Find resources and forms that help you and your employees maximize plan benefits and make informed decisions about care options.
Resources for You and Your Employees
For over 30 years, Blue Cross VT has been dedicated to enhancing the health and wellness of Vermonters as the state's only local, non-profit health plan. We're committed to supporting you and your employees, helping you understand your Qualified Health Plan (QHP) benefits and services.
When you have a Blue Cross VT health Plan, you have:
- Trusted Local Coverage: As a non-profit organization based in Vermont, we provide reliable coverage you can count on.
- Award-Winning Support: Our Vermont-based staff delivers exceptional customer service recognized for excellence.
- Extensive Network Access: Benefit from the largest network of doctors and hospitals in Vermont.
- Global Reach: Access healthcare professionals and facilities across the U.S. and worldwide.
If you're looking to enroll an employee in your group coverage or make changes to your existing coverage, additional information and forms can be found below. You can also log in to ourEmployer Resource Centerto access forms online for making updates.For brokers supporting employer groups, access our Broker Resource Center to help manage your group's plan.
If you need assistance with choosing plans for your employees or managing your plan throughout the year, connect with our local small business team at (800) 255-4550 (TTY/TDD: 711).
Getting Started
Open Enrollment begins November 1 each year for enrollment in our Qualified Health Plans (QHP). Access our tools and resources to help find the right plans for your organization and employees.
Use our plan finder tool for further details about our small group Qualified Health Plan costs and benefits.
Enroll Your Business
Review the steps needed to enroll in our plans and get started on the process.
Health Spending and Savings Options
We offer integrated HRAs, FSAs, and HSAs that gives you and your employees a seamless way to manage health care spending and savings.
Benefits & Programs
Be Well Vermont
Our Qualified Health Plans offers access to Be Well Vermont – our free, wellness program that helps members with setting wellness goals, tracking progress, and fun challenges.
Personal Health Services
Our registered nurses, licensed social workers, and behavioral health counselors offer personal health services. We offer expertise in different areas of health care, including medical, mental health and substance use treatment.
Prescription Drug Coverage
Vermont Blue Rx is your one-stop solution for prescription drug coverage, and includes access to trusted local pharmacies and a nationwide network of retail pharmacies, home delivery options, and medication management programs.
Primary and Preventive Care
Our plans cover primary care and specialty provider visits (cost-share, deductibles and copays apply). Use our find a doctor tool to get locate a provider near you.
Telemedicine Care
We provide 24/7 telemedicine care with Amwell so you can access care whenever you need, from wherever you may be.
Pediatric Dental and Vision Benefits
Included as part of the Essential Health Benefits, dental and vision benefits are available for members up to age 21.
Downloadable Resources
Share the resources below with your employees to help them with managing their health plan and care.
Understanding Preventive Coverage
The foundation of a well-rounded health plan is a regular preventive health visit. Check out our tips for getting the most out of your preventive coverage.
Mental Health Telemedicine Resources
To meet the increasing need for mental health and substance use disorder providers, we’ve partnered with Sondermind®, Valera Health®, and Amwell® to increase access to mental health care providers for our members.
Register for the Member Resource Center
Our Member Resource Center provides helpful information for your employees, including eligibility, claims and approvals. They can also access forms and send secure messages.
Maximize Your Benefits
Our blog provides members with resources for understanding health insurance and maximizing their health plan, as well as other health and wellness articles. Below are a few articles to share with your employees to help them with managing their benefits.
Blue Cross VT Blog
Zero-Dollar Office Visits
We offer zero-dollar office visits in many of our qualified health plans (QHPs) for in-network primary care, mental health, or substance use disorder treatment.
Tips for Maximizing Your Benefits
From understanding your benefits to strategically planning procedures, we've got you covered with tips to help you maximize your health plan and save money on health care.
Everything to Know About HSAs
Some of our Consumer-Directed Health Plans (CDHP) are eligible to be paired with a MyMoney Health Savings Account (HSA). HSAs let you set aside money on a pre-tax basis to pay for qualified medical expenses.
Enrollment and Change Forms
Enrolling an employee in your group coverage or making changes to your existing coverage can be doneelectronically through our Employer Resource Center or by completing the enrollment/change form(s) below and sending to us via email, fax, or mail.
Employees may enroll in your group's plan during the following times.
- Initial opportunity:the first opportunity in which employee is eligible to enroll following completion of company's waiting period if applicable.
- Open enrollment period:usually the anniversary date of the group's original enrollment
- Special enrollment period:triggered by a qualifyingevent
Changes to existing coverage may be made during the open enrollment or special enrollment periods. Use the table below to help understand stand when enrollment or enrollment changes can be made.
| Event | Date of Submission | Change Effective Date |
|---|---|---|
| New Hire/ Rehire* | No later than 60 days from the date of hire | Effective date based on Group's probationary period –not to exceed 90 days from date of hire |
| Marriage/Civil Union* | Within60 days following marriage | First of the month following receipt |
| After 60 days following marriage | Void - must wait until next Open Enrollment | |
| Birth* | Newborn is automatically added for first 60 days Within 60 days following the date of birth, to continue coverage or to request other changes to your coverage | Date of birth for child and 61st day after the birth for the membership type change |
| After 60 days following birth | Void - must wait until next OpenEnrollment | |
| Adoption* | Within 60 days following the date of birth, to continue coverage or to request other changes to your coverage | Date of birth for child and 61st day after the birth for the membership type change |
| After 60 days following birth | Void - must wait until next open enrollment | |
| Death | Within 6 months of the date of death | Date of death |
| Divorce | Within 60 days of divorce | First of the month following divorce |
| Qualifying Loss of Coverage* | Within 60days of loss of coverage | Retroactive to date of coverage loss or first month following receipt |
| Voluntary Cancellation | Submit Small Group Employee Enrollment and Change Form with employee signature Outside of Open Enrollment, proof of other coverage must be provided | First of the month following receipt or mid-month date if other coverage begins mid-month |
| Left Employment | Submit Group Membership Update Form indicating key word as "LE" | Term date of employment termination or first of the month following date ofreceipt |
| COBRA Eligibility | If subscriber accepts COBRA within 60 days, he or she can be retroactively reinstated | Not Applicable |
| Medicare SupplementCoverage | Within 90 days of the date of Medicare coverage | Date of Medicare entitlement. If received prior to Medicare effective date, coverage will be effective to coincide with Medicare. |
| Addition of Employee who Refused Initial Enrollment | Prior to or afterOpen Enrollment | Void - must wait until next Open Enrollment |
| During Open Enrollment | Effective the first of the new calendar year (January 1) after Open Enrollment ends |
*Requests not received as indicated above can be processed during Open Enrollment to begin the first of the new calendar year (January 1).
Before enrolling or making changes to your employee's membership, you must determine
- Eligibility
- The employee's dependent(s) eligibility
- Type of membership the employee will need (employee only; two-person; adult and child(ren); or family)
- If the plan requires a primary care provider (PCP) be selected, the PCP must be selected for the employee and all eligible dependents in order for the membership to become effective.
Prior tocompleting an enrollment form, you must ensure that your employees have the Summary of Benefits Coverage (SBC)that apply to the coverage for which they may enroll.
| Employer Forms | Purpose |
|---|---|
| 2024 Small Group Employee Enrollment/Change Form | Used to submit a change or to enroll an employee in a small group qualified health plan |
| 2024Small Group: New Group Enrollment Packet | Small groups who are NEW to Blue Cross and Blue Shield of Vermont should complete this packet |
| 2024Small Group Plan Selection Form | To show your employees what plan(s) you are offering and what contribution amounts are and allow employees to provide you their plan selection. |
All group enrollment & change forms must be signed and dated by the subscriber.
All membership update forms must be signed and dated by the appropriate group representative.
- 834 Submissions Companion Guide
| Employer Forms | Purpose |
|---|---|
| Group Contact Update Form | This form allows employer groups to add or change designated contacts to receive or change information at Blue Cross VT for your organization. |
| Broker Authorization Form | This form allows employer groups to designate a broker agency and/or individual brokers as authorized contacts to receive or change information on behalf of the group. It will be included in this year's renewal forms that CBSS and account managers review with both small and large groups. |
Continuity of Care Members can complete this form electronically through the Member Resource Center (under "My Forms") | For new members receiving treatment for a chronic medical, mental health or substance abuse condition or pregnant and are in their 2nd or 3rd trimester. Completion of this form will ensure a seamless transition of health care and pharmacy needs. |
| Statement of Domestic Partnership | Domestic Partner Coverage |
| Adult Dependent Coverage Request | Request for coverage, and medical certification |
| MSP Step-by-Step Guide for Small Group Exception | Step-by-step guidance on how to apply for a small employer exception from Medicare coordination of benefits contractor. |
| Waiver of Group Health Insurance | Used by spouses or partners to opt-out of Blue Cross and Blue Shield of Vermont coverage. |
Go to Member Forms
All group enrollment & change forms must be signed and dated by the subscriber.
All membership update forms must be signed and dated by the appropriate group representative.
| Forms | Purpose |
|---|---|
| Credibility Analysis | Important notice concerning prescription drug coverage |
| Creditable Coverage Simplified Determination | Important notice concerning prescription drug coverage |
| Creditable Notice Template | Important notice concerning prescription drug coverage |
| Non-Creditable Notice Template | Important notice concerning prescription drug coverage |
| CMS Creditable Coverage Guidance | Important notice concerning prescription drug coverage |
| Vermont Blue 65 Group Enrollment Application and Change Form | Medicare Supplement enrollment form for group members to enroll or make changes. |
Go to Member Forms
For additional information on the above forms, visit CMS.gov.
All group enrollment & change forms must be signed and dated by the subscriber.
All membership update forms must be signed and dated by the appropriate group representative.
- Where can I locate additional Blue Cross and Blue Shield of Vermont forms?
- Member Forms
- Provider Forms
- Is it required to submit a Group Membership Update form with the Group Enrollment Form?
- No, most membership changes can be processed from the Group Enrollment Form.
- When can an employeeexpect to receive theirID card(s)?
- Generally, ID cards are mailed to the subscriber’s home address within 7-10 days of processing.
- Can I submit membership changes using my invoice?
- No, do not make membership changes on the invoice or send any membership changes to our payment address.
- Can I pay a lower premium than billed based on a pending change?
- It is highly recommended you pay the total amount due shown on the last page of your invoice. If you are expecting adjustments, because we bill a month in advance, these adjustments may appear on a future invoice.
- How do I obtain information regarding COBRA/VIPER coverage?
- COBRA is federally mandated. VIPER (VT Statute) is state mandated. Please contact your legal counsel for questions.
- If COBRA/VIPER has been offered to a former employee, when should I submit the cancel request?
- Blue Cross and Blue Shield of Vermont recommends you submit the cancel request once the individual has left employment. If continuation of coverage is elected, the coverage will be effective the day coverage was lost, as long as the paperwork is received on time.
- When can I make benefit changes?
- Benefit changes can only be made once a year, on the anniversary of your original enrollment or association renewal date, or due to special enrollment event.
