Silver Reflective Plan for Individual

This is a Silver tier plan.
Regular

Good for occasional medical needs

Only available if purchased directly with Blue Cross

No premium assistance available

Plan Costs & Overview

Monthly premium

Your premium is the amount you pay for your health insurance each month.

$747.00

per month

Deductible amount

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

$4,000

per year

Deductible type

There are two kinds of deductibles: stacked and aggregate. Stacked deductible plans pay benefits for an individual once the individual deductible is met, even on a two-person or family plan. With aggregate deductibles, the full single or family deductible must be satisfied before benefits are paid.

Stacked

Out-of-pocket maximum

A limit on the amount you will pay for covered services (medical or prescriptions) in a calendar year. Once you meet this limit, we will pay for 100% of covered health care costs for the rest of the calendar year.

$9,100

per year

Health Savings Account (HSA) compatibility

A Health Savings Account (HSA) is a savings account that allows you to save money tax-free which can be used to pay for qualified health care expenses set by the IRS.

Not Compatible

Health Reimbursement Arrangement (HRA) compatibility

A Health Reimbursement Arrangement (HRA) is for some employer-funded health plans in which employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year.

Not Compatible

Network type

The type of health insurance plan offered that determines the network of providers and facilities available in that health plan. For example, our EPO network plans cover services for doctors, specialists, or hospitals in our Blue Cross network within Vermont and nationwide.

EPO

Prescriptions

Prescription deductible

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

$500

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.

$1,400

Generic prescriptions

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

Before Deductible

$20

co-pay

After Deductible

$20

co-pay

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

$70

co-pay

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

50%

co-insurance

Generic wellness prescriptions

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

Before Deductible

$20

co-pay

After Deductible

$20

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

Full price

After Deductible

$70

co-pay

Non-preferred wellness prescriptions

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

Before Deductible

Full price

After Deductible

50%

co-insurance

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. It can include annual check-ups, immunizations, as well as certain tests and screenings.

$0

Screening

A test that helps find diseases and conditions early. 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

A health care provider who provides primary, routine care services.

Before Deductible

3 visits at $0, then $40

After Deductible

$40

co-pay

Specialist

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

Before Deductible

$90

co-pay

After Deductible

$90

co-pay

Chiropractor

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

Before Deductible

$50

co-pay

After Deductible

$50

co-pay

Outpatient Physical Therapy

A series of visits to a clinic (either in a hospital or facility) to receive therapy that relieves pain of an acute condition, restores function, and prevents disability following disease, injury. or loss of body part.

Before Deductible

$50

co-pay

After Deductible

$50

co-pay

Nutritional Counseling

A healthcare provider helps you assess your dietary habits to help create an individual action plan for ongoing self-care. Nutritional counseling benefits are covered up to 3 visits. There is no limit on the number of nutritional counseling visits for treatment of diabetes.

Before Deductible

$90

co-pay

After Deductible

$90

co-pay

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 person’s particular occupation.

Before Deductible

$90

co-pay

After Deductible

$90

co-pay

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

$100

co-pay

After Deductible

$100

co-pay

Emergency Room Care

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

Before Deductible

Full price

After Deductible

$500

co-pay

Emergency Medical Transportation

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

Before Deductible

$105

co-pay

After Deductible

$105

co-pay

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

50%

co-insurance

Outpatient Hospital Care

A patient who receives services/care that usually doesn’t require an overnight stay or admitted into a hospital. Outpatient care may be provided in a hospital or ambulatory surgical center. These services can include surgery, diagnostic services, advanced imaging (MRI, CT or PET scan), treatments, or other types of procedures.

Before Deductible

Full price

After Deductible

50%

co-insurance

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

50%

co-insurance

Enrollment & Help

Ready to enroll? Based on whether you qualify for federal subsidies or not, we have outlined the enrollment options below.

For those who do not qualify for subsidies or want to enroll directly with us

You can enroll directly online or download a PDF form to send to us.

 

By clicking the enrollment option directly with us, you are acknowledging you will not receive any premium assistance through Vermont Health Connect, and as a result may end up paying more for your health coverage. To verify you’re your eligibility to qualify for premium assistance and help reduce your monthly premium, click Check my Subsidy Eligibility button below.

For those who may qualify for subsidies

If you do qualify for subsidies, you must enroll through the Vermont Health Connect website. 

Have Questions?

Samantha Jenkins, Senior Sales & Service Consultant

We're here for you

We'll help you find the right plan for yourself or your whole family.

Connect with Us

Connect with Us

Want to chat with our local team about our available plans for you and your family? We can connect you with an agent who can answer your questions or explore our plans with you. Note: all form fields are required.






Communication Preference:

By submitting my information on this form, I give permission for Blue Cross and Blue Shield of Vermont to contact me by phone or email to answer questions and discuss health insurance products available for my needs. Information may be provided by phone, mail or email by Blue Cross and Blue Shield of Vermont licensed, authorized agents.

Hours

Monday–Friday
8:00 a.m. to 4:30 p.m.