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 health plan, and to help you understand how to use your health care spending accounts (where applicable).

  • Life of a Medical Claim
    Click the heading to view the path your medical claim takes on its way through the health care and payment system.
  • 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 heading to view the path of your prescription claim through the health care and payment system. 
  • 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 heading 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.
  • Cost Transparency 
    Use this tool to compare prices of services and providers in Vermont.  
  • Pricing Drugs on the Member Resource Center
    Click the heading to check the cost of your 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.
  • Summary of Health Plan Payments
    The Summary of Health Plan Payments (SHPP) is sent at the end of the month when claims have processed.  You should use the SHPP to compare invoices from the medical providers as well as your HRA or HSA claims paid.