June 25 webinar to help commercial groups navigate the rising cost of healthcare
Healthcare costs continue to climb year over year — and understanding the “why” behind these trends is the first step toward helping your groups stay ahead. Join us for an informative webinar on Wednesday, June 25 at 10:00 AM to learn how Capital is addressing these challenges with innovative, cost-effective solutions.
Changes to minimum participation requirement for Capital Blue Cross Dental and Vision plans is effective July 1
Effective July 1, 2025, the 75% minimum participation requirement for dental and vision is eliminated.
Voluntary plans will be eliminated.
Nonlarge group customers with current higher-priced voluntary plans will be mapped to plans with the same benefits at a lower cost at renewal.
Large groups will continue to be experience rated.
Please note that at Capital, products presented as “voluntary” required only 25% minimum participation (instead of the normal 75% participation). Employer groups can still set their own contribution rules and can describe a plan as “voluntary” for their own HR purposes. Standard documents published from Capital, however, will no longer use the word “voluntary” or “nonvoluntary,” nor will Capital distinguish between a voluntary vs. nonvoluntary contribution strategy from a rating perspective.
A Multiple Coverage Credit is available to a fully insured large group if they have 75% participation in medical and dental/vision plans.
IntegratedRx offers coordinated pharmacy experience for members with cancer and cystic fibrosis
Capital is pleased to offer IntegratedRx, a new pharmacy program that supports our commitment to go the extra mile for our customers. The program helps to ensure convenient, quality care for members with cancer and cystic fibrosis.
We have activated an additional network of provider-based specialty pharmacies for eligible members with Capital’s prescription drug benefit. Starting June 1, 2025, IntegratedRx launched for Capital members with fully insured group, Small Business ASO, and individual account plans.
Here's how the program can help members with cancer or cystic fibrosis who get care at a facility with a pharmacy in the IntegratedRx network:
Enhanced care coordination — The provider and pharmacist are part of the same care team in the same facility working together to provide quality care.
Faster treatment — Up to two days faster than using mail order pharmacies.
Convenience — Members pick up prescriptions where they get care.
Improved adherence — Simplified process can make it easier to take prescription drugs as prescribed.
We plan to expand the program to Large Group ASO employer groups in 2026, and we’ll share details when available.
New tip sheets and videos on MyCare Finder
Capital members now have access to tip sheets and videos to assist them with common MyCare Finder questions behind the Need Help with MyCare Finder? tile.
Health Reimbursement Arrangement (HRA) administration application required for renewing groups
Groups offering an HRA must complete an administration application annually at renewal, even if the group is not making changes to their HRA offering. The forms are specific to small and mid-market groups or custom groups of 101+. Completing the form confirms the funding and administration components for a group's new benefits period.
The completed form should be submitted at least 30 days before the group’s effective date to avoid potential delays to HRA claims processing.
Capital is working to implement a cardiology UM program for medical necessity and appropriate length of stay.
Starting July 1, 2025, UM for select cardiology services will begin for small business ASO and large group ASO plans. Earlier this year, we also implemented these services for plans in these Capital business lines: Individual Account, Medicare Advantage, CHIP, and fully insured group.
Examples of cardiac surgeries and procedures that will require preauthorization include coronary angioplasty/stenting, pacemaker implantation, and cardiac catheterization. Impacted procedures are on Capital’s single source preauthorization list.
The new program will help ensure that our members get the best possible care, delivered cost effectively. Contact your account executive with any questions.
June is Alzheimer’s and Brain Awareness Month
According to the Alzheimer’s Association, over 7 million Americans live with Alzheimer’s disease. Alzheimer’s disease is a degenerative brain disease and the most common cause of dementia. Dementia is not a specific disease. It's an overall term that describes a group of symptoms.
Many risk factors play a role in developing Alzheimer's disease:
Age.
Family history and genetics.
Head injury.
Modifiable risk factors, such as diet and exercise, tobacco use, stress management, weight and body composition, sleep, etc.
Employers can use the 2025 Monthly Healthy Blue Rewards (HBR) Happeningsto learn more about Alzheimer's disease and other brain disorders. They are encouraged to promote their Healthy Blue Rewards program to help employees reach their health and fitness goals with this monthly promotional calendar of activities.
All Capital Blue Cross members have access to Healthy Blue Rewards at no cost and includes web access. Employees can also use the AlwaysOn® Wellness app, offering a highly personalized experience to help employees manage their health journey.
The Healthy Blue Rewards Premier program offers a branded, customizable platform where your clients can customize incentives and rewards based on their company’s goals with custom reporting and one-on-one support.
AlwaysOn® is a registered trademark of Onlife Health, Inc., an independent company. On behalf of Capital Blue Cross, Onlife Health provides health information content and wellness tools.
The value of dental coverage
Dental coverage is crucial for bright smiles and overall health. Regular dental care can lower risks of severe conditions like heart disease and cancer.
For businesses, this means offering employees dental coverage. By providing comprehensive dental plans and promoting regular check-ups, they empower employees to prioritize oral health. This proactive stance not only reduces dental issues but also enhances overall well-being, leading to increased productivity and a healthier workforce that thrives beyond just dental health.
Capital provides plans with minimal or no cost-sharing for diagnostic and preventive services, making preventive dental care a valuable option to alleviate the financial strain of chronic health issues. Moreover, members with specific chronic conditions can access enhanced dental benefits for gum disease treatment, available on most dental plans, ensuring comprehensive care for overall health.
To encourage use of the dental benefits, Capital engages in ongoing communication and education about its dental plans. For customer companies, Capital can provide a dental wellness awareness toolkit with resources that explain the benefits of oral wellness.
Contact your General Agent or Account Executive for more information on our variety of dental plans.
CONTACT
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.
