Capital BlueCross
Capital BlueCross is a nonprofit health insurer and independent BlueCross BlueShield licensee offering individual, family, Medicare, employer group, CHIP, and student health plans across 21 counties in Central Pennsylvania and the Lehigh Valley.
- Company typePrivate
- Founded1938
- HeadquartersHarrisburg, United States
- Headcount1,001–5,000
- GTM typeB2B and B2C
- OfferingServices
What Capital BlueCross does
Capital BlueCross is a nonprofit, private health insurance company headquartered in Harrisburg, Pennsylvania, and founded in 1938. Operating as an independent licensee of the BlueCross BlueShield Association, the company serves 21 counties in Central Pennsylvania and the Lehigh Valley through three core operating subsidiaries: Capital Advantage Insurance Company, Capital Advantage Assurance Company, and Keystone Health Plan Central. It offers a portfolio of health coverage products including individual and family plans (including ACA-compliant offerings), Medicare Advantage and Medicare Supplement plans, employer group health plans of every size, the Children's Health Insurance Program (CHIP), and student health plans for colleges and universities.
The company's underlying technology consists of a health insurance administration platform supporting digital member services: a website portal for plan shopping and enrollment, the VirtualCare telehealth service for on-demand video consultations, the MyCare Finder provider directory, and online claims and benefits management. It also operates Capital Blue Cross Connect, a network of physical health and wellness centers offering classes and member engagement resources. Distribution is multi-channel, combining direct-to-consumer online sales, licensed insurance producers and brokers (via a dedicated producer portal), direct employer group enrollment, and healthcare provider referrals.
Capital BlueCross generates revenue primarily through recurring health insurance premiums billed monthly across its individual, family, employer group, Medicare, CHIP, and student segments, with a more recent addition of ICHRA (Individual Coverage Health Reimbursement Arrangement) offerings. The company maintains HIPAA compliance and adheres to federal Transparency in Coverage requirements through published machine-readable files. Leadership comprises Todd Shamash as President and CEO, Glenn Heisey as EVP and COO, Jennifer Chambers as SVP and Chief Medical Officer, and Joel C. Hopkins as SVP and General Counsel.
Capital BlueCross firmographics
Firmographics- Name
- Capital BlueCross
- Legal name
- Capital BlueCross
- Website
- https://capbluecross.com
- Company type
- Private
- Founded year
- 1938
- Operating status
- Operating
- Headcount range
- 1,001–5,000 employees
- Short description
- Capital BlueCross is a nonprofit health insurer and independent BlueCross BlueShield licensee offering individual, family, Medicare, employer group, CHIP, and student health plans across 21 counties in Central Pennsylvania and the Lehigh Valley.
- Ownership category
- akta.pro rank
Capital BlueCross industry classification
Industry- Product category
- Health Insurance
- NAICS
- Direct Health and Medical Insurance Carriers (524114), Direct Life, Health, and Medical Insurance Carriers (52411)
- SIC
- Accident & Health Insurance (6321), Hospital & Medical Service Plans (6324)
- akta.pro primary industry
- Large Group Health Insurance (Mid-Market & National Accounts) (FSAIAFAE)
- akta.pro secondary industries
- Small Group Health Insurance (2–50/100) (FSAIAFAD), Level-Funded Group Health Plans (FSAIAFAC), On-Exchange Qualified Health Plans (QHPs) (HLAEABAA)
Keywords
Where Capital BlueCross is headquartered
LocationHeadquarters
- HQ city
- Harrisburg
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Capital BlueCross business model
Business model- GTM type
- B2B and B2C
- Offering type
- Services
- Cost components
- Personnel, Operations, Marketing or Sales, Technology or R&D, Infrastructure, Supply Chain
Revenue model
- Health Insurance Premiums: Capital BlueCross generates revenue through health insurance premiums charged to individuals, families, employers, and government programs (Medicare, CHIP). Premium revenue is recurring on a monthly or annual basis.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | Individual and Family Plans |
| Subscription | Monthly | Medicare Plans |
| Subscription | Monthly | Employer Group Plans |
| Subscription | Monthly | CHIP (Children's Health Insurance Program) |
Go-to-market motion1 record
Distribution channels4 records
Marketing channels3 records
Capital BlueCross product offering
Product offeringCore offering
Capital BlueCross underwrites and administers a portfolio of health insurance plans — including individual and family plans, Medicare Advantage and Medicare Supplement plans, CHIP coverage, employer group health benefits, and student health plans — across 21 counties in Central Pennsylvania and the Lehigh Valley. These plans are complemented by member-facing services such as the VirtualCare telehealth platform, MyCare Finder provider search, online claims and benefits management, and the Capital Blue Cross Connect health and wellness centers.
Product overview
Capital BlueCross is a health insurance company that operates as a portfolio of health coverage products and member services. The core offerings include Individual and Family Health Plans, Medicare Plans, CHIP, Employer Health Plans, and Student Health Plans. These are supported by member-facing digital services including VirtualCare (telehealth), Capital Blue Cross Connect (wellness centers), and online tools for finding doctors, managing prescriptions, and accessing claims and benefits. The company serves 21 counties in Central Pennsylvania and the Lehigh Valley as an independent licensee of the Blue Cross Blue Shield Association.
Differentiator
Problem solved
Functional benefit
Brands
- Capital Blue Cross Connect: Health and wellness centers operated by Capital BlueCross
- VirtualCare
Products and services
- Individual and Family Health Plans Health insurance coverage options for individuals and families outside of employer-sponsored plans, with multiple tiers and cost structures for ACA-compliant and other individual market plans.
- Medicare Plans (Medicare Advantage) Medicare Advantage health coverage plans designed for Medicare-eligible individuals in the Capital BlueCross service area, providing benefits beyond Original Medicare.
- Medicare Supplement Supplemental insurance coverage that works alongside Original Medicare to help cover additional costs such as copayments, coinsurance, and deductibles.
- CHIP (Children's Health Insurance Program) Free and low-cost health insurance coverage for children in Pennsylvania who do not qualify for Medicaid, offered under the state's Children's Health Insurance Program.
- Employer Health Plans Group health insurance coverage options for organizations of every size, including small business and large employer plans, with employer and employee premium contributions.
- Student Health Plan Health coverage designed for college and university students, offered through educational institutions partnering with Capital BlueCross.
- VirtualCare Telehealth and virtual care service allowing Capital BlueCross members to consult with doctors anytime, anywhere through video-based virtual visits.
- Capital Blue Cross Connect Health and wellness centers operated by Capital BlueCross offering in-person health resources, classes, and member engagement programs for members.
Companies that use Capital BlueCross
Customer profileSegments5 records
Ideal customer profiles5 records
Capital BlueCross technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature3 records
Capital BlueCross partnerships and signals
Strategic signalPartnerships
One partnership is on record.
- Blue Cross Blue Shield AssociationcoreCapital BlueCross is an independent licensee of the Blue Cross Blue Shield Association, one of the nation's largest health insurance organizations. This licensing relationship provides access to the BCBS brand, national provider networks, and shared best practices while allowing Capital BlueCross to maintain local market focus in Central Pennsylvania and the Lehigh Valley.
Scale indicators1 record
Recent moves6 records
Expansion highlights5 records
Capital BlueCross competitors and assessment
Company assessmentDirect peers
- Highmark Blue Cross Blue Shield: Highmark is the dominant BCBS licensee in western and central Pennsylvania, directly competing with Capital BlueCross in overlapping geographies for individual, group, Medicare, and CHIP business under the same BCBS brand framework.
- Geisinger Health Plan: Geisinger Health Plan is a Pennsylvania-based integrated insurer serving Central and Northeastern PA, offering HMO, PPO, Medicare Advantage, and employer group products that directly overlap with Capital BlueCross's product set and service area.
- UPMC Health Plan: UPMC Health Plan is a large Pennsylvania-based integrated payer-provider offering individual, group, Medicare Advantage, and Medicaid plans across PA, and is a key in-region competitor for Capital BlueCross's employer and Medicare lines.
Regional players
- Independence Blue Cross: Independence Blue Cross is a Philadelphia-area BCBS licensee offering similar individual, family, employer, and Medicare products in southeastern PA. It is a BCBS-system peer with comparable product portfolio but distinct geographic territory from Capital BlueCross.
Broad incumbents
- UnitedHealthcare: UnitedHealthcare is the largest U.S. health insurer with national employer group, individual, Medicare Advantage, and Medicaid footprints. It competes with Capital BlueCross for large employer accounts and Medicare members across Pennsylvania.
- Aetna (CVS Health): Aetna is a national carrier offering group, individual, Medicare, and Medicaid plans with a Pennsylvania employer group and individual market presence, competing for the same broker-distributed employer accounts as Capital BlueCross.
- Cigna Healthcare: Cigna is a national health insurer focused heavily on employer-sponsored and individual plans with significant PA employer group penetration, directly competing for mid-market and large employer accounts.
- Elevance Health (Anthem): Elevance Health operates BCBS-licensed plans across multiple states and competes in PA's large group, individual, and Medicare markets. As a multi-state BCBS-affiliated carrier, it shares structural and brand commonalities with Capital BlueCross.
Emerging players
- Humana: Humana is a leading Medicare Advantage-focused carrier with growing Pennsylvania MA presence, competing directly with Capital BlueCross's Medicare Advantage line and increasingly with its employer group business.
- Kaiser Permanente: Kaiser Permanente operates an integrated staff-model HMO in select regions. While not in Capital BlueCross's footprint, it represents the vertically-integrated payer-provider model that Capital BlueCross Connect and provider partnerships partially emulate.
Market position
Strengths1 record
Competitive moat5 records
Key risks6 records
Key highlights6 records
Customer concentration
Capital BlueCross social profiles
Digital presenceCapital BlueCross compliance and trust
Trust signalCompliance1 record
Capital BlueCross financial estimates
Financial estimateRevenue estimate
Valuation estimate
Capital BlueCross leadership team
Management profileNumber of profiles
Profiles4 records
Capital BlueCross subsidiaries and ownership
Company hierarchySubsidiaries3 records
Capital BlueCross funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Capital BlueCross M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Capital BlueCross
What does Capital BlueCross do?
Capital BlueCross underwrites and administers a portfolio of health insurance plans — including individual and family plans, Medicare Advantage and Medicare Supplement plans, CHIP coverage, employer group health benefits, and student health plans — across 21 counties in Central Pennsylvania and the Lehigh Valley. These plans are complemented by member-facing services such as the VirtualCare telehealth platform, MyCare Finder provider search, online claims and benefits management, and the Capital Blue Cross Connect health and wellness centers.
Is Capital BlueCross a public or private company?
Capital BlueCross is a private company. It is classified as nonprofit foundation owned and is currently operating.
When was Capital BlueCross founded?
Capital BlueCross was founded in 1938. It employs 1,001 to 5,000 people.
Where is Capital BlueCross based?
Capital BlueCross is headquartered in Harrisburg, United States, in the North America region.
How does Capital BlueCross make money?
One revenue line is on record: health Insurance Premiums.
Who are Capital BlueCross's main competitors?
Direct peers on record are Highmark Blue Cross Blue Shield, Geisinger Health Plan and UPMC Health Plan. Independence Blue Cross is listed as a regional player. Broad incumbents are UnitedHealthcare, Aetna (CVS Health), Cigna Healthcare and Elevance Health (Anthem). Emerging players are Humana and Kaiser Permanente.
Does Capital BlueCross have an API?
No public API is recorded for Capital BlueCross.
What industry is Capital BlueCross in?
Capital BlueCross's product category is Health Insurance. Its primary akta.pro industry code is FSAIAFAE, Large Group Health Insurance (Mid-Market & National Accounts), with a secondary code of FSAIAFAD, Small Group Health Insurance (2–50/100). Its NAICS code is 524114 and its SIC code is 6321.