Individual and Family Enrollment

For Off Exchange plans purchased directly from Capital Blue Cross

You could be eligible for financial assistance to help lower your premium or out of pocket cost, based on your household income. In order to apply for assistance, you will need to visit Pennie.com to enroll. Financial assistance is not available when you purchase directly with Capital Blue Cross.

Enrollment Information

Are you enrolling in new coverage, changing coverage/member information or canceling coverage?

Log in to your member portal to make changes or terminate an enrollment.

If you are a producer trying to change or terminate an enrollment, log in to Book of Business and select the 'Request policy change' in order to proceed with the application.

If you are not the producer on file, you will need to complete this form prior to being able to make the change.

Need help with your application? Call us at 800.451.1181

Need a quote? Visit capbluecross.com/quickquote

Required fields are noted with an asterisk *.
  

Capital Advantage Assurance Company® and Keystone Health Plan® Central, Capital Blue Cross companies, do not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

Ind-WebAPP-v0125IAC-80