Our member forms are available to help you manage your health plan. Many of the forms are available via the Member Resource Center for easy completion and submission online – eliminating the need for printing and mailing.
If you are an employer looking to enroll new members or make changes to your group’s existing enrollment information, visit our Member Maintenance page.
Complete the below form and submit via the Member Resource Center, or via email or fax. The Blue Cross and Blue Shield of Vermont claims team accepts some member-submitted claims for covered services with out-of-network (non-preferred) providers. If you need help completing the form, contact our Customer Service team at (800) 247-2583.
Members enrolled in Blue Cross and Blue Shield of Vermont coverage through Vermont Health Connect have the option to request their plan administration be transferred to Blue Cross and Blue Shield of Vermont. This means that you would become a direct enroll member and would work directly with us for enrollment, getting bills, paying premiums, and reporting changes. It's important to note, direct enroll members are NOT eligible for any subsidies. To learn more about this option, or for any questions, please contact an exchange consultant at (800) 255-4550. They are available Monday - Friday from 8:00 a.m - 4:30 p.m.