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Individual & Family Products

Frequently Asked Questions


Individual & Family Products

What is Comprehensive?
What is a Preferred Provider Organization (PPO)?
Where can I find price quotes for coverage?
After I apply, when does my coverage take effect?
Can I enroll in the prescription drug or vision programs?
Can I enroll my children for Individual Coverage?
My children qualify for CHIP. Can I enroll only myself for coverage with Capital?


What is Comprehensive?

Comprehensive2 coverage is issued by Capital Advantage Insurance Company and combines basic hospitalization, basic medical-surgical and major medical into one product with all services being subject to a deductible and coinsurance until any applicable out-of-pocket maximum is met. Both group and individual coverage are available.

What is a Preferred Provider Organization (PPO)?

A Preferred Provider Organization (PPO) is an arrangement designed to supply health care services at a discounted cost. Members who use health care providers in the PPO network receive the highest level of benefits at the lowest out-of-pocket expense. Members may also choose health care providers who are not part of the PPO network, but their level of benefits may be lower while their out-of-pocket expenses may be higher.

Where can I find price quotes for coverage?

The individual coverage section of the web site has our published rates for each product, including Traditional, Comprehensive, HIPAA Comprehensive, Special Care and Security (for individuals who have Medicare coverage). For group coverage, contact your benefits administrator.

After I apply, when does my coverage take effect?

Your coverage may begin on either the first or the fifteenth of the month that follows the receipt of your completed application. If you are changing from a Capital BlueCross program or from another Blue plan located outside our service area, your effective date will be the same as the cancellation of your prior coverage.

Can I enroll in the prescription drug or vision programs?

These programs are not offered separately for individual account coverage. In some instances coverage is included for prescription drugs or routine vision services. For example, Traditional and Comprehensive plans include prescription drug coverage. For group coverage information, please contact your benefit administrator.

Can I enroll my children for Individual Coverage?

No. Dependent children cannot be enrolled separately. They can only be enrolled as dependents of an adult purchasing coverage, except under certain circumstances. However, in Pennsylvania there is a special program called CHIP, which provides coverage for children up to and including age 18. Eligibility is based on income guidelines. For more information, call 800.KIDS.101.

My children qualify for CHIP. Can I enroll only myself for coverage with Capital?

Yes. However, many CHIP parents are eligible to enroll in the Special Care program, where eligibility is based on income.