There are three (3) medical insurance options offered to full-time employees as follows:

1. Blue Cross and Blue Shield.
2. Community Health Plan.
3. Waiver of Medical Coverage.

Regardless of which option is elected, coverage begins on the first day of employment and the cost of coverage is the same. Coverage is free for employee coverage. There is a dependent premium equal to 1/2 of 1% of base salary to cover your spouse and 1/4 of 1% base salary to cover each eligible dependent child, with a maximum deduction of 1/2 of 1% to cover 2 or more children.

Each year during the open enrollment, which is held in November, you will be given the option of changing our Medical Insurance option for the upcoming calendar year.

If you elect this option you have two (2) choices, depending on where you live, The BCBS UVM Managed Care Plan or the BCBS Comprehensive Plan.

If you elect BCBS coverage and you live in Addison, Chittenden, Franklin, Grand Isle, Lamoille, or Washington County in the State of Vermont, your coverage will be the UVM Managed Care Plan. Under the UVM Managed Care Plan you will be required to select a Primary Care Physician (PCP) from a list of doctors who are members of the Vermont Managed Care (VMC) network.

When you seek medical care, either directly through your PCP, or with a referral from your PCP, you only pay $2.00 per office visit.

You have the option of seeking medical treatment on your own, without the benefit of a referral from your PCP, each time you seek medical care. This is known as self-referral. When you self-refer, there is a $250 deductible per covered family member, then the plan covers 80% of the usual and customary (U & C) charges of self-referred care. A stop-loss provision limits your share of self-referred medical expenses to 10% of your UVM base salary per year for each covered family member. The maximum life-time benefit for self-referred benefits is $1,000,000.

Hospital care is paid at 100% with a PCP referral and pre-certification by VMC. Should you self-refer to a hospital, benefits are subject to a $400 if you do not obtain approval from VMC prior to admission. This is in addition to the self-referral deductible of $250. After those deductibles have been satisfied, self-referred hospital benefits are payable at 80% of U & C.

Mental health and substance abuse (MH/SA) treatment is provided through a network managed by Fletcher Allen Mental Health Service (FAMHS). As long as out-patient MH/SA treatment is pre-authorized by FAMHS you will be required to pay a co-payment of 20% of the cost of treatment. If you self-refer for MH/SA treatment you must pay a $200 deductible and then the co-payment is 50%. The maximum benefit for self-referred MH/SA is $3,000 per year, subject to a $10,000 lifetime limit.

Prescription drug coverage is provided through a pharmacy network managed by RESTAT, under contract with BCBS. After a $100.00 per person deductible, the covered member pays 20% of the cost of the prescription. There is an optional mail order prescription drug program for people who use maintenance drugs. Under the mail order program the $100 deductible is waived. Employees only pay 20% of the cost of mail order drugs.

If you elect BCBS coverage and you live outside one of the counties mentioned above, you are eligible for the Comprehensive Plan. The Comprehensive Plan covers the same scope of services as the UVM Managed Care Plan except that you do not need to select and use a specific PCP. Under this Plan, since there is no network of physicians available, you may use any physician you wish for primary or specialty care without a referral from a PCP.

For routine care you must pay 10% of the charges. All hospital based care and surgical care is paid at 100%. In the event you require hospitalization, or hospital based, (i.e., out-patient) surgery you must obtain prior approval from BCBS. If you do not, there is a $400 penalty.

MH/SA benefits are the same as the UVM Managed Care Plan, except that the MH/SA network is Merit Behavioral Health (MBH).

Prescription drug benefits are exactly the same as those described under the UVM Managed Care Plan.

CHP is an health maintenance organization (HMO), based in Latham, NY, and is part of the Kaiser Permanente Health Group.

Under this Plan you and your covered dependents will be required to select a Primary Care Physician (PCP), who belongs to CHP. You may each select a different PCP. All medical care must either be directly provided by or referred by your PCP. You will be required to pay a $2.00 co-payment for each office visit. If you go to a physician who is not your PCP without a referral there will be no coverage.

Hospital care is 100% covered with a PCP referral.

MH/SA benefits are provided by CHP however you must receive a prior referral from a special MH/SA unit of CHP for all treatment. You are allowed 20 out-patient visits per year. The co-payment is $2 for each visit.

Prescription drug coverage is provided through a network of participating pharmacies. You must pay 50% of the discounted price for all prescriptions filled at a participating pharmacy.

If you are covered by group insurance through an employer other than UVM, you may elect to waive medical coverage and receive $600 per year in lieu of Medical Insurance.

In order to receive this benefit you must elect it within 31 days of your date of full-time employment and you must provide verification of other group coverage. Medicare or Medicaid are not considered eligible group plans.

You may elect to receive your payments in lieu of coverage as extra payments, subject to payroll withholding taxes, or you may elect to have it contributed to a flexible spending account.