Save the date: Capitalize on Rx webinar — February 25, 9:30 AM ET
Learn how an integrated, data-driven pharmacy strategy can help your groups control costs, avoid common carve-out pitfalls, and stay ahead of emerging Rx trends. Watch your inbox for an invitation and registration link.
2026 employee wellness programs presented by our Health Promotion and Wellness team
New to 2026, we are pleased to offer multi-session wellness programs to our small and mid-market group customers. Please share these programs with your groups! We make it easy for them to pass along the details to employees with ready to copy/paste email templates in our digital promo guide and toolkit.
Programs include:
Register for Balance
Balance is a six-week program designed to help members manage stress and build mindfulness strategies for everyday life. Wednesdays, April 7-May 12, 12:00-1:00 PM ET
Register for Take Charge
Take Charge is a six-week program that will help members make the right lifestyle choices to prevent or manage diabetes. Mondays, July 6-August 10, 12:00-1:00 PM ET
Register for Empower
Empower is a six-week program that combines practical strategies with personalized planning to help members achieve their ideal weight. Wednesdays, October 7-November 11, 12:00-1:00 PM ET
Capital Blue Cross complies with all applicable mandates and encourages preventive care and wellness. To comply with the Women’s Preventive Service Initiative (WPSI) recommendations and the Pennsylvania mandate under Act 1 of 2023 and Act 52 of 2025, for women at average risk of breast cancer, Capital’s preventive coverage has been updated.
Beginning at the start of this month for women at average risk of breast cancer, Capital’s preventive coverage will include additional imaging (mammogram, ultrasound, and MRI) to complete the screening process and to address any findings on the initial screening mammography. Patient navigation services for breast and cervical cancer screening will also be covered as preventive.
Capital already covers BRCA screenings and related genetic counseling and testing as preventive (at no cost-share) for all non-grandfathered group customers that cover PPACA preventive services under their medical benefits.
In-network preventive services are provided at no member cost-share. Receiving services by an out-of-network provider may apply cost-share.
All fully insured and ASO non-grandfathered group customers and individual members who have PPACA preventive coverage under their Capital medical benefits are impacted by this update.
Health insurance companies and certain employers are required to provide information to members and the Internal Revenue Service (IRS) that confirm their members have minimum essential coverage (MEC).
Membership and coverage spreadsheets for mid-market ASO and large group ASO customers
As a courtesy to our mid-market* and large group** ASO customers, Capital emailed group administrators a list of subscribers and their respective dependents for whom each ASO customer provides MEC. Any new mid-market and large group ASO customer that enrolled in December 2025, will be emailed their spreadsheet no later than January 24. Producers may request a copy of the spreadsheet by contacting Producer Support.
Fully-Insured and small group ASO member mailing of 1095-B forms
Capital will mail the required 1095-B tax document no later than January 31, to the following:
All fully insured group subscribers.
Off-exchange individual subscribers.
On-exchange catastrophic subscribers.
PersonalBlue subscribers.
Small group ASO subscribers (small group ASO are those groups with 50 or fewer employees).
We will also send this information to the IRS to confirm MEC during the 2025 tax year.
1095-B Forms are only issued to subscribers. If the subscriber is enrolled through a group, the group does not receive copies of their employees’ 1095-B forms. Groups do not receive any listings, reports, or any other documentation specific to the 1095-B forms issued to their employees.
Individuals or groups should contact their tax adviser with any tax-related questions.
* A mid-market group is a group with 51 or more employees and fewer than 100 expected enrollees.
** A large group is a group with 51 or more employees and 100 or more expected enrollees, or a group enrolled in a large group coalition or consortium.
Capital is introducing a unique PPO benefit that encourages members to get treatment at Blue Distinction Specialty Care (BDSC) and Blue Distinction Specialty Care+ (BDSC+) hospitals and facilities, which are recognized for delivering high-quality care.
Large groups (100+) with custom plans can offer their members a zero or lower-than-normal cost share for care at BDSCs that specialize in the following services:
Knee and hip replacement
Spine surgery
Bariatric surgery
Transplants (heart, liver, bone marrow, pancreas, and lung)
The benefit is available for PPO, PPO HRA, or PPO HSA products, and can help employers control costs and improve member health to BDSCs' proven history of delivering quality care.
Members can use MyCare Finder to locate BDC/BDC+ providers. If a facility has the designation, the member will see a Blue Distinction Center icon. To see their specific center status, click 'Quality Details' under the icon.
Contact your account executive to learn more and request a quote.
Protect client and agency security by advising us of changes within the organizations that impact health plan and member information. This could include personnel updates or changes to employee responsibilities. When you reach out to your general agent or account executive with these updates, we can act to update or suspend access to group information and producer web tools.
Pennie and off-Pennie open enrollment for 2026 ends January 31. A February 1 effective date will apply.
Pennie extended the enrollment window this year so consumers can have more time to get assistance, review their options, and choose the plan that works best for themselves and their families.
Capital Blue Cross offers a portfolio of products on and off Pennie. As a reminder, producers must be certified by Pennie to participate.
Capital Blue Cross has adopted a team approach to support you, as we collaborate to enhance business relationships, foster your growth through education and incentives, and actively support the communities we serve. The commercial group teamthanks you for your commitment and hard work. Reach out whenever you need them.
From managers to broker resources and member service information, Capital has you covered. Producers for Individual and Medicare-focused clients, check out your agent guide when you need assistance.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association serving 21 counties in Central Pennsylvania and the Lehigh Valley. Communications issued by Capital Blue Cross in its capacity as administrator of programs.
