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Plan documents

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

2021 plan year

Gold Simple PPO 0/0/25 (Available in all counties except Lancaster)

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

Gold PPO 2150/10/20 (Available in all counties except Lancaster)

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

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

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


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

Bronze PPO 8000/0/50 (Available in all counties except Lancaster)

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

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

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

Vision Plans (Available in all counties)

Highlight sheet

Vision Essential Plan