1. Is the Dual Option Plan a BCBSVT plan?
Yes. In fact, the VEHI Dual Option Plan includes two BCBSVT health plans: the BCBSVT Vermont Health Partnership plan, and a fee-for-service plan known as the $250 Comprehensive plan. Presently, all VEHI plans are purchased from BCBSVT.

2. Are the covered medical services in the Dual Option plans different from my current JY plan coverage?
If you choose the $250 Comprehensive option, the core medical services covered are identical to those in your current JY plan. If you select the Vermont Health Partnership option (VHP), the covered services are virtually identical. The VHP Plan includes benefits for a vision exam other plans don't offer.

3. What are the key differences between the JY plan and the Dual Option $250 Comprehensive plan?
The key difference between JY and the $250 Comprehensive plan is the way they pay for the services they cover.

The JY plan covers most necessary services at 100% of the Allowed Price. You pay only a $10 Visit Fee for each office visit, including mental health and chiropractic visits. For certain services, such as ambulance or medical equipment and supplies, you must pay a $100 deductible and then 20% of the Allowed Price in coinsurance up to a maximum of $500 per calendar year. Visit Fees you pay for office visits do not apply to this out-of-pocket maximum.

Under the $250 Comprehensive plan, you must meet your $250 deductible before we begin paying 80% coinsurance for covered services. Your maximum individual out-of-pocket expense under this plan is also $500: a $250 deductible and $250 in coinsurance expenses.

Both plans offer the same Three-tier Prescription Drug plan. Refer to page 19 for details.

4. How does VHP differ from fee-for-service plans?
The Vermont Health Partnership is a point-of-service plan. In this type of plan, your Primary Care Physician manages your care, handles routine or preventive medicine needs and directs you to specialty providers when you need further care. When you visit your Primary Care Physician, you pay only $5 per visit. For visits with a VHP network specialist, you pay $15 per visit.

5. Can some family members select the Dual Option $250 Comprehensive plan while others select the VHP plan?
No. All family members must be on the same plan.

6. If I choose the $250 Comprehensive plan at first, can I later change my mind and move into the VHP option?
Yes. Regardless of which plan you initially select, you may change plans once in a 12-month period, on either January 1 or July 1, in accordance with plan guidelines (see Making Changes on page 17). You must give written notice to BCBSVT at least 30 days prior to the date you will be changing options. See representatives from your district's business office for proper BCBSVT forms.

7. What types of doctors are usually considered Primary Care Physicians under the VHP option?
Pediatricians, general practitioners, internists, and family practitioners. You can find a list of Primary Care Physicians on page 23 of this brochure.

8. Are all Vermont Primary Care Physicians participating in the Vermont Health Partnership network?
Most are. In order to join the network, a Primary Care Physician must apply and be credentialed by BCBSVT. Presently, 85% of in-state BCBSVT Primary Care Physicians are in the VHP network. Many New Hampshire doctors along the Connecticut River, and some in New York, are also in the VHP network. See the list of network Primary Care Physicians in your area beginning on page 23 of this brochure. You can always find the most current list of Primary Care Physicians in the "Find a Doctor" section of our web site at www.bcbsvt.com.

9. What if my present primary care doctor isn't in the VHP network? What are my options?
First, ask your doctor why, and then urge him or her to apply. By doing so, you can help BCBSVT expand the list of network Primary Care Physicians. Second, you could consider picking a different Primary Care Physician who is in the network. Remember, while you do not need a referral from your Primary Care Physician for in-network specialty care, you do need to use your Primary Care Physician for your primary care needs and for referrals for specialty care if you use an out-of-network specialty provider. Finally, you may want to consider the $250 Comprehensive option rather than the VHP option, or consider remaining in your present plan if your school district offers a third option. The list of Primary Care Physicians continues to grow, so you should regularly consult the most current listing. Call customer service at (800) 344-6690 to get a current list or log onto our web site at www.bcbsvt.com.

10. If I select the VHP plan, can I designate a different Primary Care Physician for each member of my family?
Each family member may designate a different Primary Care Physician. Any children away at college and covered by your VHP plan must also designate a Primary Care Physician from the VHP network.

11. In my area, most of the Primary Care Physician practices are closed to new patients. What should I do?
Although the Directory of Primary Care Physicians lists most physician offices as closed, openings occur from week to week. Consider calling the practice directly to inquire about recent openings.

12. How often can I change my Primary Care Physician under VHP?
We encourage you to develop a long-term relationship with your Primary Care Physician. However, should you need to change physicians, you may do so as often as once a month. Changes become effective the first of the month following the date BCBSVT receives your request to change. BCBSVT strongly encourages you to provide notice, by phone or in writing, by the 15th of the month in order to properly notify your new Primary Care Physician that you will be coming under his or her care for the upcoming month. Please note that we cannot make retroactive changes.

13. If I select the VHP plan, when do I need my Primary Care Physician's referral?
It is not necessary for your Primary Care Physician to submit a written referral to BCBSVT as long as you’re using a network provider. We encourage you to contact your Primary Care Physician before seeking specialty care to ensure you get the correct level of care.

Your Primary Care Physician must submit a referral to us when appropriate care cannot be provided in-network and he or she wishes to refer you to an out-of-network specialty provider. In such cases, BCBSVT must also approve the referral in advance. If you see an out-of-network provider without an approved referral, Standard Benefits may apply. See the chart on page 13 for further details.

14. If I choose the VHP option, do I need to contact my Primary Care Physician if I need care out of state?
Yes, unless you are facing a medical emergency. Such emergencies never require advance approval, but do require notice to BCBSVT within 48 hours, if you are admitted to the hospital. In non-emergency situations, you must contact your Primary Care Physician before seeking any out-of-network care, including care while you’re in another state, or out of the country.

15. Are dependent children away at college covered?
Yes. Unmarried, full-time students are covered until age 25. If you choose VHP, students attending school out of state should schedule most primary care and specialty provider visits while at home on break. Although some services are not included in Standard Benefits, out-of-state care may be covered at the Standard Benefit level if BCBSVT determines care cannot be provided in-network and the Primary Care Physician submits a referral. Students may receive urgent or emergency care at school, but we encourage you to keep the student's primary care doctor informed of any emergency care so he or she may coordinate follow-up care. We also pay Preferred Benefits for care for any condition that needs continuing therapy during a student's time at college.

16. How does my coverage work in emergency situations?
Emergency room treatment must meet the criteria in your Certificate of Coverage to be covered by any VEHI plan. No matter which plan you choose, it's also wise to inform your primary care doctor when you've received emergency care. He or she will want to coordinate necessary follow-up care and ensure you get the appropriate treatment. If you are admitted to the hospital, be sure to call for Managed Benefit reviews to avoid penalties.

17. What is the difference between Preferred and Standard Benefits?
“Preferred” and “Standard” refer to levels of reimbursement for services covered by the Vermont Health Partnership. To find out how to obtain maximum, or “Preferred," benefits, please see the chart on page 13.

18. For maternity visits, will I be required to pay a VHP visit fee for each visit?
No. One visit fee covers all prenatal and postnatal visits with a VHP network OB/GYN provider.

19. How do the different Dual Option plans provide services for mental health and substance abuse care?
Both Dual Option plans offer access to mental health and substance abuse services (MH/SA) only in a managed care setting. This means treatment is approved and directed by the clinical staff retained by BCBSVT. You can easily secure initial authorization by calling (800) 395-1356. Neither the $250 Comprehensive option nor VHP require you to get a referral from your Primary Care Physician before seeking care. Network representatives will approve services and direct you to a network provider in your area who can provide the type of care you need.

20. How are dental services covered under the plan?
The Vermont Health Partnership covers the same dental procedures as other BCBSVT plans. They include only the procedures listed below:

• treatment for accidental injury to the jaws, teeth, mouth or face;
• surgery to correct gross deformity resulting from major disease;
• surgical removal of bone-impacted teeth; and
• treatment of temporomandibular joint syndrome.

You must use a VHP Network oral surgeon to receive benefits. You must also obtain prior approval from Blue Cross and Blue Shield of Vermont for the surgery.

21. My daughter just graduated from college and has purchased my existing plan under COBRA. Does she have other health plan choices in addition to the plan I've chosen?
Yes. According to COBRA regulations, unless she decides to waive COBRA and purchase a different plan outside of your group, she must select from the plan options offered by the employer. She is eligible for coverage for up to 36 months.