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Health Benefits Overview

Who is eligible for health coverage?

  • A classified or exempt permanent employee of the State of Vermont who is expected to work at least 1,040 hours per year (e.g., .5 FTE, 20 hours/week).
  • The spouse of an eligible employee. In the case of a divorce, a spouse must be removed from coverage on the date of the final divorce decree.
  • The domestic partner of an eligible employee. See instructions regarding additional documentation required.
  • The children of an eligible employee, and/or the children of an eligible employee's domestic partner. Adult children under the age of 26 may remain on the plan regardless of marital or professional status. The last day of coverage is the date of the 26th birthday. Disabled adult children may qualify for a contunuation of benefits. Contact for information.

Declaration of Health Insurance Coverage

All employees should annually submit their declaration, particularly any employee who is not covered by the State of VT employee health insurance, due either to ineligibility or access to alternate coverage. The declaration is located in VTHR . Navigation to the form is as follows:


Medical/Dental Enrollment form (pdf)

Current Health Premiums Chart (Active Employees)
Health Premiums for 2023 (Active Employees) (pdf)
Health Premiums for 2024 (Active Employees) (pdf)

Medical Plan Options

Prescription Drug Plan

Dental Plan

Health Insurance Coverage

SelectCare POS (Plan Summary) (pdf)
Most services by a BlueCross/BlueShield network provider are covered at 100% after a copay per visit. Services by non-network providers are covered at 70% after a $500 deductible.

TotalChoice (Plan Summary) (pdf)
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.

Covered services are the same under either plan.

Vision Benefit (pdf)

Claims forms for reimbursement of vision expenses can be found here.(pdf)

In addition, Delta Dental 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, and does include discounts on frames.

After an annual deductible of $50, the plan pays:
90% for Generic Drugs
80% for Preferred Brand Drugs
60% for Non-Preferred Brand Drugs

There is an annual out of pocket maximum of $1,400 or $800 if all prescriptions for the year were generic and/or preferred brand drugs. These are inclusive of the annual deductible.

There is a lifetime coverage cap of $20,000 for infertility drugs.

2024 National Drug Formulary (pdf)

There is an annual deductible of $25 per person and an annual maximum benefit of $1,000. Note that the plan year for benefit usage is the State's fiscal year, which is from July 1 to June 30 each year. This benefit is optimized when using dentists in the Delta Dental network. When fees charged by non-network dentists exceed Delta Dental's capped limits, you may be direct-billed by the dentist for the difference.

  • 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

Outline of Coverage (pdf)

HOW Program for Enhanced Benefits (pdf)

Dental Policy Booklet (pdf)

Delta Dental Vision Discount

Access Benefits

What is the difference between the two medical plans?

SelectCare TotalChoice
Difference between Medical Plans

The SelectCare POS plan is a co-pay plan. You pay a specific co-pay based on the type of service obtained (listed below). The annual out-of-pocket maximum is $1,500 per person/$3,000 per family. Services obtained outside of the BCBS network of providers are subject to additional cost.

The TotalChoice plan has an annual deductible of $300 per person/$600 per family, and an additional annual out-of-pocket maximum of $750 per person/$2,250 per family. 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)



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

SelectCare POS 

2024 Rates

  • Single:
    • $109.38
  • Two-person:
    • $218.75
  • Family:
    • $300.79


2024 Rates

  • Single:
    • $130.69
  • Two-person:
    • $261.38
  • Family:
    • $359.39

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. NOTE: Due to the COVID emergency, the customary 30-day waiting period for new employees is suspended until further notice.

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 with the following information:

  • Name
  • Employee ID number
  • Date of hire
  • If seeking a waiver of the 30-day waiting period, attach documentation to your email that confirms the termination date of your current/previous coverage (e.g., a letter from your employer or the insurance company, 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?

Outside of the November Open Enrollment period, 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 with the following information:

  • Name
  • Employee ID number
  • Date of qualifying event
  • 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

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, there must be a qualifying event within the past 60 days in order to add a domestic partner to coverage (e.g., involuntary loss of coverage, birth, meeting the six-month co-residency requirement, etc.)
Employees must complete the Domestic Partner Application, along with the Medical/Dental enrollment form, and send them to

Domestic Partner Application (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.

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 .

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 eligible (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

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.


2024 Retiree Health Premium Chart (pdf)

2024 Medicare Drug Formulary (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 Please also see the below contacts should you want to contact our plan administrators directly.

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