75 and $200. Prescription drug copays are $10 for generic, 25% for preferred generic, $25 for preferred brand, and $75 for non-preferred brand ($25, 25%, $63, and $178 mail order).
Gold PPO Choice 3000/0/25 – $25 and $50 office visit copays. $3,000 deductible with maximum out-of-pocket expenses of $8,550. Urgent Care and ER copays are $75 and $300. Prescription drug copays are $10 for generic, 25% for preferred generic, $25 for preferred brand, and $75 for non-preferred brand ($25, 25%, $63, and $178 mail order).
Gold Valley Advantage EPO 2650/10/20 – $20 and $45 office visit copays. $2,650 deductible with maximum out-of-pocket expenses of $8,550. Urgent Care and ER copays are $75 and $350. Prescription drug copays are $10 for generic, 25% for preferred generic, $25 for preferred brand, and $75 for non-preferred brand ($25, 25%, $63, and $188 mail order).
Gold Valley Advantage EPO 1800/10/20 – $20 and $45 office visit copays. $1,800 deductible with maximum out-of-pocket expenses of $8,550. Urgent Care and ER copays are $75 and $300. Prescription drug copays are $10 for generic, 25% for preferred generic, $25 for preferred brand, and $75 for non-preferred brand ($25, 25%, $63, and $188 mail order).
Gold Capital Advantage EPO 2650/10/20 – $20 and $45 office visit copays. $2,650 deductible with maximum out-of-pocket expenses of $8,550. Urgent Care and ER copays are $75 and $350. Prescription drug copays are $10 for generic, 25% for preferred generic, $25 for preferred brand, and $75 for non-preferred brand ($25, 25%, $63, and $188 mail order).
Gold Capital Advantage EPO 1800/10/20 – $20 and $45 office visit copays. $1,800 deductible with maximum out-of-pocket expenses of $8,550. Urgent Care and ER copays are $75 and $300. Prescription drug copays are $10 for generic, 25% for preferred generic, $25 for preferred brand, and $75 for non-preferred brand ($25, 25%, $63, and $188 mail order).
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.
“Virtual Care” makes it possible to see a physician at any time and anywhere in the US. Your phone, computer, or laptop can be used to see doctors, counselors, psychologists, psychiatrists, and nutrition counselors. The cost of using this service is substantially less than an ER visit, and often is quicker than scheduling an in-person visit.
“90DayMyWay” provides coverage for two 30-day refills of maintenance drugs at Broad Network pharmacies. If a generic drug is available, and your physician did not request that brand name drug be used, you will be charged the difference in cost between the drugs. Available pharmacies can be viewed online along with the list of formulary drugs.
Current Monthly Rates (Under Age-65)
Age 25 (Lancaster County and $29,000 Income)
$22 – Bronze PPO Choice 7100/0/50
$22 – Bronze QHDHP Choice 6300/0/50 HSA
$129 – Gold PPO Choice 3000/0/25
$156 – Gold PPO Choice 2000/30
$188 – Silver PPO Choice 4000/15/25
$240 – Catastrophic PPO 9100/0/0
Married Couple Ages 32 (Lancaster County and $44,000 Income)
$40 – Bronze PPO Choice 7100/0/50
$40 – Bronze QHDHP Choice 6300/0/50 HSA
$292 – Gold PPO Choice 3000/0/25
$354 – Gold PPO Choice 2000/30
$431 – Silver PPO Choice 4000/15/25
Age 37 (York County and $34,000 Income)
$40 – Bronze PPO Choice 7450/0/50
$40 – Bronze QHDHP Choice 6300/0/50 HSA
$117 – Gold PPO 2650/10/20
$143 – Gold PPO 1800/10/20
$155 – Gold Simple PPO 0/0/25
Married Couple Ages 40 (York County and $47,000 Income)
$0 – Bronze PPO Choice 7450/0/50
$0 – Bronze QHDHP Choice 6300/0/50 HSA
$173 – Gold PPO 2650/10/20
$227 – Gold PPO 1800/10/20
$252 – Gold Simple PPO 0/0/25
Age 45 (Dauphin County and $35,000 Income)
$70 – Bronze PPO 8000/0/50
$225 – Gold PPO 2150/10/20
$243 – Silver PPO 6000/20/40
$246 – Gold Simple PPO 0/0/25
Married Couple Ages 50 (Dauphin County and $50,000 Income)
$0 – Bronze PPO 8000/0/50
$299 – Gold PPO 2150/10/20
$345 – Silver PPO 6000/20/40
$352 – Gold Simple PPO 0/0/25
Capital Blue Cross Senior Plans
Medicare Supplement
BlueReliance (Capital Advantage Insurance Company) plans are available to applicants that are currently enrolled in Part A (hospital benefits) and Part B (medical coverage). If you are within six months of your 65th birthday or Part B enrollment, medical information is not needed to enroll. You can also avoid answering medical questions if you qualify for a “Guarantee Issue Right.” The service territory (picture above) includes the following counties: Centre, Mifflin, Juniata, Union, Snyder, Northumberland, Perry, Cumberland, Franklin, Fulton, Adams, York, Dauphin, Lebanon, Lancaster, Berks, Lehigh, Northampton, Montour, Columbia, and Schulykill.
Plans available are A, B, C, D, F, G, and N. Original Medicare pays for about 70%-80% of expected expenses. Specialist visits do not require a referral. Emergency treatment is covered outside the designated territory, including anywhere in the US. Generally, claim submission is handled by the provider. Out-of-pocket expenses are reduced and you can choose your own physicians, specialists, and providers. Also, all plans qualify for a membership to “Silver&Fit.” Although prescription drug benefits are often provided by “Advantage” contracts, Supplement plans require (if desired), separate Part D drug coverage.
Current Monthly Rates:
Age 65
Plan A – $118.30
Plan B – $129.10
Plan C – $146.40
Plan D – $130.90
Plan F – $148.60
Plan G – $131.90
Plan N – $101.20
Age 68
Plan A – $132.90
Plan B – $146.10
Plan C – $165.90
Plan D – $148.30
Plan F – $168.00
Plan G – $149.30
Plan N – $116.50
Age 70
Plan A – $143.60
Plan B – $159.20
Plan C – $180.30
Plan D – $161.20
Plan F – $181.50
Plan G – $161.20
Plan N – $126.90
Age 72
Plan A – $154.60
Plan B – $172.60
Plan C – $195.20
Plan D – $174.50
Plan F – $197.50
Plan G – $175.50
Plan N – $140.00
Age 75
Plan A – $171.60
Plan B – $193.50
Plan C – $221.10
Plan D – $197.70
Plan F – $223.40
Plan G – $198.40
Plan N – $160.10
Age 80
Plan A – $185.40
Plan B – $216.50
Plan C – $255.60
Plan D – $228.50
Plan F – $258.00
Plan G – $229.20
Plan N – $188.90
“Security” Supplement plans are available if you have reached age 65 or are receiving Social Security benefits. Coverage includes inpatient and outpatient hospital care, payment of Medicare deductibles, diagnostic services, mammograms, and durable medical equipment. Sample monthly rates are illustrated below:
Ages 0-64
Plan A – $264
Plan B – $290
Plan C – $308
Plan F – $312
Plan N – $240
Ages 65-69
Plan A – $149
Plan B – $166
Plan C – $183
Plan F – $186
Plan N – $137
Ages 70-74
Plan A – $182
Plan B – $202
Plan C – $219
Plan F – $222
Plan N – $167
Medicare Advantage Plans
BlueJourney Essential HMO – $0 monthly premium with $0 deductible. Maximum out-of-pocket expenses are $6,500. Office visit copays are $5 and $30 with a $40 Urgent Care copay. Inpatient hospital stay copay is $250. The ER copay is $100 (waived if admitted), and the outpatient hospital copay is $0-$300. Lab services are subject to a $0-$25 copay. The outpatient x-ray copay is $25, and the diagnostic radiology x-ray copay is $0-$175.
Hearing services are subject to a $30 copay with a $0 copay for evaluations and fittings. The routine vision copay is $20, with $0 copays for contact lenses, eyeglass frames, and eyeglass lenses. The preventative dental services copay is $10. Durable medical equipment is subject to 20% coinsurance. Preferred/Standard 30-day cost sharing for prescriptions: Tier 1 (preferred generic) drugs are subject to $0/$10 copays and Tier 2 (generic) drugs are subject to $10/$20 copays. Tier 3 (preferred brand) drugs are subject to $47/$47 copays and Tier 4 (nonpreferred) drugs are subject to $100/$100 copays. Tier 5 (specialty) drugs have 33% coinsurance. Summary Star Rating is 4.0.
BlueJourney Value HMO – $65 monthly premium with $0 deductible. Maximum out-of-pocket expenses are $5,500. Office visit copays are $5 and $25 with a $50 Urgent Care copay. Inpatient hospital stay copay is $225. The ER copay is $90 (waived if admitted), and the outpatient hospital copay is $0-$250. Lab services are subject to a $0-$20 copay. The outpatient x-ray copay is $25, and the diagnostic radiology services copay is $0-$125.
Hearing services are subject to a $25 copay with a $0 copay for evaluations and fittings. The routine vision copay is $20, with $0 copays for contact lenses, eyeglass frames, and eyeglass lenses. The preventative dental services copay is $10. Durable medical equipment is subject to 20% coinsurance. Preferred/Standard 30-day cost sharing for prescriptions: Tier 1 (preferred generic) drugs are subject to $0/$7 copays and Tier 2 (generic) drugs are subject to $5/$15 copays. Tier 3 (preferred brand) drugs are subject to $47/$47 copays and Tier 4 (nonpreferred) drugs are subject to $100/$100 copays. Tier 5 (specialty) drugs have 33% coinsurance. Summary Star Rating is 4.0.
BlueJourney Premier HMO – $117 monthly premium with $0 deductible. Maximum out-of-pocket expenses are $3,700. Office visit copays are $5 and $20 with a $30 Urgent Care copay. Inpatient hospital stay copay is $125 for four days. The ER copay is $120 (waived if admitted), and the outpatient hospital copay is $0-$200. Lab services are subject to a $0-$20 copay. The outpatient x-ray copay is $25, and the diagnostic radiology x-ray copay is $50.
Hearing services are subject to a $20 copay with a $0 copay for evaluations and fittings. The routine vision copay is $20, with $0 copays for contact lenses, eyeglass frames, and eyeglass lenses. The preventative dental services copay is $10. Durable medical equipment is subject to 20% coinsurance. Preferred/Standard 30-day cost sharing for prescriptions: Tier 1 (preferred generic) drugs are subject to $0/$24 copays and Tier 2 (generic) drugs are subject to $0/$60 copays. Tier 3 (preferred brand) drugs are subject to $47/$141 copays and Tier 4 (nonpreferred) drugs are subject to $100/$300 copays. Tier 5 (specialty) drugs have 33% coinsurance. Summary Star Rating is 4.0.
BlueJourney Prime PPO – $177 monthly premium with $0 deductible. Maximum out-of-pocket expenses are $5,000. Office visit copays are $5 and $25 with a $35 Urgent Care copay. Inpatient hospital stay copay is $175 for the first 5 days. The ER copay is $120 (waived if admitted), and the outpatient hospital copay is $0-$225. Lab services are subject to a $0-$20 copay. The outpatient x-ray copay is $20, and the diagnostic radiology x-ray copay is $0-$125.
Hearing services are subject to a $25 copay with a $0 copay for evaluations and fittings. The routine vision copay is $10, with $0 copays for contact lenses, eyeglass frames, and eyeglass lenses. The preventative dental services copay is $10. Durable medical equipment is subject to 20% coinsurance. Preferred/Standard 30-day cost sharing for prescriptions: Tier 1 (preferred generic) drugs are subject to $0/$8 copays and Tier 2 (generic) drugs are subject to $5/$20 copays. Tier 3 (preferred brand) drugs are subject to $47/$47 copays and Tier 4 (nonpreferred) drugs are subject to $100/$100 copays. Tier 5 (specialty) drugs have 33% coinsurance. Summary Star Rating is 4.5.
BlueJourney Classic PPO – $51 monthly premium with $0 deductible. Maximum out-of-pocket expenses are $6,7000. Office visit copays are $5 and $30 with a $45 Urgent Care copay. Inpatient hospital stay copay is $240 for the first 5 days. The ER copay is $90 (waived if admitted), and the outpatient hospital copay is $0-$300. Lab services are subject to a $0-$20 copay. The outpatient x-ray copay is $25, and the diagnostic radiology x-ray copay is $230.
Hearing services are subject to a $0 copay with a $0 copay for evaluations and fittings. The routine vision copay is $20, with $0 copays for contact lenses, eyeglass frames, and eyeglass lenses. The preventative dental services copay is $10. Durable medical equipment is subject to 20% coinsurance. Preferred/Standard 30-day cost sharing for prescriptions: Tier 1 (preferred generic) drugs are subject to $0/$8 copays and Tier 2 (generic) drugs are subject to $5/$20 copays. Tier 3 (preferred brand) drugs are subject to $40/$47 copays and Tier 4 (nonpreferred) drugs are subject to $93/$100 copays. Tier 5 (specialty) drugs have 33% coinsurance.
Capital Blue Cross Select PPO – $0 monthly premium with $0 deductible. Maximum out-of-pocket expenses are $7,000. Office visit copays are $5 and $40 with a $50 Urgent Care copay. Inpatient hospital stay copay is $325. The ER copay is $95 (waived if admitted), and the outpatient hospital copay is $0-$330. Lab services are subject to a $0- $25 copay. The outpatient x-ray copay is $25, and the diagnostic radiology x-ray copay is $200.
Hearing services are subject to a $40 copay with a $0 copay for evaluations and fittings. The routine vision copay is $10, with $0 copays for contact lenses, eyeglass frames, and eyeglass lenses. The preventative dental services copay is $10. Durable medical equipment is subject to 20% coinsurance. Preferred/Standard 30-day cost sharing for prescriptions: Tier 1 (preferred generic) drugs are subject to $0 copays and Tier 2 (generic) drugs are subject to $5 copays. Tier 3 (preferred brand) drugs are subject to $40 copays and Tier 4 (nonpreferred) drugs are subject to $93/$100 copays. Tier 5 (specialty) drugs have 33% coinsurance.
Capital Blue Cross Small Group Plans
Platinum PPO 0/0/15 Rx 0 – $0 deductible and 0% coinsurance, with $6,900 maximum out-of-pocket expenses. Office visit copays are $15 and $30 with ER and Urgent Care copays of $150 and $50. Virtual visits are subject to only a $5 copay. Hi-Tech imaging subject to $0 copay. Lab test copays are $15 or $30 (independent lab or hospital lab). Speech, physical medicine, and occupational therapy visits are covered with a $30 copay for 30 visits. Outpatient surgery subject to $0 copay. 90-day mail-order prescription drug copays are $4 (generic preferred), $15 (non-generic preferred), $45 (brand preferred), and $70 (brand non-preferred).
Platinum PPO 0/0/15 Rx 250 – $0 deductible and 0% coinsurance, with $6,900 maximum out-of-pocket expenses. Office visit copays are $15 and $30 with ER and Urgent Care copays of $150 and $50. Virtual visits are subject to only a $5 copay. Hi-Tech imaging subject to $0 copay. Lab test copays are $15 or $30 (independent lab or hospital lab). Speech, physical medicine, and occupational therapy visits are covered with a $30 copay for 30 visits. Outpatient surgery subject to $0 copay. 90-day mail-order prescription drug copays are $14 (generic preferred), $50 (non-generic preferred), $110 (brand preferred), and $160 (brand non-preferred). A $250 deductible applies to brand drugs.
Platinum PPO 250/0/15 Rx 0 – $250 deductible and 0% coinsurance, with $6,900 maximum out-of-pocket expenses. Office visit copays are $15 and $30 with ER and Urgent Care copays of $200 and $50. Virtual visits are subject to only a $5 copay. Hi-Tech imaging subject to the deductible and $0 copay. Lab test copays are $15 or $30 (independent lab or hospital lab with deductible). Speech, physical medicine, and occupational therapy visits are covered with a $30 copay for 30 visits. Outpatient surgery subject to $0 copay but must meet deductible. 90-day mail-order prescription drug copays are $8 (generic preferred), $30 (non-generic preferred), $90 (brand preferred), and $140 (brand non-preferred).
Platinum PPO 250/0/15 Rx 250 – $250 deductible and 0% coinsurance, with $6,350 maximum out-of-pocket expenses. Office visit copays are $15 and $30 with ER and Urgent Care copays of $200 and $50. Hi-Tech imaging subject to the deductible and $0 copay. Lab test copays are $15 or $30 (independent lab or hospital lab with deductible). Speech, physical medicine, and occupational therapy visits are covered with a $30 copay for 30 visits. Outpatient surgery subject to $0 copay but must meet deductible. 90-day mail-order prescription drug copays are $10 (generic preferred), $50 (non-generic preferred), $100 (brand preferred), and $163 (brand non-preferred). A $250 deductible applies to brand drugs.
Gold PPO 0/0/25 Rx 0 – $0 deductible and 0% coinsurance, with $6,350 maximum out-of-pocket expenses. Office visit copays are $25 and $50 with ER and Urgent Care copays of $300 and $75. Hi-Tech imaging subject to $250 copay. Lab test copays are $25 or $50 (independent lab or hospital lab). Speech, physical medicine, and occupational therapy visits are covered with a $50 copay for 30 visits. Outpatient surgery subject to $125 or $250 copay. 90-day mail-order prescription drug copays are $10 (generic preferred), $38 (non-generic preferred), $113 (brand preferred), and $175 (brand non-preferred).
Gold PPO 0/0/25 Rx 250 – $0 deductible and 0% coinsurance, with $6,350 maximum out-of-pocket expenses. Office visit copays are $25 and $50 with ER and Urgent Care copays of $300 and $75. Hi-Tech imaging subject to deductible and $125 copay. Lab test copays are $25 or $50 (independent lab or hospital lab). Speech, physical medicine, and occupational therapy visits are covered with a $50 copay for 30 visits. Outpatient surgery subject to $125 or $250 copay. 90-day mail-order prescription drug copays are $10 (generic preferred), $50 (non-generic preferred), $100 (brand preferred), and $163 (brand non-preferred). A $250 deductible applies to brand drugs.
Gold PPO 500/0/25 Rx 0 – $500 deductible and 0% coinsurance, with $6,350 maximum out-of-pocket expenses. Office visit copays are $25 and $50 with ER and Urgent Care copays of $300 and $75. Hi-Tech imaging subject to $250 copay. Lab test copays are $25 or $50 (independent lab or hospital lab with deductible). Speech, physical medicine, and occupational therapy visits are covered with a $50 copay for 30 visits. Outpatient surgery subject to $125 or $250 copay, although deductible applies to acute care hospital. 90-day mail-order prescription drug copays are $10 (generic preferred), $38 (non-generic preferred), $113 (brand preferred), and $175 (brand non-preferred).
Gold PPO 500/0/25 Rx 250 – $500 deductible and 0% coinsurance, with $6,350 maximum out-of-pocket expenses. Office visit copays are $25 and $50 with ER and Urgent Care copays of $300 and $75. Hi-Tech imaging subject to deductible. Lab test copays are $25 or $50 (independent lab or hospital lab with deductible). Speech, physical medicine, and occupational therapy visits are covered with a $50 copay for 30 visits. Outpatient surgery subject to $125 or $250 copay, although deductible applies to acute care hospital. 90-day mail-order prescription drug copays are $10 (generic preferred), $38 (non-generic preferred), $113 (brand preferred), and $175 (brand non-preferred). A $250 deductible applies to brand drugs.
Gold PPO 1000/0/25 Rx 0 – $1,000 deductible and 0% coinsurance, with $6,350 maximum out-of-pocket expenses. Office visit copays are $25 and $50 with ER and Urgent Care copays of $250 and $75. Hi-Tech imaging subject to deductible. Lab test copays are $25 or $50 (independent lab or hospital lab with deductible). Speech, physical medicine, and occupational therapy visits are covered with a $50 copay for 30 visits. Outpatient surgery subject to $150 or $300 copay, although deductible applies to acute care hospital. 90-day mail-order prescription drug copays are $10 (generic preferred), $38 (non-generic preferred), $113 (brand preferred), and $175 (brand non-preferred).
Blue Cross Dental Plans
Counties – Adams, Berk, Centre, Columbia, Lancaster, Lehigh, Mifflin, Montour, Northampton, Schuylkill, Snyder, Union, and York. Counties B – Cumberland, Dauphin, Franklin, Fulton, Juniata, Lebanon, and Perry.
Dental PPO Care Plan – Adult rates are $23.53 (Counties A) and $26.37 (Counties B). Child rate is $25.20. Benefits include diagnostic and preventative services, basic services, and major services and orthedontia for children.
Dental PPO Loyalty Plan – Adult rates are $28.09 (Counties A) and $31.48 (Counties B). Child rate is $25.20. Benefits include diagnostic and preventative services, basic services, major services, and orthedontia for children.
Dental PPO Standard Plan – Adult rates are $38.00 (Counties A) and $42.59 (Counties B). Child rate is $25.20. Benefits include diagnostic and preventative services, basic services, major services, and orthedontia for children.
Dental PPO Premium Plan – Adult rates are $55.00 (Counties A) and $61,65 (Counties B). Child rate is $25.20. Benefits include diagnostic and preventative services, basic services, major services, and orthedontia for children.
Dental Select Basic – Adult rates are $18.14 (Counties A) and $18.14 (Counties B). Child rate is $20.92. Benefits include diagnostic and preventative services, basic services, major services, and orthedontia for children.
BC dental PPO plans allow you to use any dentist. However, by using a network dentist, savings will be the greatest. Select plans utilize a primary-care dentist (required). Additional routine and necessary and treatment is coordinated through the PCD. “Value-added discounts” are provided for certain pediatric orthodontic services without a waiting period.
Vision Plans
Vision benefits are offered at a monthly cost of $8.99. Network providers include Sears Optical, J.C. Penney, Walmart, Sams Club, Target Optical, and Pearle Vision. Contact lenses can also be ordered by mail, and a 15% discount applies to LASIK services. A $10 copay applies to an annual lenses exam. Contact lens visits do not have a copay. In-network lens copays include $12 for UV coating, $10 for tint and scratch-resistant, $40 for reflective, and $50 for standard progressive. Maximum allowances are $120 for frames and $100 for contact lenses instead of glasses.
Maximum allowances for providers outside of the network include $75 for contact lenses, $46 for trifocal lenses, $36 for bifocal lenses, $24 for single vision lenses, $60 for frames, and $32 for an exam.
Temporary Medical Plans (Currently Not Offered)
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, and 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 previously-available plans were:
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, unless no 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 Blue Cross 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. Short-term plans can be kept for 12 months without renewing the policy.
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.
PAST UPDATES:
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 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.
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 by avoiding the addition of many benefits that are now required by recent legislation. To be eligible, the company must have 50 employees (or less).
The PPO Silver Reserve has been eliminated from the list of available 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.
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 pre-authorization are also changing. Several non-emergency situations have been added and policyholders will be notified in writing.
Telehealth is coming! 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.
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.
Individual and family rates (Under age-65) will be released within the next five days. Rate increases will vary, depending on the plan and level of coverage.
