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).

  • Understanding Your SHPP (Formerly 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. 
  • Paying for Medical Out-of-Pocket Costs
    With health care spending accounts you may need help determining how to pay for your care.  Click the heading 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.
  • Paying for Prescription Out-of-Pocket Costs
    With health care spending accounts you may need help determining how to pay for your prescriptions and what to expect at the pharmacy.  Click the heading to learn about your costs, depending upon the type of health plan you chose and the type health care spending account.
  • 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 ESI
    VEHI and BCBSVT partner with the pharmacy benefit manager Express-Scripts Inc. (ESI) to bring you prescriptions at the lowest cost.  Click the heading 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.
  • HRA
    Health Reimbursement Arrangement (HRA) is an account funded by your employer that helps pay for certain out-of-pocket medical expenses.  
  • 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.  
  • 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.