If you dwell in the Lehigh Valley, Capital BlueCross could be your direct link to health care coverage. A licensee of the Blue Cross and Blue Shield Association, the company provides health insurance products to individuals and employer groups, with a total of about 1 million members in central and eastern Pennsylvania. It offers traditional, PPO, HMO, and POS health care plans, as well as dental and vision coverage and Medicare Advantage plans. Capital BlueCross' network includes more than 11,000 health care providers and some 40 hospitals. The company also provides benefits administration services to self-funded customers through for-profit subsidiary Capital Administrative Services (dba NCAS Pennsylvania).
Capital BlueCross provides additional health care coverage through its Keystone Health Plan Central (including Medicare HMO and Medicaid plans) and Capital Advantage Insurance subsidiaries. Its for-profit Avalon Insurance and Consolidated Benefits subsidiaries, which are not licensed by the Blue Cross and Blue Shield Association, sell life, long-term disability, and accidental death insurance.
The company's supplemental plans include vision coverage provided through a partnership with National Vision Administrators, and prescription drug benefits managed by CVS Caremark. Capital BlueCross also runs its own dental plan provider, Dominion Dental, which serves some 400,000 dental plan members located in Pennsylvania and elsewhere in the Mid-Atlantic states.
To promote wellness services to its members, Capital BlueCross opened a new Capital Blue retail location to provide personalized health management and wellness services to the Lehigh Valley in 2012. In addition, the company partnered with area hospital operator PinnacleHealth to form an accountable care alliance, which aims to improve the quality of health care while controlling expenses through analytics, care coordination, and technology programs.
In addition to focusing on customer retention through wellness, education, and support programs, Capital BlueCross is regularly looking to expand its customer base by adding affordable health plan offerings and attracting new members. It widened its offerings in 2010 when it started providing the adultBasic plan, a state-administered plan for low-income adults.
However, at the end of 2010 Capital BlueCross lost its contract to provide the Pennsylvania Employee Benefit Trust Fund's PPO health plan for state employees, which covered about 70,000 people; the company continues to provide HMO options under the program.
In addition, the health plan announced workforce cuts in 2010, laying off about 10% of its employees to reduce its operating costs. Capital BlueCross cited increases in technological efficiency processes (including new claims management and reimbursement systems) that created a reduced need for administrative employees. The move was made in the midst of economic difficulties and uncertainties in the US health care industry, conditions that have caused lower enrollment levels and rising premiums in many markets.
Capital BlueCross has its origins in two hospital service plans begun in the 1930s: Easton Hospital Association (which later became Blue Cross of the Lehigh Valley) and Capital Hospital Service (which was renamed Capital BlueCross in 1965). The two entities merged in 1985.