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Blue Cross and Blue Shield of Vermont health care plans offer you a range of benefits that help you focus on your health and well-being, from office and preventive care visits to prescription drugs coverage, we have you covered.
Preventive care refers to health care services meant to help you avoid serious medical problems through routine care and screening. Some preventive care services help identify a health issue before it becomes very serious—like your cholesterol test, while other preventive care services help prevent a health issue before it happens—like your annual flu shot.
Are all preventive care services free?
No. Many services that are considered preventive in terms of your personal health do not meet the guidelines for zero-cost preventive care. There are two factors that determine whether a preventive care service is available to you at no cost:
Generally speaking, a service usually does not qualify as zero-cost preventive care if a medical problem is known, suspected, or found during the course of care. This means that you may have to pay some of the cost of an otherwise qualified service (such as a copay, coinsurance, or deductible) based on your personal medical situation.
Here are some quick tips to help you and your provider determine when services may not be part of the preventive benefit:
If you receive coverage under a retiree benefits plan, you may not have zero-cost preventive benefits available to you. Check your benefits in the Member Resource Center or contact customer service at (800) 247-2583 for more information.
I received a bill for care that I thought would be free. What happens now?
When it comes to zero-cost care, it is very important to review your benefits coverage in advance. Make sure you understand any requirements or limitations for zero-cost care before your appointment. Once you have received care from a facility or provider, you will be responsible for any copays, coinsurance, or deductibles that apply.
What if I still don’t understand whether a care or service should be free for me?
If you have any questions about your plan coverage, benefits limitations, or the specific preventive care and screening services that are available to you or your family members, contact customer service before your scheduled care appointment. We’re here to help you!
While the COVID-19 public health emergency has ended, new variants of the virus continue to emerge and new vaccines are being released. Below we outline your coverage related to COVID-19 vaccines, test, and more.
COVID vaccinations and booster shots will continue to be covered at no cost to members.
The 2023-2024 vaccines that protect against the more current strains of the COVID-19 virus will be available to Vermonters in the coming weeks. Check with your primary care provider's office or local pharmacies on availability. You can also visit vaccines.gov to find locations near you.
At-home COVID-19 antigen tests (test kits) are no longer be covered. Provider-based COVID-19 tests will be covered with a cost-share.
Note: If you have coverage through your employer and do not have our Vermont Blue Rx pharmacy coverage, please contact your employer for more information about your coverage for COVID-19 tests.
Before you throw out expired COVID-19 antigen tests, check to see if the expiration date has been extended.
Medications to Treat COVID-19
Oral medications used to treat COVID-19, including Paxlovid and Lagevrio (Molnupiravir), are covered with a Tier 3 cost-share. Injectable medications used to treat COVID-19, administered by your doctor and that are FDA-authorized or FDA-approved, will be covered with a cost-share.
If you do not have pharmacy coverage through Vermont Blue Rx, please contact your employer for more information about your coverage for COVID-19 medications.
Additional Benefits & Coverage
Blue Cross Blue Shield Global Core gives Blue Cross and Blue Shield of Vermont members access to their health care benefits wherever they go - across the country and around the world. Enrollment in the program is automatic and available to all Blue members.
Planning Your Trip
Before you travel, contact your Blue Cross and Blue Shield (BCBS) company for coverage details. Coverage outside the United States may be different. Be sure to always carry your current member ID card with you when traveling.
Depending on your health plan, you have access to certain mental health and substance abuse services for the same co-payment as your primary care physician (PCP) visit. To receive these services at the same cost as your PCP visit, the following apply:
If your service is not on the list below, you will pay the specialist co-payment amount.
|Initial psychiatric diagnostic evaluation
|90832, 90834, 90837
|Outpatient interactive psychotherapy
|90832, 90834, 90837
|Substance abuse treatment
|H0001, H0004, H0005, H0015, H0020
Certain services, supplies, and prescription drugs require advance (prior) approval before benefits are provided. This ensures the services are diagnostically appropriate, medically necessary, and cost effective.
Blue Cross and Blue Shield of Vermont network providers get prior approval for you. If the Vermont network provider fails to get prior approval for services that require it, the provider may not bill you. Work directly with your provider to request the proper prior approval. We must respond to all prior approval requests within two business days, and requests should be submitted before the member's appointment. You and your provider will be notified once the BlueCross team has reviewed the information.
If you use an out-of-network provider or an out-of-state provider, it's your responsibility to get prior approval. Failure to get prior approval could lead to denial of benefits. If you can show that the services you received were medically necessary, we will provide benefits.
To check the status of your prior approval, log in to the Member Resource Center.
We understand that there's a lot to know about health insurance - review our tips and resources to help you better understand your health plan so you can take care of yourself and loved ones.
Our free wellness programs provide a variety of resources and information to help you improve and maintain your health. Access one-on-one advisors for managing a new health diagnosis or your medications, as well as resources for ongoing health and wellness
Vermont Blue Rx is our local solution to answer your pharmacy needs. We offer a local and national network of pharmacies to help you manage your care and reduce prescription drug costs.
Before heading home from the hospital or another treatment facility, check out these tips and resources to help you take care of yourself. It is important to ask questions so that you're fully informed and able to take care of yourself. This is crucial in lowering your chances of having to return to the facility after you've been discharged.
Contact our award-winning customer service team to discuss your benefits, claims and other health plan questions.
Monday - Friday, 7:00am to 6:00pm