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Individual & Family Products

Member Materials

To access any of the member materials listed below, click on the form name. If you prefer to have paper copies of these materials please call 1.800.KIDS.101 or e-mail us to request one.

Member Handbook

The Member Handbook includes program information regarding eligibility, enrollment and detailed benefit information:

Medical Member HandBook

Guía para los Miembros

Attachments referred to in the Member Handbook:

Schedule of Preventive Health Services

Child Health Maintenance Guidelines

Services Requiring Preauthorization
   Be sure to choose the latest version of the HMO Preauthorization Guide

Health and Wellness

Emergency and Urgent Care

Knowing when to take your child to an emergency room can be a hard decision. Be prepared for emergencies: learn what problems need emergency room care and which can be treated by your child's primary care physician or an urgent care center. Discover other measures that will help provide your child with the best care possible in an emergency.

Medical Benefits Summary

For a summary of your child's medical coverage benefits offered through Keystone Health Plan Central:

Medical Summary of Benefits

Beneficios Médico

Prescription Drug Coverage Summary

For a summary of your child's prescription drug coverage benefits offered through CVS Caremark:

Prescriptions Summary of Benefits

Additional information regarding your child’s prescription drug benefit, including a Guide to Rx Benefits, preauthorization program requirements, drug formulary, and a preferred medication list:

Pharmacy Information

Dental Coverage Summary

For a summary of your child's dental coverage benefits offered through BlueCross Dental:

Dental Summary of Benefits

Beneficios Dentales

Vision Coverage Summary

For a summary of your child's vision coverage benefits offered through BlueCross Vision:

Vision Summary of Benefits

Vision Summary of Benefits en Español

Network Care Providers

If your child’s enrollment letter indicated that you did not select a Primary Care Physician (PCP) for your child you can use the Online Provider Search to choose a PCP for your child. Once you have selected a PCP for your child or if you want to change your child’s PCP please call 1.800.KIDS.101 and we will update your child’s PCP.

Check It Out®

If your child is enrolled in any of the low cost programs or the full cost program you may sign up for Check It Out®. This allows you to have your child’s monthly premium payment deducted directly from your checking account. Print the Check It Out® form, complete the requested information, and return to the address on the form.

Check It Out®


Your child’s privacy is important to us. Please take time to read our Notice of Privacy Practices and the GLBA Notice. If you ever want Capital BlueCross to talk with another individual, not included on the CHIP application, regarding your child’s CHIP coverage you must complete and return a Member Authorization Form (PO-9). Print and sign the form and return it to the address listed on the form.