Medical Insurance
- Plan Options and Cost
- Plan Documents and Information
- Membership and Eligibility Information
- Open Enrollment
- Adding an Eligible Dependent (between open enrollment periods)
- Removing an Ineligible Dependent
- Terminating Coverage
- Cash-in-lieu of Insurance
- Continuation Option (COBRA)
- Related links
- Important Contact Information
- On-line Resources
- Related Forms
- Insurance Options for employees not eligible for coverage under our plans
- CHIPRA Notification
Plan Options and Costs
Chittenden Central Supervisory Union offers four different health insurance plan options to eligible employees. All plans are provided by Blue Cross Blue Shield of Vermont (BCBSVT) through the Vermont Education Health Initiative (VEHI). Below is a list of the plans offered:
- VEHI Dual Option Plan:Vermont Health Partnership (VHP)
- VEHI Dual Option Plan: Comprehensive 250 Plan (Comp 250)
- Comprehensive 1000 Plan (Comp 1000) – available beginning 7/1/10 for eligible employees
- This plan is coupled with a Health Reimbursement Arrangement (HRA) to reimburse employees for deductible expenses up to $1,000 for single coverage and $2,000 for 2-person and family coverage
- 2011-12 Cost Comparison – VEHI Dual Option vs Comp 1000
- Indemnity J Plan (J Plan) – limited availability
Plan Documents and Information
For more detailed information about plan coverage, please refer to the subscriber contract documents below:
Comp 250/1000 Plan Documents & Information:
-
Health Reimbursement Arrangement (applies to Comp 1000 Plan only)
- Open Network Mental Health Rider (applies to EJ & U#46 only)
- Waiver of Waiting Periods
Prescription Drug Benefits (applicable to all plans):
Other Plan Information (applicable to all plans):
Membership and Eligibility Information
New Hires/Rehires
New hires/rehires can enroll on our plan as early as the first of the month following his/her first day of work as an eligible employee, provided a completed enrollment form is submitted prior to the effective date of coverage. There are no waiting periods for coverage. The completed Group Enrollment Change Form and any corresponding paperwork must be received within 60 days of the date of hire or rehire. Enrollment forms received after 60 days will take effect on the next earliest open enrollment date.
Membership Types
Eligible employees may selected Single, Two-person (e.g. employee and child or employee and spouse/civil union partner), or Family coverage. If participant elects to cover one eligible dependent, all eligible dependents must be covered – Participants cannot pick and choose which dependents to cover.
Eligible Dependents
(Click here for changes to the eligible dependent status for children under age 26)
Eligible dependents of the employee shall include:
- Employee’s spouse/civil union partner
- Employee’s natural or adopted children who are:
- unmarried,
- under the age of 19, and
- living with the employee
- Employee’s spouse/civil union partner’s natural or adopted children who are:
- unmarried,
- under the age of 19, and
- living with the employee
- Employee’s natural or adopted children that do not live with him/her but s/he is responsible for their medical coverage under a court order. (A copy of the court order is required.)
- Employee’s dependent between the ages of 19 and 25 who is a full-time student (see below)
- Employee’s “incapacitated” dependent age 19 or older (see below)
- In certain cases, a child whom the employee has assumed legal guardianship
Full-time Student:
(Click here for changes to the eligible dependent status for children under age 26)
The employee’s dependent who is between the ages of 19 and 25 and is a full-time student is considered an eligible dependent. In order to be considered a full-time student, the following requirements must be met:
- The student earns at least 12 credits per semester.*
- The employee submits a Student Certification Form along with proof of the student’s full-time status. Acceptable proof of full-time status shall include:
- tuition bills, and
- copies of valid identification from the institution
Student Certification must be completed at the following times:
- When the student turns 19 and would otherwise be ineligible for coverage
- Every year as long as the student remains a full-time student
- When the dependent stops being a full-time student
- When the student turns 25
If a dependent turns 19 and is removed from covered then later becomes a full-time student, s/he can be added as a dependent. To do so, a completed Student Certification and Group Enrollment Change Form would need to be received within 60 days of the date the dependent becomes a full-time student. Coverage for the student will begin the first of the month following receipt of the required forms.
*A dependent college student with a “serious illness or injury” will remain eligible for active dependent coverage for 12 months, even if he or she no longer qualifies as a full-time student.
Incapacitated Dependent:
(Click here for changes to the eligible dependent status for children under age 26)
The employee’s dependent who is over the age of 19 who is deemed “incapacitated” is considered an eligible dependent for coverage purposes. In order to be considered “incapacitated:, the dependent must meet the following criteria:
- S/he is incapable of self-support because of a physical or developmental disability, mental illness or mental retardation,
- The incapacitating disability must have begun while the dependent was still a child, and
- The dependent must be primarily dependent on the employee for support and maintenance.
In order to request coverage for an incapacitated dependent, the following documents must be submitted for consideration. These documents must be provided at time of initial enrollment (if dependent is capacitated at time of initial enrollment), or within 31 days of when the dependent becomes incapacitated (if coverage already commenced):
- A completed Incapacitated Dependent Certification Form
- Physician certification of the extent and nature of the disability
The status of an incapacitated dependent will be reviewed annually by BCBS.
Membership Summary
| Type of Event | Deadline for Receipt of Enrollment/Change Form | Change Effective Date |
| *New Hire/Rehire | No later than 60 days from date of hire or rehire. | First of month following date of receipt |
| *Marriage/Civil Union | Within 31 days following marriage/civil union | First of month following marriage/civil union |
| Within 32 to 60 days following marriage/civil union | First of month following date of receipt | |
| *Birth (Baby is automatically covered for the first 31 days) | Within 31 days following birth | 32nd day after the birth |
| Within 32 to 60 days following birth | First of month following receipt | |
| *Adoption | Within 31 days following adoption (or placement for adoption) | Date of adoption (or placement for adoption) |
| Within 32 to 60 days following adoption (or placement for adoption) | First of month following date of receipt | |
| Death | Within 60 days of death | First of the month following death |
| Divorce/Dissolution of Civil Union | Within 60 days of divorce | First of the month following divorce |
| Beyond 60 days of divorce | First of month following date of receipt | |
| Voluntary Cancellation | Must submit a Group Enrollment Form | First of month following receipt |
| Left Employment | First of month following receipt | |
| Medicaid/CHIP coverage terminated | Must submit a Group Enrollment Form | Within 60 days of the loss of coverage |
| Eligible for premium assistance under Medicaid or CHIP | Must submit a Group Enrollment Form | 60 days of when eligiblity is determined |
* Requests not received as indicated above will be processed with the next open enrollment period.
Open Enrollment
Our group medical insurance open enrollment periods are July and January each year. During an open enrollment period, eligible employees may elect to:
- Enroll in one of our group BC/BS health insurance plans if s/he is not currently enrolled;
- Add eligible dependents who are not currently enrolled; or,
- Change from one BC/BS Plan to another (i.e., JY to VHP).
If you wish to take advantage of an open enrollment, please contact Human Resources to request an enrollment form. Completed enrollment forms must be returned to Human Resources for processing at least 15 days prior to the effective date of coverage. Late enrollments will not be processed until the next available open enrollment date. [In other words, enrollment forms must be returned by June 15th for a July 1st effective date. Completed enrollment forms received after June 15th but before July 15th will take effect on August 1st. Completed enrollment forms received after July 15th will not take effect until the subsequent January at the earliest.]
If you are unsure which plan you are currently enrolled under or which dependents are enrolled under your policy, please check your BC/BS medical ID card. Below is a guide to determine which plan you are enrolled in:
VHP = Sections 200, 201, 202, 203, 206, and 236
Comp 250 = Sections 100, 101, 102, 103, 106, 136
JY = Sections 000, 001, 002, 003, 006, 036
Adding an Eligible Dependent (between open enrollment periods)
In order to process a membership change, the employee must complete and submit a Group Enrollment Change Form (and any additional required paperwork) to Human Resources. The paperwork must be submitted at least two weeks prior to the enrollment deadlines outlined below in order to allow time for processing. Human Resources will forward the necessary paperwork to BCBS after processing the change on our records.
In order to add a spouse/civil union partner after initial enrollment, a completed Group Enrollment Change Form must be completed and submitted. If the completed form and corresponding paperwork are received within 31 days of the date of marriage/civil union, coverage will begin the first of the month following the date of marriage/civil union. If the completed form and corresponding paperwork are received within 32 to 60 days of the date of marriage/civil union, coverage will begin the first of the month following the date the form is received. If BCBS receives the required paperwork after 60 days, coverage cannot begin until the next available open enrollment period.
A newborn child is automatically covered under the birth mother’s medical insurance for the first 31-days following birth. Likewise, a child placed for adoption is covered under the employee’s membership for first 31-days following adoption/placement for adoption. In order to add a newborn or newly adopted child after the initial 31-day enrollment, the employee must complete and submit a Group Enrollment Change Form to the Human Resource Department. In order to avoid a break in coverage, BCBS must receive the completed enrollment form within 31 days of the date of birth/placement. If BCBS receives the completed enrollment form after 31 days, but within 60 days of the date of birth/placement, coverage for the dependent will begin the first of the month following the date BCBS receives the completed enrollment form. If BCBS receives the enrollment form after 60 days, coverage cannot begin until the next available open enrollment period.
Spouse/Civil Union Partner Loses Coverage
If an employee refuses coverage under our group medical plan because s/he has coverage under the plan of a spouse/civil union partner, then later loses that coverage as a result of the spouse’s/civil union partner’s termination of employment (or ineligibility for coverage), s/he may enroll on our group medical insurance plan between open enrollment periods. To do so, the employee must complete a Group Enrollment Change Form and provide proof that the spouse/civil union partner lost coverage. A letter from the spouse’s/civil union partner’s employer stating his/her employment terminated or that the employer will terminate coverage will suffice. The enrollment form and proof of loss must be received within 31 days of the loss in coverage. Coverage under our group medical plan will be made retroactive to the date of the loss in coverage. If BCBS receives the enrollment form after 31 days, coverage cannot begin until the next available open enrollment period.
Likewise, if an employee refuses coverage for his/her spouse/civil union partner because s/he is covered under another group plan, then the spouse/civil union partner later loses coverage as a result of a termination of employment or the employer terminates the coverage, s/he may be added as a dependent on our group medical insurance plan between open enrollment periods. The timelines and requirements are the same as specified above.
CHIPRA Special Enrollment Rights
On February 4, 2009, the Children’s Health Insurance Program Reauthorization (CHIPRA) was signed into law by President Obama. CHIPRA allows states to subsidize premiums for employer-provided group health plans for eligible children, and provides special enrollment rights under the group health plans to eligible employees. Consistent with the requirements under CHIPRA, effective April 1, 2009, our group medical and dental plans shall permit enrollment by an employee or dependent who is eligible, but not enrolled, in either of the following situations:
- The eligible employee or a dependent’s Medicaid or CHIP coverage is terminated as a result of loss of eligibility for such coverage. (The employee must request enrollment within 60 days of the loss of coverage to take advantage of this special enrollment.)
- The eligible employee or dependent becomes eligible for premium assistance subsidy under Medicaid or CHIP. (The employee must request enrollment within 60 days of when the eligiblity for premium assistance is determined to take advantage of this special enrollment.)
Coverage will begin as of the first of the month in which the required enrollment form is completed (provided it is within the 60 days). Requests received after the 60-day notice requirement will take effect with the subsequent open enrollment period.
Removing an Ineligible Dependent
Since the employee may be responsible for the entire premium cost of the ineligible dependent’s coverage if s/he fails to complete and submit the required paperwork within the time frame indicated, it is important for employees to be aware of the timelines of when dependents must be removed from their policy. Below is an outline of the timelines and requirements.
Divorce/Dissolution of Civil Union
When an employee divorces or dissolves a civil union, the spouse/civil union partner must be removed from the policy the first of the month following the divorce/dissolution. To do so, a completed Group Enrollment Change Form must be received within 60 days after the divorce/dissolution. If the form is received after 60 days, the spouse/civil union partner will be removed the first of the month following receipt of the form. The employee must provide us with the address of the spouse/civil union partner so that a COBRA Notification letter can be issued.
A participating employee must contact Human Resources within 30 days following the death of covered participating dependent. A completed Group Enrollment Change Form must be received within 60 days of the death.
In the event of a legal separation, the employee must remove his/her spouse/civil union partner from membership on the first of the month following legal separation. To do so, the employee must complete and submit a Group Enrollment Change Form along with a copy of the separation agreement filed in court. The required paperwork must be received within 60 days after the date of legal separation to make the change. The employee must provide us with the address of the spouse/civil union partner so that a COBRA Notification letter can be issued.
If a participating employee’s dependent loses eligibility for coverage, the dependent must be removed from coverage effective the first of the month following the change of status. To do this, the employee must complete and submit a Group Enrollment Change Form and a Student Certification form. These forms must be received within 30-days of the change in status. A child is considered no longer eligible for coverage if s/he:
- Becomes married,
- Turns age 19 and is not a full-time student,
- Is a full-time student who turns age 25,
- Is over age 18 and loses full-time student status (e.g. takes less than 12 credits, takes a semester off, drops out of school)
- The child no longer lives with the employee and there is no court order requiring the employee to cover the child
Terminating Coverage
When an employee separates from employment, s/he is no longer eligible for coverage on our group plans effective the first of the month following his/her last day of work. However the employee has the right to continue coverage at his/her own expense under COBRA for up to 18 months (or 29 months in the case of a disability). A COBRA Notification letter will be issued to employees upon separation explaining this option.
With the exception of approved leave under the Family Medical Leave Act (FMLA) or the Vermont Parental and Family Leave Law (VPFL), an employee who is on an unpaid leave of absence for longer than two weeks is no longer eligible for coverage on our group plans effective the first of the month following the date the unpaid leave began. The employee has the right to continue coverage at his/her own expense under COBRA for up to 18 months (or 29 months in the case of disability). The employee can re-enroll on our group plan effective the first of the month following return from his/her approved unpaid leave. To re-enroll, the employee must complete and submit a Group Enrollment Change Form prior to the effective date of coverage. If the unpaid leave begins and ends during the same month, coverage is unaffected.
An employee can elect to voluntarily cancel his/her coverage between open enrollment periods. To do so, the employee must complete and submit a Group Enrollment Change Form. Coverage will terminate the first of the month following receipt of the required form.
Cash-in-lieu of Insurance
Eligible employees have the option of electing $1,000 cash-in-lieu of medical insurance coverage under our group plan for the benefit year, which runs July 1 through June 30. (Please refer to your contract agreement to see if you qualify.) Elections must be made on an annual basis, so those who elect the cash-in-lieu of insurance option for one benefit year must make a new election for the subsequent benefit year.
In order to elect the $1,000 cash-in-lieu of insurance option, eligible employees must complete and/or submit the following:
- Election of Benefits Form and Sworn Statement of Alternative Health Insurance Coverage
- Vermont Department of Labor Employee Declaration of Health Care
- Proof of having alternative coverage – Acceptable proof of alternative coverage shall include: a copy of the employee’s alternative medical insurance ID card indicating the employee’s name as a dependent; a letter from the spouse/civil union partner’s employer indicating the employee is covered under their plan; or, a letter from the alternative insurance carrier indicating proof of coverage.
The completed forms and documents outlined above must be submitted by June 1st of the preceding benefit year. For new employees, the election must be made within 30-days of their date of hire.
This $1,000 payment is taxable income and can be paid in either one or two annual installments, at the employee’s election, as indicated on the enrollment form. The payment option selected cannot be changed during the benefit year.
Employees electing cash-in-lieu of insurance may reverse his/her decision during the health plan year subject to the limitations of the carrier (BCBS of VT). Prior to such enrollment, the employee shall be required to make pro-rated restitution to the District for any payment(s) made in lieu of. Such restitution shall be made in a single payment (not through payroll deduction).
Those employees who elect cash-in-lieu of insurance option for one benefit year and wish to re-enroll in one of our medical insurance plans for the subsequent benefit year may do so during an open enrollment period.
Continuation Option (COBRA)
Under federal law, employees and their covered dependents have the right to continue medical/dental coverage under the employer’s plan for a limited period following termination of benefits under COBRA. The medical/dental plan benefits under COBRA are identical to those provided for employees of the district. For information about COBRA, please click here.
Related links
- Vermont Education Health Initiative (VEHI) web page
- Blue Cross Blue Shield of Vermont (BCBS VT) web page
- Vision Service Plan (VSP)
- Magellan Health Services
- Express Scripts
Important Contact Information
- Vermont Health Partnership Plan: (800) 344-6690
- Comprehensive $250 Plan: (800) 247-2583
- JY Plan: (800) 247-2583
- Magellan Health Services: (800) 395-1356
- Admission/Preadmission Review: (800) 922-8778
- EXPRESS Scripts Benefit Manager: (877) 493-1949
On-line Resources
- Dual-Option Plan Questions & Answers
- VEHI Plan Comparison
- Making Health Plan Changes
- BCBS Prior Approval Program
- Prescription Drug Plan
- Healthwise Knowledge Base
- VT Division of Health Care Administration (BISHCA)
Related Forms
Click here for the following forms:
- BCBS Authorization to Release Information
- BCBS Group Enrollment Form
- BCBS Incapacitated Dependent Form
- BCBS Prescription Reimbursement Form
- BCBS Student Certification Form
- BCBS Subscriber Claim Form
Medical Insurance Options
The Vermont Campaign for Health Care Security Education Fund is a non profit organization working to educate all Vermonters about, and assist them in enrolling in, the State of Vermont’s health care programs: Catamount Health, VHAP, Dr Dynasaur and Medicaid. Their goal is to see that every Vermonter has access to affordable, high quality health insurance. If you do not have access to healthcare through your employer, please visit their website at http://www.catamounthealth.org/ to see if you qualify for coverage under any of these Vermont helath care programs.
Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA)
Free or Low-Cost Health Coverage to Eligible Children and Families
If you are eligible for health coverage from Chittenden Central Supervisory Union (CCSU) but are unable to afford the premiums, the State of Vermont has a premium assistance program that can help pay for coverage. Vermont uses funds from their Medicaid program to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.
If you or your dependents are already enrolled in Medicaid, you can contact the Vermont Medicaid office to find out if premium assistance is available at:
Website: http://ovha.vermont.gov/ Telephone: 1-800-250-8427If you or your dependents are NOT currently enrolled in Medicaid, and you think you or any of your dependents might be eligible for the program, you can contact the Vermont Medicaid office (above) or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the VT Medicaid office if it has a program that might help you pay the premiums for an employer-sponsored plan.
Once it is determined that you or your dependents are eligible for premium assistance under Medicaid, CCSU is required to permit you and your dependents to enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the employer’s plan. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.
For more information on special enrollment rights, you can contact either:
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa 1-866-444-EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Ext. 61565Last updated: Oct 24 at 12:53 pm
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