Standard Silver CDHP Plan for Individual Individual

This is a Silver tier plan.
Regular Use

Good for occasional medical needs

Plan Costs & Overview

Monthly premium

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

$789.15

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.

$1,850

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.

Aggregate

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.

$6,900

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.

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.

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.

$1,400

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

$10

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

$40

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

$10

co-pay

After Deductible

$10

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

$40

co-pay

After Deductible

$40

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

50%

co-insurance

After Deductible

50%

co-insurance

Notes

The prescription deductible is waived for select 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. 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

Full price

After Deductible

10%

co-insurance

Specialist

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

Before Deductible

Full price

After Deductible

30%

co-insurance

Chiropractor

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

Before Deductible

Full price

After Deductible

30%

co-insurance

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

Full price

After Deductible

30%

co-insurance

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 or heart disease.

Before Deductible

Full price

After Deductible

30%

co-insurance

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

Full price

After Deductible

30%

co-insurance

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

30%

co-insurance

Emergency Room

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

Before Deductible

Full price

After Deductible

30%

co-insurance

Emergency Medical Transportation

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

Before Deductible

Full price

After Deductible

35%

co-insurance

Outpatient

A patient who receives services/care while not an inpatient. Outpatient care may be provided in a hospital, walk-in clinic, outpatient surgery center, and your doctor’s office. It includes diagnostic tests, treatments, or other types of procedures.

Before Deductible

Full price

After Deductible

30%

co-insurance

Inpatient Hospital Stay

Inpatient hospital stay is when you are admitted to a hospital or other type of inpatient facility and spend at least one night.

Before Deductible

Full price

After Deductible

30%

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.

 

For those who may qualify for subsidies

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

Have Questions?

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Contact us today

Hours

From November 1, 2021 — December 30, 2021:

 - Monday-Friday: 8:00am to 6:00pm

 - Saturday: 9:00am to 12:00pm