Offices Insurance Information

Open Enrollment 2013

1. Open Enrollment Memo
2. Open Enrollment Instructions

Health Insurance

3. Health Insurance Rates for 2013
4. Preliminary Election Form for Health Insurance
5. BCBSVT Group Enrollment Form
6. Health Insurance Salary Reduction Agreement
7. HSA Direct Deposit Form
8. Health Insurance Waiver Form
9. Vermont Declaration of Coverage
10. HSA Over the Counter Items Requiring Prescription
11. Optional Dental and Vision Insurance Election Form
12. Delta Dental Enrollment Form
13. Election of Vision Benefits Form
14. Dental & Vision Insurance Salary Reduction Agreement
15. Delta Dental Benefits Chart
16. Vision Discount with Delta Dental
17. VSP Vision Benefits Summary
18. Statement of Domestic Partnership
19. HDHP Summary of Benefits and Coverage
20. PPO Summary of Benefits and Coverage

Access to BCBSVT

• Login to the Blue Cross Blue Shield website. From the Blue Cross Blue Shield website you can access your coverage history, find providers and order prescriptions.
  1. Once on the BCBSVT website, click Member at the top of the page.
  2. Then click LOGIN or REGISTER at the bottom of the page.
  3. Using your ID card and personal information you can setup an account for access to all BCBSVT services.

Life & Long Term Insurances

• Beneficiary Change Form
• Life Insurance Application
• Life Insurance Plan Details
• Long-Term Disability Plan Details