Health Benefits Overview

What are my health benefit options?

The State of Vermont offers two options for medical insurance plans, a prescription drug plan and a dental plan.
Medical/Dental Enrollment form (pdf)

Medical Plans Prescription Drug Plan Dental Plan
Health Plan Options

SelectCare POS - Most services by a network provider are covered with a $20 copay per visit. Services by non-network providers are covered at 70% after a $500 deductible.

TotalChoice - Most services are paid at 80% after a $300 annual deductible. When you are in the hospital, services are paid at 90% after the $300 annual deductible.

Both plan options include a vision benefit, which is a $100 benefit per person every 24 months.

After an annual deductible of $25 per person, the plan pays:
90% for Generic Drugs
80% for Preferred Brand Drugs
60% for Non-Preferred Brand Drugs

Prescription Drug Basic Formulary

 There is an annual deductible of $25 per person and an annual maximum of $1,000.

  • Diagnostic and Preventive Services (Coverage A) covered at 100%
  • Basic Restorative Services (Coverage B) covered at 80%.
  • Major Restorative Services (Coverage C) covered at 50%
  • Orthodontia (Coverage D) covered at 50% up to the lifetime maximum of $1,750

Delta Dental also offers a Vision Discount Program that is free for all subscribers, which can serve as a supplement to the vision care offered in the medical plan

What is the difference between the two medical plans?

SelectCare TotalChoice
Difference between Medical Plans

The SeleCare POS plan is a co-pay plan. You pay a specific co-pay based on the type of service obtained (listed below). There is no annual out-of-pocket maximum for the co-pay amounts. Services obtained outside of the BCBS network of providers are subject to additional cost.

The TotalChoice plan has an annual deductible of $300, and an annual out-of-pocket maximum of $750, for a total of $1,050 per person, per year. After meeting the deductible, services are covered at a designated percentage until the maximum out-of-pocket amount is reached, after which services are covered at 100%. TotalChoice covers in-network and out-of-network services at the same designated percentage, allowing individuals to choose providers out-of-network, but those providers who are out-of-network reserve the right to bill for any additional balance beyond the plan's allowed amount. This additional charge would not count towards the deductible or out-of-pocket maximum.
TotalChoice Plan Summary (pdf)

Plan Comparison Chart (pdf)

How much will my benefits cost me?

There is a bi-weekly premium associated with each plan in addition to your co-pays and deductibles.

Medical Prescription Drug Dental
Health Plan Costs

Note: 2016 rates begin with the 1/21/16 payday
SelectCare POS 

  • Single:
    • 2016: $76.50
    • 2017: $$78.79
  • Two-person:
    • 2016: $153.00
    • 2017: $157.58
  • Family:
    • 2016: $210.37
    • 2017: $216.68

TotalChoice

  • Single:
    • 2016: $91.40
    • 2017: $94.15
  • Two-person:
    • 2015: $182.81
    • 2017: $188.29
  • Family
    • 2016: $251.36
    • 2017: $258.90

Health Plan Premium Chart (pdf)

This coverage is part of your health insurance benefit and carries no additional premium.

Dental coverage is provided at no cost to you and your dependents.

 

When will my benefits start?

Medical Prescription Drug Dental
When Benefits Start
New employees: There is a 30-day waiting period for coverage (coverage begins on the 31st day after the date of hire), unless you had coverage that terminated no more than 3 days before your date of hire, or if you have coverage that will terminate before the 31st day. New employees have up to 60 days from their date of hire to elect benefits.

After 60 days: You must have a qualifying event (e.g., marriage, birth, no-fault loss of coverage, etc.) to be eligible for enrollment. Without a qualifying event, you must wait until the next Open Enrollment month (November of each year).

Prescription drug coverage will be effective on the same date as your medical coverage effective date.

Single coverage for the employee will begin automatically six months after your date of hire. You may add dependents to the dental plan during your initial enrollment and their coverage will begin at the same time.

How do I enroll as a new employee?

All new employees have up to 60 days from their date of hire to enroll, and must contact the Employee Benefits Unit at DHR.Benefits@vermont.gov with the following information:

  • Name
  • Employee ID number
  • Date of hire
  • Statement of what type of benefits you are requesting
  • If seeking a waiver of the waiting period, attach documentation that confirms the termination date of your current/previous coverage (e.g., a letter from your employer, a COBRA letter, a HIPPA statement)

How do I enroll in benefits if I didn't elect coverage within 60 days of my hire date?

In order to enroll in benefits if you did not elect when you first started, you must provide proof of a qualifying event. Examples include: having a baby, getting married, or losing health coverage (through no fault of your own). Employees have up to 60 days from the date of the qualifying event to enroll in benefits and must contact the Employee Benefits Unit at DHR.Benefits@Vermont.gov with the following information:

  • Name
  • Employee ID number
  • Date of qualifying event
  • Statement of what type of benefits you are requesting
  • Attach a document certifying the qualifying event , such as a birth certificate, marriage certificate, proof of loss of coverage

How do I find a network provider?

Employees can search in-network providers by going to the following websites. You may also contact your preferred provider's office and ask if they are in the BCBS network.

Medical Dental
Find a Network Provider
http://www.bcbsvt.com/find-a-doctor http://www.nedelta.com/LocalDentistSearch

How do I add a Domestic Partner to my plan?

The State of Vermont offers coverage to Domestic Partners of employees. In order to be eligible to enroll a Domestic Partner, you must certify that the following criteria applies to you and your Domestic Partnership:

  1. You are each other’s sole domestic partner and have been in an exclusive and enduring domestic relationship, while sharing a residence, for not less than six consecutive months prior to the submission of this application.
  2. You are both eighteen years of age or older.
  3. Neither one of you is married to anyone.
  4. You are not related by blood closer than would bar marriage under Vermont State law.
  5. You are both competent to enter into a legally binding contract.
  6. You have agreed between yourselves to be responsible for each other’s welfare.

​Note: Outside of the Open Enrollment month of November, you must be within 60 days of meeting  the six-month co-residency requirement to add the domestic partner as  a qualifying event
Employees much complete the Domestic Partner Affidavit, along with the Medical/Dental enrollment form, and send them to DHR.Benefits@vermont.gov

Domestic Partner Affidavit (pdf)
 

What would be the additional cost for adding a Domestic Partner to my plan?

Along with the additional premium associated with adding an individual to your plan, adding a Domestic Partner also has tax implications. The Domestic Partner tax is known as an imputed income tax. The imputed income tax is calculated by adding your share and the state’s share of the domestic partner's premium to your gross income. Payroll then calculates your tax contribution for federal, state, social security, etc., using the higher imputed gross income rate. Once calculated, the state share amount is removed from your gross earnings resulting in less take home pay. Because there are many factors involved in this calculation such as rate of pay, tax withholdings, etc, the Benefits Unit is unable to provide a figure on the additional imputed income tax fee. However, employees can consult with their tax preparer to get a better idea of the overall impact.  The link below will give you the breakdown of your share and the state's share of the total premium amount.

What is an annual Open Enrollment period?

An annual Open Enrollment period is a time when you can switch medical plans and/or add dependents to your plan without a qualifying event (e.g., birth, marriage, loss of health coverage). You may cancel coverage or remove a dependent from your medical plan any time during the year.
The State of Vermont’s annual Open Enrollment period begins Nov 1st of each year and ends Nov 30th with changes becoming effective on Jan. 1st of the new plan year.

How do I find out what plan I am in or who is covered under my plan?

Your plan enrollment information can be viewed through your employee self- service portal in VTHR (the same system used for coding  your timesheet). You can go to Main Menu, Self Service, Benefits Summary. Once there you will be able to see the current plan you are enrolled in or, by adjusting the view date, you can see benefits as of a specific time. If you would like to see who is enrolled on your plan, just click the Medical or Dental hyperlink and you should be able to view your dependents. As always, please feel free to contact Benefits should you have additional questions at 802-828-6700 (option 1, option 3) or email us at DHR.Benefits@Vermont.gov .

As an active employee, do I need to enroll in Medicare Part B when I turn 65?

When you turn 65, you will receive information from Social Security informing you of your automatic enrollment in Medicare Part A. You will also be asked if you wish to enroll in Part B.  Active employees who are enrolled in medical benefits can defer enrollment in Medicare Part B until they retire, Your State of Vermont employee medical plan will continue to be your primary coverage for all medical services. If  a dependent on your active employee medical plan is turning 65, they can also defer enrollment in Medicare Part B until you retire. The exception is domestic partners, who must enroll in Medicare Part B when they become eligible at age 65. 
Once you retire or terminate employment with the state, you and your dependents must apply for Medicare Part B immediately, if you are already eligilbe (65 and over), or when you become eligible.  Forms can be obtained from Social Security and if needed, the Employee Benefits can complete the sections certifying your employee coverage. All forms can be sent to DHR.Benefits@Vermont.gov

How do my benefits differ as a retired state employee?

Medical Prescription Drug Dental
Differences in Benefits as a Retired State Employee
Retired state employees have access to the same two plan options (SelectCare POS and TotalChoice) available to active state employees. The plans co-pays, deductibles and, out of pocket maximums are also the same as active employees. The main difference occurs when an individual or dependent becomes eligible for Medicare. Eligibility for Medicare will adjust the premium payment contribution for retired employees. Non Medicare participants follow the same plan as active employees. For more information on individuals who are Medicare eligible and on our retirement benefits please click the link below. The dental benefit for retired state employees  differs from the plan for active state employees, although the plan administrator is the same. For more information regarding the retiree dental plan please contact the retirement office at 802-828-2305.

Retiree Health Premium Chart (pdf)
Prescription Drug for Medicare Eligible Retirees (pdf)

Where do I find more detail about my plan and what services it covers?

Additional information about our plans, rules and specific covered services can be found in our Medical Plan Document and Dental Booklet. As always, if you are having any issues finding information or have specific questions about your benefits, please feel free to contact Benefits at 802-828-6700 (option 1, option 3) or email us at DHR.Benefits@Vermont.gov.

Medical Plan Document (pdf)
Dental Plan Booklet (pdf)

Who do I call if I have questions?

If you have any questions please feel free to contact the Employee Benefits Unit at 802-828-6700 (option 1, option 3) or email us at DHR.Benefits@Vermont.gov. Please also see the below contacts should you want to contact our plan administrators directly.

Medical Prescription Drug Dental
Who to Call with Questions
BCBS
PO Box 186
Montpelier, VT 05601-0186
(888) 778-5570
http://www.bcbsvt.com/sov
ExpressScripts, Inc.
PO Box 8545
Bensalem, PA 19020-8545
(800) 550-8090 (available 24 hours)
www.express-scripts.com
Northeast Delta Dental
One Delta Drive
PO Box 2002
Concord, NH 03302-2002
(800) 832-5700
www.nedelta.com

 

Forms & Documents - Health Benefits Overview