Vermont Select Bronze CDHP Plan

This is a Bronze tier plan.
Basic Use

Good for infrequent medical needs

Plan Costs & Overview

Monthly premium

Your monthly payment for your health plan coverage.

Employee

$810.79

per month
Employee & Spouse

$1,621.58

per month
Employee & Child(ren)

$1,564.82

per month
Family

$2,278.32

per month

Deductible amount

The dollar amount you pay for services and/or medications before your plan begins to pay a larger portion of your costs.

Employee

After Deductible

$7,700

per year
Employee & Spouse
Employee & Child(ren)
Family

After Deductible

$15,400

per year

Deductible type

There are two deductible types, stacked and aggregate. Members enrolled in an individual-only plan are not impacted, but if a family member is added onto the plan at a later date, it will change how the plan pays benefits.

 

On a stacked plan, once an individual meets their deductible or out-of-pocket limit, the plan pays accordingly, even on a two-person or family plan. With an aggregate plan, the full deductible or out-of-pocket limit must be met collectively by members on the plan before benefits are paid.

Aggregate

Out-of-pocket maximum

The maximum amount you will pay for covered services (medical or prescriptions) during a plan year. Once you meet this limit, your plans pays 100% of covered health care costs for the rest of the plan year.

Employee

After Deductible

$7,700

per year
Employee & Spouse
Employee & Child(ren)
Family

After Deductible

$15,400

per year

Health Savings Account (HSA) compatibility

A Health Savings Account (HSA) is a tax-free savings account that can be used to pay for IRS-approved medical expenses that are not covered by a member’s health plan. HSAs work in conjunction with an HSA-eligible health plan that meets IRS guidelines.

Compatible

Health Reimbursement Arrangement (HRA) compatibility

Health Reimbursement Arrangements (HRA) are administered and funded by employers to help employees pay for out-of-pocket health care expenses like deductibles, office visits, hospital stays, and prescription drug costs.

Compatible

Network type

A network type determines the network of providers and facilities available in a health plan. For example, all of our Qualified Health plans have an Exclusive Provider Organization (EPO) network which allows access to the preferred BlueCard® network of providers & facilities in Vermont and nationwide.

EPO

Prescriptions

Prescription deductible

The amount you pay toward the cost of medications before your plan will begin to pay costs.

Combined with Medical

Prescription out-of-pocket maximum

A limit on the amount you will pay for covered prescriptions in a calendar year. Once you meet this limit, we will pay for 100% of covered costs for the rest of the calendar year. Some plans may have a separate prescription out-of-pocket maximum, or it may be combined with the overall out-of-pocket maximum.

Employee

After Deductible

Combined with medical

Employee & Spouse
Employee & Child(ren)
Family

After Deductible

Combined with medical

Generic prescriptions

A generic drug is a medication created to be the same as an existing approved brand-name drug.

Before Deductible

Full price

After Deductible

$0

Preferred brand prescriptions

Brand-name drugs that are listed on our formulary drug list (drugs covered by your plan).

Before Deductible

Full price

After Deductible

$0

Non-preferred brand prescriptions

A medication that has been determined to have an alternate drug available that is clinically equivalent such as a generic equivalent.

Before Deductible

Full price

After Deductible

$0

Generic wellness prescriptions

Generic medication for select conditions such as asthma, antidepressants, cardiovascular/heart disease, diabetes, smoking deterrents, and more.

Before Deductible

$25

co-pay

After Deductible

$25

co-pay

Preferred wellness prescriptions

Preferred brand medications for select conditions such as asthma, antidepressants, cardiovascular/heart disease, diabetes, smoking deterrents, and more.

Before Deductible

65%

co-insurance

After Deductible

65%

co-insurance

Non-preferred wellness prescriptions

Preferred brand medications for select conditions such as asthma, antidepressants, cardiovascular/heart disease, diabetes, smoking deterrents, and more.

Before Deductible

85%

co-insurance

After Deductible

85%

co-insurance

Notes

The prescription deductible is waived for wellness drugs.

Office Visits

Preventive care

Services used to find or reduce your risks when you do not have symptoms, signs, or specific increased risk for the condition being targeted. They may include immunizations, screenings, counseling, or medications that can prevent or find a condition.

$0

Screening

A test that helps find diseases and conditions early, such as diabetic screenings, colonoscopies, mammograms, and more,. Routine health screenings are recommended for people throughout life as part of preventive care.

$0

Immunization

Vaccinations for adults and children.

$0

Primary Care & Mental Health

Primary Care: A visit to a healthcare provider who provides primary, routine care services.

 

Mental Health: A visit to a healthcare provider for routine, office-based mental health and/or substance use disorder treatment.

Before Deductible

Full price

per visit

After Deductible

$0

Specialist

A visit to a healthcare provider that is considered a medical specialist, such as an orthopedic surgeon or cardiologist.

Before Deductible

Full price

per visit

After Deductible

$0

Chiropractor

A visit to a licensed chiropractic provider to treat and prevent neuromusculoskeletal disorders.

Before Deductible

Full price

per visit

After Deductible

$0

Outpatient Physical Therapy

A visit to a healthcare provider for therapy that relieves pain of an acute condition, restores function, and prevents disability following disease, injury, or loss of body part.

Before Deductible

Full price

per visit

After Deductible

$0

Nutritional Counseling

A visit to a healthcare provider that helps you assess your dietary habits and create an individual action plan for ongoing self-care.

Before Deductible

Full price

per visit

After Deductible

$0

Outpatient Speech and Occupational Therapy

Speech therapy services provide treatment of swallowing, speech-language and cognitive-communication disorders. Occupational therapy services promote the restoration of a physically disabled person’s ability to accomplish the ordinary tasks of daily living or the requirements of their particular occupation.

Before Deductible

Full price

per visit

After Deductible

$0

Hospital Services

Urgent Care

Health care services that are necessary to treat a condition or illness of an individual that if not treated within 24 hours would cause risk.

Before Deductible

Full price

After Deductible

$0

Emergency Room Care

Care for illness or injuries that need immediate attention and care.

Before Deductible

Full price

After Deductible

$0

Emergency Medical Transportation

Transportation provided to the nearest facility or hospital, such as by an ambulance service.

Before Deductible

Full price

After Deductible

$0

Diagnostic Testing

Tests ordered by your provider to learn or determine more about a specific condition or disease. These services can include labs, x-rays, testing, and other procedures. These tests can be performed in an office and in an outpatient hospital.

Before Deductible

Full price

After Deductible

$0

Outpatient Hospital Care

Outpatient care in a General Hospital or ambulatory surgical center that does not require an overnight stay. Services may include surgery, diagnostic services, advanced imaging (MRI, CT, or PET scan), treatments (such as chemotherapy), or other types of procedures.

Before Deductible

Full price

After Deductible

$0

Inpatient Hospital Stay

Medical care when you get admitted to a health care facility, like a hospital or other type of inpatient facility and spend at least one night.

Before Deductible

Full price

After Deductible

$0

Enrollment & Help

Enrollment & Help

Ready to enroll? You can enroll through our Online Enrollment Form or download a PDF of our enrollment form to complete and send back to us.

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Hours

Monday–Friday
8:00 a.m. to 4:30 p.m.