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How Do I Know What To Pay?

The following documents have been designed to help you know what costs are your responsibility to pay under your new health plan, and to help you understand how to use your healthcare spending accounts (where applicable).

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Understanding Your SHPP (Formally EOB)

A Summary of Health Plan Payments (SHPP) - formerly known as an Explanation of Benefits or EOB - is a statement from BCBSVT that explains how your benefits were paid. Reviewing a SHPP is an important tool in understanding what you are required to pay for care. Click the compass to learn more about the SHPP.

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Paying for Medical Out-of-Pocket Costs

With the new health plans and health care spending accounts, you may need help determining how to pay for your care.  Click the compass to learn about what to expect, which will depend on the type of health plan you chose and the and the type health care spending account.

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Paying for Prescription Out-of-Pocket Costs

With the new health plans and health care spending accounts, you may need help determining how to pay for your prescriptions and what to expect at the pharmacy.  Click the compass to learn about your costs, depending upon the type of health plan you chose and the type health care spending account.
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Life of a Medical Claim

Click the compass to view the path your medical claim takes on its way through the health care and payment system.
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Life of a Pharmacy Claim

Prescription claims are considered “point of sale” transactions because you cannot receive your prescription until it is paid for.  Click this compass to view the path of your prescription claim through the health care and payment system. 
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Employee Mid-Year Change

Occasionally you may have the opportunity to change your plan mid-year.  Perhaps you have a mid-year open enrollment, or a qualifying life event.  Click the compass to learn how your deductibles and other accumulators are automatically credited from one plan to another, and when you may need to request the credit.
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Cost Transparency 

Use this tool to compare prices of services and providers in Vermont.  Click the compass to learn more.
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Pricing Drugs on ESI

VEHI and BCBSVT partner with the pharmacy benefit manager Express-Scripts Inc. (ESI) to bring you prescriptions at the lowest cost.  Click the compass to check the ESI website (log on required) to find out the cost of a prescription before you get to the pharmacy, to find a pharmacy, or see if there are equivalent prescriptions that you can get at a lower cost.  You can also reach this information via the Member Resource Center without additional sign-on.

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HRA

Health Reimbursement Arrangement (HRA) is an account funded by your employer that helps pay for certain out-of-pocket medical expenses.  Click the compass to learn more!

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HSA

A Health Savings Account (HSA) is a tax-favored IRS-type of trust or custodial account to which "eligible individuals" or someone, such as an employer, on behalf makes contributions.  The deposited money earns tax-free interest, and funds are not taxed when used to pay for qualified medical expenses.  Click the compass to learn more!

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FSA

With a Flexible Spending Account (FSA) you may elect to have a portion of your paycheck contributed pre-tax to pay for qualified medical expenses such as deductibles, co-payments, dental and vision care.  Click the compass to learn more!