Medically Underwritten PersonalBlue PPO Application
Please read these general instructions before applying for coverage
You will need the following personal information readily available in order to complete the medically underwritten PersonalBlue PPO application:
- The birth date, height, weight, and social security number for all individuals for whom coverage is being requested
- E-mail address of the applicant
- Names and dates medication was prescribed for medications currently taken by, or prescribed in the last 12 months for all individuals for whom coverage is being requested
- Medical information for all individuals for whom coverage is being requested, including dates of treatment and any routine or emergency visits to a hospital or health care provider in the last five years
There are a few things to keep in mind when applying for PersonalBlue PPO coverage:
- You must be at least 19 years old, have not yet reached your 65th birthday and are not eligible for Medicare coverage
- You must live within our 21-county service area for at least six months per year to apply for PersonalBlue PPO coverage
- Submitting an application does not guarantee coverage. You are not insured for coverage until we have approved your application and received your signed âacceptance formâ and the first monthâs premium by the required date.
- You are applying for the medically underwritten PersonalBlue PPO. This means that your acceptance into the product is based on your medical history and you are not guaranteed coverage. Medically underwritten programs use specific individual information compared to industry-wide norms to determine the probability of the services that will be used. Healthy individuals for example, may have a lower risk of incurring services, and may find their premium less costly under a medically underwritten program than they would have found through a group sponsored or guaranteed issue program.
- Individuals who live within our 21-county service area for at least six months per year, are at least 19 years old, have not yet reached their 65th birthday and are not eligible for Medicare coverage can submit an application for the guaranteed issue PersonalBlue PPO. For more information about this product please go to www.capbluecross.com/Products/ForIndividuals or call 1.800.451.1181 to talk to a representative.
Premium Estimates and Payment
- If you are accepted for the medically underwritten PersonalBlue PPO coverage then you will receive a proposal and acceptance form indicating the premium associated with your policy and the option to accept coverage in exchange for the monthly premium proposed.
- If you are not accepted for medically underwritten PersonalBlue PPO coverage we notify you by mail or by email and provide information about how to enroll in one of our guaranteed issue products.
- Do not send us a payment prior to being approved for coverage. If your application is approved, you will be billed for your first monthâs premium. Your identification cards will be mailed separately.
Completing the Application
- If you cannot complete your application in one session, you will be able to save any information already entered and return to it later.
- Please allow 20-40 minutes to complete the application. The time needed to complete the application will vary based on your familyâs size and medical history.
- Once your application is completed you will be able to track its progress through the review process.
Making Changes to an Application
- If you need to make changes to an application after you have submitted it to us you can call 1.800.451.1181 to talk to a representative.
Seeking Medical Treatment Before You Are Approved
If you, your spouse, or any dependents applying for coverage receives medical advice or treatment from a physician or other professional physician for a condition which is incurred after this application is submitted but prior to the effective date of coverage, you must notify the underwriting department at Capital BlueCross immediately by writing to 1221 West Hamilton Street Allentown, PA 18102-9948.
A change in your medical condition that occurs prior to your effective date could result in a denial of coverage if your application has not yet been approved or cancellation of coverage if your application has been approved but coverage is not yet effective.