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Plan documents

If you’re a Capital Blue Cross member, log in to see the the benefit contracts for your plan.

2021 plan year

Gold Valley Advantage EPO 2150/10/20 (Available in Lehigh and Northampton counties)

Silver PPO Choice 3950/20/35 (Available in Lancaster county)

Benefit contracts Summary of benefits and coverage (SBCs) Highlight sheet

Off Pennie

Off Pennie

Off Pennie

On Pennie - Spanish

Silver Valley Advantage EPO 5950/20/40 (Available in Lehigh and Northampton counties)

Benefit contracts Summary of benefits and coverage (SBCs) Highlight sheet

Off Pennie

Off Pennie

Off Pennie

Off Pennie - Spanish

Silver PPO 5950/20/40 (Available in all counties except Lancaster)

Benefit contracts Summary of benefits and coverage (SBCs) Highlight sheet

Off Pennie

Off Pennie

Off Pennie

On Pennie - Spanish


Bronze Valley Advantage EPO 8000/0/50 (Available in Lehigh and Northampton counties)

Bronze HMO 8000/0/50 (Available in all 21 counties)

Subscriber agreements Summary of benefits and coverage (SBCs) Highlight sheet

Off Pennie

Off Pennie

Off Pennie

Off Pennie -Spanish


Catastrophic PPO 8550/0/75 (Available in all 21 counties)

Benefit Contracts Summary of Benefits and Coverage (SBCs) Highlight sheet

On Pennie

On Pennie

On Pennie

On Pennie - Spanish

Off Pennie

Off Pennie

Off Pennie

Catastrophic HMO 8550/0/75 (Available in all 21 counties)

Subscriber agreements Summary of benefits and coverage (SBCs) Highlight sheet

Off Pennie

Off Pennie

Off Pennie

Off Pennie - Spanish

Vision Plans (Available in all counties)

Highlight sheet

Vision Essential Plan