VirtualCare offers members access to healthcare professionals 24 hours a day, 7 days a week, every day of the year. A new feature allows members to see how many patients are in line before them, giving them a better idea of their expected wait time. Their position in line updates every 60 seconds.
New rates for services effective January 1, 2026*
For covered medical services, Capital will consider Amwell doctors and therapists as in-network providers. Medical visits for urgent care-type services "before insurance" cost will be $70.
Counseling and psychiatry visits vary by the type of provider and service the member requires. The "before insurance" average cost range will be $101-$270, depending on the provider and visit.*
Nutritional counseling services "before insurance" cost will be $70.*
You can check out the video that shows how members with access can use VirtualCare through the Capital Blue Cross mobile app or on our website.
* Members who must meet a deductible before their VirtualCare copay begins — such as those on standard QHDHPs — will pay the listed amount per visit until their deductible is met. Afterward, standard copays will apply.
We are adding an in-network deductible to the Blue Distinction® Centers for Transplant (BDCT) travel expense benefit. Effective upon renewal on or after January 1, 2026, the in-network deductible will apply to all standard travel expense benefits for transplants performed at a BDCT facility.
The change will apply to the following standard products, except Qualified High Deductible Health Plans (QHDHPs): Small group PPACA, small business ASO, mid-market, large group, and large custom group (both fully insured and self-funded). Note that QHDHPs and individual account plans already apply a deductible for this benefit today.
Federal law prohibits insurers and health plans from including language in network contracts that forbids the disclosure of certain provider-specific cost and/or quality information.
Plans and issuers must submit an attestation of compliance with the Consolidation Appropriations Act (CAA) gag clause requirements annually to CMS by December 31. Capital will be submitting our attestation for the time period of November 1, 2024 through October 31, 2025, or the effective date of the applicable group health plan or health insurance coverage (if later), to CMS no later than December 31, 2025.
Capital is preparing to submit the CAA Gag Clause Prohibition Compliance Attestation (GCPCA) on behalf of fully-insured and small business ASO group customers.
Self-funded ASO group customers may elect to have Capital submit an attestation on their behalf by completing the appropriate form by November 21, 2025. The form must be completed by an authorized employee of the group and cannot be completed by a producer.
Self-funded ASO group customers are not required to submit their attestation through Capital Blue Cross and can choose to submit their attestation on their own.
Please direct any questions to your legal counsel or Account Executive.
Avalon Insurance Company’s cell and gene therapy product for Avalon Stop Loss customers can help manage the financial impacts of high-cost cell and gene therapies by placing them into a separate risk pool.
ASO groups who have a current Avalon stop loss policy are eligible for this buy-up option.
Key features of Avalon’s cell and gene therapy product include:
Competitive pricing at $3.25 PCPM.
Annual updates of covered therapies based on FDA approvals. Seven new drugs have been added effective January 1, 2026.
First dollar coverage with no additional deductible.
Available advanced funding for qualifying Avalon customers.
When members use MyCare Finder to search for in-network providers and compare costs, they aren't limited to just primary care physicians. They can search for services related to dental, vision, pharmacy, and even lab work and outpatient care.
The MyCare Finder Resource Library houses guides and videos that empower members to use the tool to their advantage. When members visit the page, they are prompted to log in or register. When members log in to their secure account, their inquiry can return search results specific to their plan.
CMS recently released Star Ratings for plan year 2026. We are pleased to announce that all of Capital’s Medicare Advantage HMO and PPO plans have received a 4.5 Star Rating.
For any 2026 enrollment kits that you have in inventory, please replace the Star Rating sheets. Be sure to include both HMO and PPO versions. You should begin using the 2026 Star Ratings in 2026 enrollment kits effective immediately.
If you need us to send you a printed supply of Star Rating sheets, email us at CBCMSPI@capbluecross.com.
Capital has included the proposed rates for BlueReliance® Medicare Supplement plans that apply to newly eligible members effective January 1, 2026. (These rates should not be used for existing members at this time.) These are proposed rates and may change until final approval is received from the Pennsylvania Insurance Department (PID).
Effective January 1, 2026, Capital is introducing gender rating for Plans D, G, and N. The proposed rate charts include both female and male rates for new members enrolling for January 1. Plans A, B, C, and F will continue to have the same rates for females and males.
Use these charts when enrolling individuals in BlueReliance Medicare Supplement plans for a January 1 or later effective date. Please do not distribute these rate charts. We are unable to update the BlueReliance Medicare Supplement enrollment kits until rates are approved.
Please also do not share these proposed rates with existing BlueReliance members, as they remain pending PID approval. Capital will send a premium increase mailing to members once approval is received.
The open enrollment period this year is November 2025 through January 2026.
Capital offers medical plans in our 21-county service area with various network options depending on where the member lives. And we don't stop at health coverage. Members can take advantage of the network and benefits of Capital Blue Cross Dental and Capital Blue Cross Vision plans as well.
To help ensure paper Medicare Advantage applications are processed quickly and accurately, please review the following reminders when using the upload process. Improperly scanned applications may fail in the Optical Character Recognition (OCR) process and require manual entry into the enrollment system, which can delay processing.
Common reasons for OCR failure:
Blank pages inserted every other page.
Pages scanned upside down or skewed.
Including the instruction page in the scan.
Helpful reminders:
Applications must be uploaded in PDF format.
Scan pages in the correct order (one-sided only).
Do not include the first page of instructions.
Do not include blank pages between application pages.
Ensure pages are straight and right side up.
Scan any attachments after the application pages.
Following these steps helps ensure applications are processed promptly and without delays.
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.
