Health

The Vermont Education Health Initiative (VEHI) is a large, non-profit purchaser of health care plans for Vermont's school employees. This self-funded trust is managed jointly by the Vermont School Boards Insurance Trust (VSBIT) and the Vermont-National Education Association (Vermont-NEA). Claims administration and related services are currently purchased from Blue Cross Blue Shield of Vermont.

The Health Program, which was started by VSBIT in 1984, began with 98 school districts and covered 2,327 employees (16 of these schools and 333 employees were enrolled in the JY Managed Benefit Plan). The program has since grown to include every public school district in the State and approximately 25 private schools, covering almost 19,000 employees and retired teachers.

VEHI offers the Dual Option Plan, which gives employees a choice between two of BCBSVT's health plans:

Vermont Health Partnership, a point-of-service plan; and
Comprehensive Plan with a $250 deductible, a fee-for-service plan.

VEHI also offers the following BCBSVT fee-for-service health care plans to its members:

JY Plan;
Comprehensive Plan with no deductible;
Comprehensive Plan with a $100 deductible;
Comprehensive Plus Plan with a $1,000 deductible, and
HSA Blue High-Deductible Plan

All the plans offer virtually identical covered services. The variations occur in the plans payment terms: each offers slightly different member out-of-pocket arrangements.

Each group (school district) that purchases health benefits plans through VEHI chooses the plans offered to its members. This area of the site describes the three most popular plans in detail.

Plan Options
For an overview of all the plans offered, see the comparison chart here.

Prescription Drugs
Dual Option Plan FAQs
Making Changes

The Three-tier Pharmacy Program

No matter which VEHI plan you choose, the prescription drug benefits are the same.* To use the program, present your Blue Cross and Blue Shield of Vermont I.D. card at a network pharmacy.

There is no deductible in the current pharmacy program.

You pay:

a $0 co-payment for generic drugs
a $15 co-payment of Brand-Name drugs that are on our Preferred Brand-Name Drug list, or
a $40 co-payment for Brand-Name drugs that are not on our Preferred Brand-Name Drug list (Non-Preferred drugs).

The Preferred Brand-Name Drug list can change and will be updated to ensure that newer, more effective drugs are on it. Drugs automatically come off the list when generic alternatives become available. To get the most updated list, go to www.bcbsvt.com, click on "Rx Center" and then "Preferred Brand-Name Drug List."

You pay the pharmacy for your deductible or co-payment. The pharmacy will bill us for the rest. You need not file claims if your VEHI plan is your primary coverage.

Use Network Pharmacies
You must use ExpresScripts network pharmacies to get full benefits from the VEHI plan. Most Vermont pharmacies and 97% of pharmacies nationwide currently belong to this network. All major chains (Rite-Aid, Brooks, CVS, etc.) participate.

If you travel, you may use any out-of-state pharmacy in the RESTAT network. Call (800) 248-1062 to locate a RESTAT pharmacy near your destination. You may also visit the "Find a Doctor" page of our website at www.bcbsvt.com to view a list of RESTAT network pharmacies. Some state laws may require you to transfer your prescription from your local pharmacy or have your doctor write you a new one. Alternatively, BCBSVT's customer service department may give you a waiver so that you can get a large enough supply of prescription drugs to last you on your trip. (You must pay one co-payment for each 30-day supply.)

How to Pay Lower Co-payments

Here are some tips to reduce your out-of-pocket expenses:

Ask your physician to authorize a generic substitution whenever possible. This guarantees you the lowest co-payment in the three-tier system.
When a generic is not available, ask your doctor if one of the drugs on the Preferred Brand-Name list would be appropriate for you. These drugs can often meet patient needs at a lower cost. If your physician prescribes a listed brand, you pay the $15 co-payment.
If you use the mail order program for maintenance drugs, you may secure a 90-day supply for two co-payments instead of three.

Save a Co-payment with the Mail Order Program
If you use drugs on a maintenance basis, you can save money by using the mail order program.

If you buy your drugs through the mail order program, you only have to pay two co-payments for every 90-day supply. (For example, for a Brand-Name drug on the Preferred list, you will pay $30 for a 90-day supply.)

Compare this to buying drugs at the retail pharmacy. There, you must pay a co-payment for every 30-day supply of drugs you get. So, if your doctor prescribes a 90-day supply of a drug, you must pay three co-payments. (For example, for a Brand-Name drug on the Preferred list, you will pay $45 for a 90-day supply.)

Send our mail order pharmacy your doctor's prescription, an order form and your co-payment. You must send the original prescription by mail. You may use a web-based ordering system (www.ipsrx.com) or call a toll-free number to request refills. If you are using the mail-order service for the first time, you must also send a confidential patient profile and an enrollment form. To get an order form for the mail order program, call BCBSVT's customer service department at (800) 344-6690.

Dual Option Plan Questions and Answers

Is the Dual Option Plan a BCBSVT plan?

Are the covered medical services in the Dual Option plans different from my current JY plan coverage?

What are the key differences between the JY plan and the Dual Option $250 Comprehensive plan?

How does VHP differ from fee-for-service plans?

Can some family members select the Dual Option $250 Comprehensive plan while others select the VHP plan?

If I choose the $250 Comprehensive plan at first, can I later change my mind and move into the VHP option?

What types of doctors are usually considered Primary Care Physicians under the VHP option?

Are all Vermont Primary Care Physicians participating in the Vermont Health Partnership network?

What if my present primary care doctor isn't in the VHP network? What are my options?

If I select the VHP plan, can I designate a different Primary Care Physician for each member of my family?

In my area, most of the Primary Care Physician practices are closed to new patients. What should I do?

How often can I change my Primary Care Physician under VHP?

If I select the VHP plan, when do I need my Primary Care Physician's referral?

If I choose the VHP option, do I need to contact my Primary Care Physician if I need care out of state?

Are dependent children away at college covered?

How does my coverage work in emergency situations?

What is the difference between Preferred and Standard Benefits?

For maternity visits, will I be required to pay a VHP visit fee for each visit?

How do the different Dual Option plans provide services for mental health and substance abuse care?

How are dental services covered under the plan?

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?

Changing Your Primary Care Physician
We encourage you to develop a long-term relationship with your Primary Care Physician. However, you may someday need to change Primary Care Physicians.

It's easy to do. To change your Primary Care Physician:

select a new Primary Care Physician who is in your area
call the Customer Service phone number on your identification card and request the change, or
notify our Account Services Department of the change by mailing an application form indicating your change of physician to:
Blue Cross and Blue Shield of Vermont
Account Services
P.O. Box 186
Montpelier, VT 05601-0186.

Your change becomes effective the first of the month following BCBSVT's receipt of your request. BCBSVT will make no retroactive Primary Care Physician changes. Your new Primary Care Physician may wish to review your ongoing care, so contact him or her and introduce yourself as a new patient.

Changing Plans

School Districts:

School Employees: Changes in health plan options may be made once in a 12-month interval, during the plan's "open enrollment periods." To make these changes, get a Group Enrollment Form from your school district's Group Benefits Manager. The Group Benefits Manager will submit the completed form to BCBSVT. If BCBSVT receives the request before January or July, the change will be made effective on January 1 or July 1. If the request is received during January or July, the change will be effective on the first of the following month.

If the change is from a fee-for-service plan to the Vermont Health Partnership, you must designate a Primary Care Physician for each family member.

Family Status Changes
When families grow because of marriage, birth of a child or adoption, or if your spouse loses coverage, we allow you to make membership changes between open enrollment periods. In the absence of one of these "qualifying events," employees may also add or remove dependents (to or from single, two-person or family memberships) during the plan's open enrollment periods. When you add or remove dependents, your type of membership (individual, two-person, or family) may change.

To make these changes, get a Group Enrollment Form from your school district's Group Benefits Manager. The Group Benefits Manager will submit the completed form to BCBSVT. If BCBSVT receives the request before January or July, the change will be made effective on January 1 or July 1. If the request is received during January or July, the change will be effective on the first of the following month.