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)
Benefit contracts | Summary of benefits and coverage (SBCs) | Highlight sheet |
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Gold PPO Choice 2000/0/30 (Available in Lancaster county)
Benefit contracts | Summary of benefits and coverage (SBCs) | Highlight sheet |
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Gold Valley Advantage EPO 2150/10/20 (Available in Lehigh and Northampton counties)
Benefit contracts | Summary of benefits and coverage (SBCs) | Highlight sheet |
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Gold PPO 2150/10/20 (Available in all counties except Lancaster)
Benefit contracts | Summary of benefits and coverage (SBCs) | Highlight sheet |
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Silver PPO Choice 3950/20/35 (Available in Lancaster county)
Benefit contracts | Summary of benefits and coverage (SBCs) | Highlight sheet |
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Silver PPO Choice 4000/20/35 (Available in Lancaster county)
Benefit contracts | Summary of benefits and coverage (SBCs) | Highlight sheet |
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Silver Valley Advantage EPO 5950/20/40 (Available in Lehigh and Northampton counties)
Benefit contracts | Summary of benefits and coverage (SBCs) | Highlight sheet |
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Silver Valley Advantage EPO 6000/20/40 (Available in Lehigh and Northampton counties)
Benefit contracts | Summary of benefits and coverage (SBCs) | Highlight sheet |
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Silver PPO 5950/20/40 (Available in all counties except Lancaster)
Benefit contracts | Summary of benefits and coverage (SBCs) | Highlight sheet |
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Silver PPO 6000/20/40 (Available in all counties except Lancaster)
Benefit contracts | Summary of benefits and coverage (SBCs) | Highlight sheet |
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Bronze PPO Choice 7100/0/50 (Available in Lancaster county)
Benefit contracts | Summary of benefits and coverage (SBCs) | Highlight sheet |
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Bronze Valley Advantage EPO 8000/0/50 (Available in Lehigh and Northampton counties)
Benefit contracts | Summary of benefits and coverage (SBCs) | Highlight sheet |
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Bronze PPO 8000/0/50 (Available in all counties except Lancaster)
Benefit contracts | Summary of benefits and coverage (SBCs) | Highlight sheet |
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Bronze HMO 8000/0/50 (Available in all 21 counties)
Subscriber agreements | Summary of benefits and coverage (SBCs) | Highlight sheet |
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Catastrophic PPO 8550/0/75 (Available in all 21 counties)
Benefit Contracts | Summary of Benefits and Coverage (SBCs) | Highlight sheet |
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Catastrophic HMO 8550/0/75 (Available in all 21 counties)
Subscriber agreements | Summary of benefits and coverage (SBCs) | Highlight sheet |
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Dental Plans (Available in all counties)
Vision Plans (Available in all counties)
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