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Insurance Information 2018

Open Enrollment

  1. Open Enrollment Memo
  2. Open Enrollment Presentation Slides
  3. Insurance Rates

Health Insurance

  1. Health Insurance Election Form
  2. BCBSVT Group Enrollment Form
  3. HSA Banks
  4. HSA Direct Deposit Authorization and Cancellation Form
  5. Statement of Domestic Partnership
  6. Vermont Declaration of Coverage
  7. Summary of BlueCross BlueShield Benefits
  8. Preventative Care Guide
  9. Wellness Drug List
  10. HSA Over the Counter Items Requiring Prescription

Health Plan Contract Documents

    1. Summary Plan Description
    2. Plan J and Comprehensive Certificate of Coverage
    3. BCBSVT Benefits Enhancement Rider
    4. BCBSVT Prescription Drug Rider
    5. BCBSVT Preventive Care Rider
    6. BCBSVT Vision Examination Rider
    7. Wellness Drug Rider

Dental Insurance

  1. Delta Dental Enrollment Form
  2. Summary of Delta Dental Benefits
  3. Delta Dental Vision Benefits
  4. Delta Dental Access Instructions

Vision Insurance

  1. Election of Vision Benefits Form
  2. Summary of VSP Vision Benefits

Life & Long Term Insurances

  1. Beneficiary Change Form
  2. Life Insurance Application
  3. Life Insurance Plan Details
  4. Long-Term Disability Plan Details

Access to BCBSVT

  • Login to the Blue Cross Blue Shield website. From the Blue Cross Blue Shield website you can access your coverage history, find providers and order prescriptions.
  1. Once on the BCBSVT website, click Member at the top of the page.
  2. Then click LOGIN or REGISTER at the bottom of the page.
  3. Using your ID card and personal information you can setup an account for access to all BCBSVT services.

Access to HealthEquity