Plan Documents

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


2020 Plan Year

Silver PPO 5950/20/40

Benefit Contracts Summary of Benefits and Coverage (SBCs) Highlight Sheet
Off Marketplace
Off Marketplace
Off Marketplace

Bronze HMO 8000/0/60

Benefit Contracts Summary of Benefits and Coverage (SBCs) Highlight Sheet
Off Marketplace
Off Marketplace
Off Marketplace

Catastrophic PPO 8150/0/75

Benefit Contracts Summary of Benefits and Coverage (SBCs) Highlight Sheet
Off Marketplace
Off Marketplace
Off Marketplace

Catastrophic HMO 8150/0/75

Benefit Contracts Summary of Benefits and Coverage (SBCs) Highlight Sheet
Off Marketplace
Off Marketplace
Off Marketplace

Dental PPO Loyalty Plan

Highlight Sheet
On Marketplace
Off Marketplace

Dental PPO Care Plan

Highlight Sheet
On Marketplace

Dental PPO Standard Plan

Highlight Sheet
Off Marketplace

Dental PPO Premium Plan

Highlight Sheet
Off Marketplace

Vision Plans

Highlight Sheet
Vision Essential Plan

2019 Plan Year

Silver PPO 4950/10/30

Benefit Contracts Summary of Benefits and Coverage (SBCs)
Off Marketplace
Off Marketplace


Bronze HMO 7350/0/60

Benefit Contracts Summary of Benefits and Coverage (SBCs)
Off Marketplace
Off Marketplace

Catastrophic PPO 7900/0/75

Benefit Contracts Summary of Benefits and Coverage (SBCs)
Off Marketplace
Off Marketplace

Catastrophic HMO 7900/0/75

Benefit Contracts Summary of Benefits and Coverage (SBCs)
Off Marketplace
Off Marketplace

Dental PPO Loyalty Plan

Dental PPO Care Plan

Highlight Sheet
Off Marketplace

Dental PPO Standard Plan

Highlight Sheet
Off Marketplace

Dental PPO Premium Plan

Highlight Sheet
Off Marketplace

Vision Plans

Highlight Sheet
Vision Essential Plan