2026 ACA for individuals and families product review and training
Capital Blue Cross would like to invite you to an upcoming training event as you prepare for this year’s ACA Open Enrollment. We are excited to present our ACA plans for individuals and families for the 2026 plan year.
Register now to join us online on Wednesday, October 1, 2025 from 10:00 AM to 11:00 AM ET, and learn more about:
By popular demand, we’re hosting a repeat guided demo of MyCareFinder on Wednesday, September 24, at 11:00 AM ET, ahead of AEP.
This session will walk you through how to use the tool to look up in-network providers and confirm participation quickly and accurately. We’ll also highlight tips to make provider searches smoother during client meetings. This webinar is a great opportunity to refresh your skills and feel more confident heading into AEP.
Capital Blue Cross expands network-driven product solutions with three-tier plan for 2026
Capital Blue Cross continues to design benefit plans that connect members to high-quality providers and help employers maximize their health plan investment.
Starting with 2026 effective dates, we’re introducing three new three-tier plans for all segments — large, nonlarge, consortium, and individual account (IA) members: Advance PPO, Capital Advantage PPO, and Convenience PPO.
Our current three-tier offerings — PPO Choice, PPO Choice Select, and Performance PPO — will continue for large group customers but will no longer be offered to nonlarge employer groups or IA members. Renewing nonlarge groups with one of the current tiered plans will be mapped to the corresponding new plan unless they choose an alternate plan from Capital's portfolio.
See the comparison chart for a high-level overview of all three-tier plan options.
Support for your open enrollment conversations To help employers explain these updates to their employees, use the following resources during open enrollment. Each piece is ready for you to share or link directly:
Incorporate these memos and flyers into your enrollment meetings, emails, or benefits portals so employer groups and their employees clearly understand the new tiered plan options.
2025 Out-of-pocket maximums (OOPM) increase
On June 25, 2025, the Department of Health and Human Services released final regulations that included a change to the 2026 OOPM limits under PPACA. The new limits are 4.4% higher than the initial 2026 OOPMs that were originally published. In our 2026 group product training presentation, we included the original limits. The updated amounts are $10,600 individual and $21,200 family.
Recap: Updated links for 2026 commercial group product training
We appreciate your participation in our recent 2026 group product training. A recording of the webinar and presentation deck are available if you would like to refresh what you learned or if you missed the in-person or virtual sessions.
The 2026 benefit grids include links to the highlight sheets and SBC for each plan.
The Pennsylvania Health Insurance Exchange Authority launched their annual broker certification program for 2026. Brokers can create or update their registrations and complete the training course on Pennie, the official site of the Pennsylvania Health Insurance Exchange Authority.
The annual open enrollment period on Pennie begins November 1, 2025.
Annual certificationis required to participate as a broker on the exchange. Current Pennie-certified brokers will need to complete their training by November 30. If you do not complete it by the deadline, you will be decertified effective December 31, and your customers will be de-designated.
Complete your annual Medicare certification with these tips in mind
The Medicare annual enrollment period (AEP) runs from October 15 to December 7. Complete your annual certification with Capital now so you are ready to sell our 2026 plans.
Here is some helpful information to get you started:
We’re pleased to share our 2026 Medicare Advantage plan designs and full benefit grids for each of our five market segments. Please take time to review these materials so you’re prepared to discuss options with your clients.
Segment 1 — Centre, Dauphin, Juniata, Mifflin, and Perry counties
Segment 2 — Columbia, Montour, Northumberland, Snyder, and Union counties
Segment 3 — Berks, Lehigh, Northampton, and Schuylkill counties
Segment 4 — Cumberland, Fulton, Lancaster, and Lebanon counties
As a reminder, the enrollment kit fulfillment portal is now updated with 2026 material. Be sure to place your orders early so you have the materials you need for AEP.
Thank you for your continued partnership and for the work you do to support Capital members and prospects every day.
YOUR TEAMS
Your producer relations team
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 Producer Relations 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.
