2021 Benefit Updates

For Renewing Members

If you had 2020 coverage you can view your online renewal in your secure member portal.

Renewing Medical Coverage

On exchange plans purchased through Healthcare.gov, which will now be purchased through Pennie for 2021.

Gold PPO 2150/10/20

Below are the benefit changes for 2021

All counties, except Lancaster

  • In-Network annual maximum out of pocket limit - $8,550 single/$17,100 family
  • Outpatient Surgery performed at an Ambulatory Surgical Facility - 10% coinsurance after deductible

Lancaster County

  • You are being mapped to a new plan called, Gold PPO Choice 2000/0/30 STD
  • In-Network annual deductible - $2,000 single/$4,000 family for Choice 1 providers; $4,000 single/$8,000 family for Choice 2 providers
  • In-Network annual maximum out of pocket limit - $8,550 single/$17,100 family
  • PCP copayment - $30 for Choice 1 providers; $50 for Choice 2 providers
  • Specialist copayment - $50 for Choice 1 providers; $75 for Choice 2 providers
  • Emergency Room Services - $200 Copayment after Choice 1 deductible
  • Outpatient Surgery performed at an Ambulatory Surgical Facility -Paid in full after deductible for Choice 1 providers; 30% coinsurance after deductible for Choice 2 providers

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2021.

Silver PPO 6000/20/40

Below are the benefit changes for 2021

All counties, except Lancaster

  • In-Network annual maximum out of pocket limit - $8,550 single/$17,100 family
  • Outpatient Surgery performed at an Ambulatory Surgical Facility - 20% coinsurance after deductible

Lancaster County

  • You are being mapped to a new plan called, Silver PPO Choice 4000/20/35 STD
  • In-Network annual deductible - $4,000 single/$8,000 family for Choice 1 providers; $8,550 single/$17,100 family for Choice 2 providers
  • In-Network annual maximum out of pocket limit - $8,550 single/$17,100 family
  • PCP copayment - $35 for Choice 1 providers; $60 for Choice 2 providers
  • Specialist copayment - $65 for Choice 1 providers; $85 for Choice 2 providers
  • Emergency Room Services - $400 Copayment after Choice 1 deductible
  • Outpatient Surgery performed at an Ambulatory Surgical Facility -20% coinsurance after deductible for Choice 1 providers; Paid in full after deductible for Choice 2 providers

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2021.

Silver PPO 6000/20/40 CSR73

Below are the benefit changes for 2021

All counties, except Lancaster

  • Outpatient Surgery performed at an Ambulatory Surgical Facility - 15% coinsurance after deductible

Lancaster County

  • You are being mapped to a new plan called, Silver PPO Choice 4000/20/35 CSR73
  • In-Network annual deductible - $3,800 single/$7,600 family for Choice 1 providers; $6,800 single/$13,600 family for Choice 2 providers
  • In-Network annual maximum out of pocket limit - $6,800 single/$13,600 family
  • PCP copayment - $25 for Choice 1 providers; $60 for Choice 2 providers
  • Specialist copayment - $50 for Choice 1 providers; $85 for Choice 2 providers
  • Emergency Room Services - $200 Copayment after Choice 1 deductible
  • Outpatient Surgery performed at an Ambulatory Surgical Facility -15% coinsurance after deductible for Choice 1 providers; Paid in full after deductible for Choice 2 providers

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2021.

Silver PPO 6000/20/40 CSR87

Below are the benefit changes for 2021

All counties, except Lancaster

  • Outpatient Surgery performed at an Ambulatory Surgical Facility - 5% coinsurance after deductible

Lancaster County

  • You are being mapped to a new plan called, Silver PPO Choice 4000/20/35 CSR87
  • In-Network annual deductible - $1,500 single/$3,000 family for Choice 1 providers; $2,850 single/$5,700 family for Choice 2 providers
  • In-Network annual maximum out of pocket limit - $2,850 single/$5,700 family
  • PCP copayment - $15 for Choice 1 providers; $40 for Choice 2 providers
  • Specialist copayment - $30 for Choice 1 providers; $60 for Choice 2 providers
  • Emergency Room Services - $75 Copayment after Choice 1 deductible
  • Outpatient Surgery performed at an Ambulatory Surgical Facility - Paid in full after deductible

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2021.

Silver PPO 6000/20/40 CSR94

Below are the benefit changes for 2021

All counties, except Lancaster

  • In-Network annual deductible - $425 single/$850 family
  • Outpatient Surgery performed at an Ambulatory Surgical Facility -Paid in full after deductible

Lancaster County

  • You are being mapped to a new plan called, Silver PPO Choice 4000/20/35 CSR94
  • In-Network annual deductible - $500 single/$1,000 family for Choice 1 providers; $1,000 single/$2,000 family for Choice 2 providers
  • In-Network annual maximum out of pocket limit - $1,000 single/$2,000 family
  • PCP copayment - $5 for Choice 1 providers; $10 for Choice 2 providers
  • Specialist copayment - $10 for Choice 1 providers; $30 for Choice 2 providers
  • Emergency Room Services - $50 Copayment after Choice 1 deductible
  • Outpatient Surgery performed at an Ambulatory Surgical Facility - Paid in full after deductible

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2021.

Bronze PPO 8000/0/50

Below are the benefit changes for 2021

All counties, except Lancaster

  • In-Network annual maximum out of pocket limit - $8,550 single/$17,100 family
  • PCP Copayment - $50
  • Virtual Care Service performed by Family Practitioner, General Practitioner, Internist or Pediatrician - $25 Copayment
  • Outpatient Surgery performed at an Ambulatory Surgical Facility -Paid in full after deductible

Lancaster County

  • You are being mapped to a new plan called, Bronze PPO Choice 7100/0/50 STD
  • In-Network annual deductible - $7,100 single/$14,200 family for Choice 1 providers; $8,550 single/$17,100 family for Choice 2 providers
  • In-Network annual maximum out of pocket limit - $8,550 single/$17,100 family
  • PCP copayment - $50 for Choice 1 providers; Paid in full after deducible for Choice 2 providers
  • Specialist copayment - $85 for Choice 1 providers; Paid in full after deducible for Choice 2 providers
  • Emergency Room Services - Paid in full after Choice 1 deductible
  • Urgent Care Services - Paid in full after Choice 1 deductible
  • Outpatient Surgery performed at an Ambulatory Surgical Facility -Paid in full after deductible

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2021.

Zero/Limited Plans

Below are the benefit changes for 2021

All counties, except Lancaster

No medical changes

Lancaster County

You are being mapped to one of the new plans, depending on your current plan:

  • Gold PPO 2150/10/20 Zero OR Limited -> Gold PPO Choice 2000/0/30 Zero OR Limited
  • Silver PPO 6000/20/40 Zero OR Limited -> Silver PPO Choice 4000/20/35 Zero OR Limited
  • Bronze PPO 8000/0/60 Zero OR Limited -> Bronze PPO Choice 7100/0/50 Zero OR Limited

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2021.

Off Exchange plans purchased directly through Capital BlueCross

Gold PPO 2150/10/20

Below are the benefit changes for 2021

All counties, except Lancaster

  • In-Network annual maximum out of pocket limit - $8,550 single/$17,100 family
  • Outpatient Surgery performed at an Ambulatory Surgical Facility - 10% coinsurance after deductible

Lancaster County

  • You are being mapped to a new plan called, Gold PPO Choice 2000/0/30
  • In-Network annual deductible - $2,000 single/$4,000 family for Choice 1 providers; $4,000 single/$8,000 family for Choice 2 providers
  • In-Network annual maximum out of pocket limit - $8,550 single/$17,100 family
  • PCP copayment - $30 for Choice 1 providers; $50 for Choice 2 providers
  • Specialist copayment - $50 for Choice 1 providers; $75 for Choice 2 providers
  • Emergency Room Services - $200 Copayment after Choice 1 deductible
  • Outpatient Surgery performed at an Ambulatory Surgical Facility -Paid in full after deductible for Choice 1 providers; 30% coinsurance after deductible for Choice 2 providers

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2021.

Silver PPO 5950/20/40

Below are the benefit changes for 2021

All counties, except Lancaster

  • In-Network annual maximum out of pocket limit - $8,550 single/$17,100 family
  • Outpatient Surgery performed at an Ambulatory Surgical Facility - 20% coinsurance after deductible

Lancaster County

  • You are being mapped to a new plan called, Silver PPO Choice 3950/20/35
  • In-Network annual deductible - $3,950 single/$7,900 family for Choice 1 providers; $8,550 single/$17,100 family for Choice 2 providers
  • In-Network annual maximum out of pocket limit - $8,550 single/$17,100 family
  • PCP copayment - $35 for Choice 1 providers; $60 for Choice 2 providers
  • Specialist copayment - $65 for Choice 1 providers; $85 for Choice 2 providers
  • Emergency Room Services - $400 Copayment after Choice 1 deductible
  • Outpatient Surgery performed at an Ambulatory Surgical Facility -20% coinsurance after deductible for Choice 1 providers; Paid in full after deductible for Choice 2 providers

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2021.

Silver PPO 6000/20/40

Below are the benefit changes for 2021

All counties, except Lancaster

  • In-Network annual maximum out of pocket limit - $8,550 single/$17,100 family
  • Outpatient Surgery performed at an Ambulatory Surgical Facility - 20% coinsurance after deductible

Lancaster County

  • You are being mapped to a new plan called, Silver PPO Choice 4000/20/35
  • In-Network annual deductible - $4,000 single/$8,000 family for Choice 1 providers; $8,550 single/$17,100 family for Choice 2 providers
  • In-Network annual maximum out of pocket limit - $8,550 single/$17,100 family
  • PCP copayment - $35 for Choice 1 providers; $60 for Choice 2 providers
  • Specialist copayment - $65 for Choice 1 providers; $85 for Choice 2 providers
  • Emergency Room Services - $400 Copayment after Choice 1 deductible
  • Outpatient Surgery performed at an Ambulatory Surgical Facility -20% coinsurance after deductible for Choice 1 providers; Paid in full after deductible for Choice 2 providers

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2021.

Bronze PPO 8000/0/50

Below are the benefit changes for 2021

All counties, except Lancaster

  • In-Network annual maximum out of pocket limit - $8,550 single/$17,100 family
  • PCP Copayment - $50
  • Virtual Care Service performed by Family Practitioner, General Practitioner, Internist or Pediatrician - $25 Copayment
  • Outpatient Surgery performed at an Ambulatory Surgical Facility - Paid in full after deductible

Lancaster County

  • You are being mapped to a new plan called, Bronze PPO Choice 7100/0/50
  • In-Network annual deductible - $7,100 single/$14,200 family for Choice 1 providers; $8,550 single/$17,100 family for Choice 2 providers
  • In-Network annual maximum out of pocket limit - $8,550 single/$17,100 family
  • PCP copayment - $50 for Choice 1 providers; Paid in full after deducible for Choice 2 providers
  • Specialist copayment - $85 for Choice 1 providers; Paid in full after deducible for Choice 2 providers
  • Emergency Room Services - Paid in full after Choice 1 deductible
  • Urgent Care Services - Paid in full after Choice 1 deductible
  • Outpatient Surgery performed at an Ambulatory Surgical Facility -Paid in full after deductible

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2021.

Bronze HMO 8000/0/50

Below are the benefit changes for 2021

All counties

  • Annual maximum out of pocket limit - $8,550 single/$17,100 family
  • PCP Copayment - $50
  • Virtual Care Service performed by Family Practitioner, General Practitioner, Internist or Pediatrician - $25 Copayment
  • Outpatient Surgery performed at an Ambulatory Surgical Facility -Paid in full after deductible

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2021.

Catastrophic PPO 8550/0/75

Below are the benefit changes for 2021

All counties

  • In-Network annual deductible - $8,550 single/$17,100 family
  • In-Network annual maximum out of pocket limit - $8,550 single/$17,100 family

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2021.

Catastrophic HMO 8550/0/75

Below are the benefit changes for 2021

All counties

  • Annual deductible - $8,550 single/$17,100 family
  • Annual maximum out of pocket limit - $8,550 single/$17,100 family

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2021.

Pharmacy Changes

Visit the prescription drug benefits page to view plan formularies and other important information for 2021.

Enrollment

Open Enrollment Timeline

Open enrollment is from November 1st, 2020- January 15th, 2021.

Applications for coverage effective January 1st, 2021 must be submitted between November 1st-December 15th, 2020.

Applications for coverage effective February 1st, 2021 must be submitted between December 16th, 2020- January 15th, 2021.

Any applications submitted outside of the above timeline will fall into the Special Enrollment Period and must have a qualifying event to enroll.

Ready to Enroll or Make a Change

You can apply for medical with Rx included, dental or vision plans if you live in our service area.

Visit our Individual and Family Plans to get started.

Enrollment Details

Current member

If you’re a current member and you would like to keep your current plan (or the one you’re being mapped to), you do not need to take any action. We will enroll you in the plan outlined in your renewal packet.

On Exchange members

Visit Pennie to review your application for any changes, including any changes to your financial help.

New Member

If you are a new member, you’ll receive a declaration page after you enroll. The page provides the effective date of coverage, covered members and expected premium amounts.

ID Cards

You may receive a new ID card in mid-December. Please keep and be ready to use beginning January 1st.

Current stand-alone dental and vision members will not receive a new ID card for 2021, unless you made a plan change.

Billing

Invoices for January enrollment will be generated on December 10, 2020.

Estimated Subsidies in Renewal Package (On Marketplace Members Only)

Reminder that the declaration page in your renewal packet may show you a premium different than your bill for 2021.

These estimates were based on your 2020 Advanced Premium Tax Credit (APTC) instead of your 2021 APTC. Your final 2021 premium may be higher or lower than the amount estimated in your renewal packet.

To confirm that your tax and income information is correct, please visit Pennie. Review your application to make sure the information is still current and accurate and to see if you qualify for more or less financial help than in 2020. Report changes in your expected income, changes to your household or individual members or changes in your healthcare (Medicare or Medicaid eligible).

Or call us at the number on the back of your member ID card to confirm your monthly premium.

Payment Options

  • Credit Card/eCheck

    Make payments by logging into your secure member account or by calling 833.496.7321. Select a single payment or setup recurring payment options.

  • Check it Out

    Members will receive a notice when Check It Out is processed. Payment will be deducted from the selected account on the first day of each month.

  • Paper Bill

    Invoices are mailed to the address on the enrollment application.

  • Bill Payer

    Payments can be made through a financial institution’s bill payer program.

You can now view your invoices and payment history here.

Pennie FAQ

What is Pennie?

If you are shopping, buying, or renewing individual health plans for 2021, you will not use healthcare.gov anymore. Instead, you will use Pennie, the new state-based exchange platform.

What changes will I see because of Pennie?

You will need to create an account on Pennie and connect it to your producer (if you have one). If you were assigned to a producer before September 1, your producer should appear once you register. Producers cannot help you enroll until you are connected to them through your account.

If you are a current member, you will need to enter the code from your Pennie renewal notice to view information the state brought over from your healthcare.gov account.

What is not changing for me?

Capital BlueCross is still your partner in health. We will continue sending you member ID cards, billing notices, and other important communications.

Is network access changing because of Pennie?

No, there are no changes to the Capital BlueCross network because of Pennie. We will continue offering products that allow you to select networks that fit your needs.

What happens if my plan renews November 1 or December 1?

You should make changes on both platforms.

For example:

  • If you are enrolling with a December 1 plan start date on healthcare.gov, you also should enroll with a January 1 plan start date on Pennie.
  • If on November 15 you are making an address change, you should make that change on both platforms.
  • If you are adding a newborn dependent starting with a birth date of December 6, you should update you 2020 application on healthcare.gov and update your 2021 application on Pennie.

How do I contact Pennie?

You can call Pennie’s customer line: 844.844.8040.

Visit the Welcome page for more information about your plan.