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FAQ

Answers to Your Common Questions

General

What counties are included in the Capital BlueCross service area?

The Capital BlueCross service area includes the Adams, Berks, Centre, Columbia, Cumberland, Dauphin, Franklin, Fulton, Juniata, Lancaster, Lebanon, Lehigh, Mifflin, Montour, Northampton, Northumberland, Perry, Schuylkill, Snyder, Union and York counties.

Does everyone in my family need to have the same Primary Care Provider (PCP)?

No.

What if I get sick out of Capital BlueCross’s coverage area?

Your member ID card opens doors to hospitals and doctors across the United States participating in the BlueCross BlueShield network. They’ll accept our payment as payment in full for covered services subject to member cost share, reducing your out-of-pocket expense. You may be responsible for more of the cost with non-participating providers or specialty care.

What if I travel outside of the country?

Your benefits travel with you! There are BlueCross BlueShield Association-participating hospitals and doctors in over 200 countries.

  • Find a doctor through BlueCross BlueShield Global Core or download the BlueCross BlueShield Global Core App.
  • If you’re able to visit a participating provider while abroad, just show your ID card.
  • If you must see a non-participating provider, ask for an itemized copy of your bill. You may have to pay this bill out-of-pocket. When you get home, submit a claim to us for possible reimbursement.
  • If you want a more robust, concierge-level health plan while abroad, explore plans from GeoBlue®*.

Can I pay my premium in person?

Yes. You can pay your premium at our Harrisburg office, Monday – Friday, 8:00 am – 4:30 pm, or at one of our Capital Blue health and wellness centers.

Can I pay my premium automatically?

Yes. Enroll in Check It Out® to give us access to your bank account.

Can I designate a third party to help me remember to pay my premium?

Yes. Enroll in Entrust®. When you are signed up and your bill is past due, we will send your final billing notice to your designated family member, friend, or agency. They can remind you to pay your premium and avoid cancellation.

My question isn’t answered here.

Please contact us online or visit one of our Capital Blue health and wellness centers for in-person assistance.  You may also call the customer service number on the back of your member ID card.

EOB Updates

What does this word mean?

Looking for a definition to a healthcare term? Check out our glossary.

Why does my EOB look different?

Starting in mid-March, your Explanation of Benefits (EOB) was redesigned to be easier to read and understand. You should now easily be able to find your medical service(s), the amount covered by your plan, and the amount you may still owe. In addition, EOBs are now bundled, meaning if you get more than one health service in a 14-day period, they will all appear on the same EOB.

Why were EOBs redesigned?

EOBs were redesigned to:

• Ensure that you can find and understand the information that is most important to you (e.g., “amount we paid” or “amount you owe”)
• Reduce the frequency at which they are sent, meaning less paper for you to sort through and file away

How are EOBs bundled?

Previously, an EOB was generated for every visit you or a dependent made to a healthcare provider. Your new EOBs span a 14-calendar-day period and include all claims finalized during that period.

What do EOBs look like online?

When you log in to your secure member account, you will continue to see individual claims listed by provider. However, the “View EOB” icon next to each claim will now bring up the same bundled EOB that you will receive in the mail.

If a claim is finalized before the bundled EOB is generated, you will not be able to view it. Instead, you will see this message: “Your EOB is not yet available. For more information on your claims, out-of-pocket costs, and copays, call the number on the back of [your ID card] for self-service options.”

What are the differences between in-network and out-of-network (OON) EOBs?

Since there is not a member rate for OON services, you will see “Allowed Amount” instead of “Your Member Rate” on OON EOBs. In addition, OON EOBs are not bundled and will continue to go out on a per claim basis, unless you receive multiple services by the same provider on the same day.

In you receive an in-network and OON EOB on the same day, they will be mailed together in the same envelope.

Remember, you can save money by choosing in-network providers.

Are EOBs for dental and vision claims changing?

No.

How can I get more information?

If you have additional questions about the new EOBs, you can contact us here or call the number on the back of your member ID card.

Where on my EOB can I see my deductible, copay, and coinsurance amounts?

You can see how much of your member and/or family deductible you have met on the bar chart(s) in the “Explanation of Benefits” section. You can find your copay/coinsurance amounts in the “Care Detail” section, along with the amount applied to your deductible and the amount you owe.

What is the “Amount You Owe” section?

This is the total amount you owe your provider(s) for the services you received. This may include your copay, coinsurance, any deductible you still need to meet, and any services that your benefits don’t cover. If you already paid your provider(s) all or part of this amount during your visit, make sure that amount is credited on your future bill.

What does it mean if the “Amount We Paid” section on an EOB shows $0?

You may see $0 if the services you received aren’t covered under your plan, if the cost went toward paying your copay, coinsurance, or deductible, or if they were paid by another insurer.

What are eligible services?

Eligible services are those that are covered under your health plan. Log in to your secure member account to review your benefits.

*GeoBlue is a trademark name of Worldwide Insurance Services, LLC, an independent licensee of the BlueCross BlueShield Association. All plans are underwritten by 4 Ever Life Insurance Company, an independent licensee of the BlueCross BlueShield Association.