Capital Blue Cross health plans cover many important vaccines — several at no cost — that help keep our members and communities healthy and safe. Members should check their plan benefits or reach out to us if they have questions about coverage, eligibility, and co-pays. The decision to receive a vaccine should be made between patients and their healthcare providers.
We appreciate your participation in the peak season prep webinar held on September 17 to help you have a smooth season. A recording of the webinar and presentation deck are available if you missed it or want to refresh what you learned.
Genetic molecular lab testing preauthorization program coming soon
Capital is working to implement an innovative genetic molecular lab testing preauthorization program designed to guide the best possible care for our members while balancing cost to best serve our customers.
Starting November 1, 2025, UM for genetic molecular lab services will begin for plans in these Capital business lines: Individual Account, Medicare Advantage, CHIP, and fully insured group. On January 1, we will also implement these services for small business ASO and upon renewal on or after January 1 for large group ASO plans.
Our genetic molecular lab testing preauthorization program is supported by a team of doctors who can provide an expert-level review for evidence-based care for specific tests such as hereditary cancer syndromes, pharmacogenomics testing, and carrier screening tests. More specialized preauthorization reviews can mean better outcomes, reduced costs, and safer procedures.
The new program will help ensure that our members get the best possible care, delivered cost effectively. Contact your account executive with any questions.
Group benefits application has been updated
We have released a new version of the Application for Group Benefits (C-70). Use Version 8 for all groups applying for new commercial group coverage or requesting changes to existing coverage with a 2026 effective date. To confirm you are using the correct version for your 2026 group activity, check the lower-left footer for the form version GpBenefitsAppV.8.
We removed the Medicare secondary payer (MSP) questions and directions from the application. Groups must now complete the MSP form NF-467 to answer the required MSP questions for both new and existing customers.
For new nonlarge groups submitted through the Your Enrollment Solution (YES) tool, the system will adjust automatically based on the effective date.
You can find the application and many other resources whenever you need them in the Producer Portal.
Capital Blue Cross continues to design benefit plans that connect members to high-quality providers and help employers maximize their health plan investment. We recently shared that 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.
Visit the comparison chart to review a high-level overview of all three-tier plan options.
We inadvertently duplicated providers for the Advance PPO plan's Choice options in our 2026 product flyer. Please refer to the corrected and updated 2026 network-driven product solutions flyer (GS-422) when speaking to your groups.
Boost your sales with Capital Blue Cross Dental
Capital Blue Cross has made it easier than ever for groups to add dental coverage and for you to grow your business. Don’t forget, every dental sale also boosts your earnings through our Producer Incentive+ Program.
Why sell Capital Blue Cross Dental?
No participation requirement: We’ve eliminated the 75% minimum enrollment for dental and vision (effective July, 2025).
New or renewing groups with medical and dental get a one-month premium/administration holiday at enrollment and again at renewal.
New large fully insured dental groups can earn a one-time $26 PCPM implementation credit (effective January 1, 2026).
Extensive network: Over 5,000 regional access points and nearly 530,000 dental access points nationwide, keeping costs down and benefits strong.
Accessibility: 97% of members have two dentists within 10 miles.
Affordable options: Our Dental PPO Value 75 plan is priced under $5 per month for individuals.
Contact your account executive today to start building more value for your clients — and more success for you.
Mental health challenges among youth are making their way into the workplace, often disguised as performance issues, stress, or burnout. Nearly 1 in 5 children in the U.S. live with a mental health condition such as anxiety, depression, or behavioral disorders. And for working parents, the impact is palpable:
Over 53% report missing work at least once a month to tend to a child’s mental health needs.
54% interrupt their workday to address those challenges.
And for parents under 40, the availability of mental health support is a key factor in choosing an employer.
When employees feel supported in caring for their children’s mental wellness, the ripple effects can be profound: fewer absences, better engagement, and a healthier work culture. Dr. Bernard DiCasimirro of Capital Blue Cross notes that even a simple conversation can open the door to help and inspire change. Share the latest THINK piece with your groups so they can see how they can best support their business by supporting their employees.
Capital will begin offering the option to opt for paperless invoices, payment reminders (for those not enrolled in autopay), and delinquency notices for Individual, Medicare, and Med Supp members. Renewal notices for Individual and Med Supp members will also be available electronically.
A web banner on our website provides a link where members can log in to their preference center to opt in to paperless billing. Capital also delivered emails to Medicare Advantage, Individual, and Med supp members letting them know they can now receive billing and renewal information digitally.
Segment 5 Medicare Advantage enrollment kit
There was an error for the plan premium amount for the Essential HMO that appears on page 5 of the enrollment kit for segment 5. Note that the correct premium is $0, not $177. We are making the correction for future kit orders, but for kits currently in your inventory, you can print the correction page to insert into your kits.
There was an error for the plan premium amount for the Essential HMO that appears on page 5 of the enrollment kit for segment 5. Note that the correct premium is $0, not $177. We are making the correction for future kit orders, but for kits currently in your inventory, you can replace the incorrect information by printing and inserting into your kits this corrected page (pg. 6).
Medicare AEP 2026: Enter a season of change with the tools and support you need
The annual enrollment period (AEP) is about to begin, and this year is shaping up to be one of the most disruptive in recent years. With shifting plan designs, service area reductions, and increased competition, members will be faced with more questions and uncertainty than ever before. That makes your role as a trusted advisor absolutely essential.
We know that AEP is the time when your business and hard work truly accelerate. The pace is fast, the demands are high, and the responsibility you carry on behalf of your clients is significant. At Capital, we recognize the commitment it takes and want to assure you that you are not doing this alone.
Our Producer Portal is designed to keep you prepared and supported throughout the season. Inside, you’ll find:
Plan documents and sales grids that make it easy to compare options across our service area.
Enrollment kits can be ordered quickly to ensure you always have what you need on hand.
Training and compliance resources to help you stay up to date and confident in your client conversations.
Market segmentation maps to guide you in identifying opportunities across our 21-county footprint.
Enrollment status look-up to easily and quickly stay on top of you enrollment submissions
In addition, we’ve created a guide that consolidates your most important phone numbers, email addresses, and websites into one convenient reference. Whether you are preparing for client meetings, responding to member questions, or navigating changes in real time, the Producer Quick Reference Guide puts the essentials right at your fingertips.
As this AEP unfolds, your professionalism, expertise, and dedication will make all the difference for members trying to navigate their choices. We value the partnership you bring and the trust you place in us. Thank you for everything you do to serve your clients and communities during this important season.
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.
