New July webinar: Recent legislation and the rising cost of care and what you need to know
Last month, we dug into what’s fueling the rise in healthcare costs, from health system consolidations to drug prices and beyond. But now, recent moves at both the federal and state levels are adding new layers that may impact employers and healthcare consumers.
Join our Government & Regulatory Affairs team on Wednesday, July 30 at 10:00 AM for a timely conversation on how policy shifts could shape costs and coverage moving forward.
Thank you for choosing Capital Blue Cross as your trusted partner. Together, we’re making a difference for Medicare beneficiaries in our communities
EOB and secure portal enhancements for three-tier plans
Enhancements to the Explanation of Benefits (EOB) and the secure portal experience are now in effect for members with three-tier products. Our current three-tier products are PPO Choice, PPO Choice Select, and Performance PPO. Additionally, we offer custom tiered products for certain employer group customers.
Updated EOBs will show deductibles, copays, coinsurance, and out-of-maximums for each tier. Additionally, EOBs will list provider tier information for every claim on the EOB.
Web and mobile enhancements were also completed. The accumulator information for both the secure member portal and the mobile app were updated to better reflect accumulator information for tiered products. The updated experience displays accumulator information for both in-network tiers in the secure portal.
New ePayment system is live
ECheck, card payments, and Capital’s Check It Out® program has transitioned to an improved autopay program with One, Inc. to process electronic invoice payments for Individual, CHIP, Medicare, Med Supp, Small Business ASO, mid-market groups, and all fully insured groups. Large ASO groups will not be impacted by this change.
Outreach to impacted members and groups about this change included invoice inserts and emails:
Check It Out: Groups and members who pay their invoices through Check It Out do not need to take any action. All payment information will be transferred to One, Inc. The only noticeable difference may be the description on their bank statement on or after July 24.
eCheck or card payments: Groups and members who pay by eCheck or card will need to update their payment information in their Capital Blue Cross secure account to ensure their payment processes on time. Card payments in the new system may be subject to a $3.00 fee per transaction from the new payment processor. ICHRA payments are not subject to the transaction fee.
Check or bill payer payments: Groups or members who pay by check or their bank’s bill payer system will not need to take any action.
The new autopay system will be available in time to make payments by August 1.
Please direct any questions to Producer Support. Thank you for your support in helping to make this a smooth transition for all.
Coming soon: MedsYourWay – Retail®, an innovative way to integrate drug discount card pricing
On August 1, we will launch MedsYourWay® – Retail, a program to simplify the retail pharmacy experience by comparing a member's copay amount to drug discount card prices, giving the member the best available price.
Drug discount cards are popular, but managing multiple cards at the pharmacy can be challenging. MedsYourWay offers convenience and savings via an integrated, point-of-sale shopping experience members can use at any participating in-network pharmacy. Prices on approximately ten different discount cards are queried each time a member fills a prescription as part of the program.
Members can get the lowest available price through either their copay amount or the discount, just by presenting their Capital member ID card at the pharmacy. Whether the copay or the discount is used, a member’s payment will be applied to their deductible and out-of-pocket maximum for covered drugs.
The initial launch will include fully insured groups, Small Business ASO, and individual account plans.
Annual Medicare certification now available
We are pleased to announce that our annual certification is now available. Since this is an important step in getting you ready to sell our 2026 plans, we encourage you to complete the certification at your earliest convenience. Here is some helpful information to get you started:
Capital Blue Cross Dental disruption analysis requests
A provider disruption analysis is a method of network analysis that compares the list of providers currently being used by employees and their eligible dependents against the list of providers in the prospective carriers’ provider network. It shows an employer how disruptive it will be for their employees to use a different network of providers because most people like their provider and don’t want to change.
By looking at the employer’s claims, the analysis can match the current provider usage by employees to the prospective network of providers. This determines what percentage of the currently utilized providers participate in the Capital Blue Cross Dental network that offers more than 500,000 national access points.
Large employer groups with 100 or more employees may request a Blue Cross Dental disruption analysis report. To provide an accurate provider disruption analysis, we need key pieces of information from the current carrier. When sharing current carrier utilization files for a disruption request, please provide:
Utilization file in Excel.
Provider participation status with current carrier: This information is crucial to assess the impact to employees and their eligible dependents. Without this information, we are unable to provide a true disruption analysis.
Full NPI (National Provider Identifier) number: This unique identifier is necessary for provider identification.
Tax Identification: This helps in verifying provider information and ensuring accuracy.
Claims count: This helps identify highly utilized providers.
Along with provider name, address, city, state, and zip code.
These key items will enable Capital Blue Cross to provide an accurate provider disruption analysis and valuable insights to a group about potential member impact when changing carriers. This also allows Capital to reach out to providers not currently in the network and start recruitment efforts.
If you have any questions, please reach out to your Account Executive.
Dental incentive credit for fully insured large group dental business
Large groups, including coalitions and consortiums with fewer than 100 enrolled, with a Capital Blue Cross medical plan are eligible for a one-time implementation credit of $26 PCPM when the group purchases a new fully insured group dental offering, beginning with January 1, 2026 effective dates. This implementation credit applies to all new fully insured group dental offerings except Dental PPO Value 75. The implementation credit will be calculated based on the fully insured dental contracts enrolled in the first billing cycle.
The credit will be issued electronically (EFT) or by check after the group’s first month bill has been paid in full, which means the credit will likely be issued in the second month of the group’s contract. If the group does not maintain continuous medical and dental coverage with Capital for a full twelve months, the dental implementation credit must be returned to Capital.
Existing Capital dental customers that add an additional dental plan do not qualify for the dental implementation credit incentive.
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.
