Q: Is there any dental or eye care coverage with the VLS plans?
A: Generally speaking, there is no dental coverage offered under the VLS plans, except accidental injury to natural teeth that requires hospital treatment. The plans do offer a $20 co-pay for an annual vision exam.
Q: What is meant by “out of pocket maximums”?
A: This refers to the total amount of money the subscriber will have to pay out of pocket towards their healthcare costs (not including the health insurance coverage premium). This maximum includes the deductible amount. For example:
A student that has single coverage under Plan A ends up with a hospital or outpatient surgery bill of $ 10,000 (using the participating provider network). The out-of-pocket costs for the student would be as follows:
Q: What is meant by “participating provider network”?
BLUE CROSS PAYS|
|A. $500 Deductible||A. Nothing|
|B. The co-insurance will start and the student will be responsible for 20% of the remainder of the bill until the out-of-pocket maximum is reached (which is at the $1,000 point).||B. The co-insurance will start and BC/BS is responsible for 80% of the remainder of the bill until the out-of-pocket maximum is reached.|
|C. The student’s final bill will be $1,500, which is comprised of the $500 deductible and the rest of the out-of-pocket maximum due to reaching the maximum amount of $1,000 (20% of $9,500 is $1,900).||C. The final bill paid by BC/BS to the healthcare provider is $8,500 ($10,000 minus the $1,500 provided by the student).|
A: The participating provider network means as long as you have services provided by a physician/doctor or hospital that participates with Blue Cross and Blue Shield, the provider will submit your claims directly to Blue Cross and Blue Shield for payment. They should not ask you to pay any monies at the time of service.
Q: What is meant by “standard allowance”?
A: “Standard allowance” means the amount that Blue Cross & Blue Shield negotiates with their participating providers and hospitals. Theses providers agree to accept the standard allowance as payment in full and not bill the subscriber the difference between what they charged (i.e., $100) and the standard allowance (i.e., $80). The difference of $20 is taken off your bill. They can only bill you for the deductible and the 20% co-insurance amount.
Q: What is meant by “routine office visit”?
A: A routine office visit refers to the amount the Doctor charges for the use of his/her office. Routine Office Visits are paid at 100%, after you pay your co-pay.
It should be noted that labs and x-rays are not considered part of the routine office visit, and are billed as “hospital care” expense. This means that the cost of the lab or x-ray might apply towards your deductible and/or out-of-pocket maxium.
Q: How am I billed for this insurance?
A: Your annual insurance premium will be billed in two installments. You will receive a charge on your tuition account from Vermont Law School for the first installment (representing six months of coverage) prior to registration day in August. You will receive a charge for the second installment (representing six months of coverage) in January prior to the date that classes resume for the spring semester.
Q: Will you deduct my insurance payment from my student aid?
A: Yes, if your student aid is in excess of the tuition charge. Otherwise we will look to you for the payment.
Q: Do I need to renew this insurance policy every year?
A: No. You will be automatically renewed (at your present coverage level A or B) each year that you are at VLS; however, if you have an approved waiver from VLS insurance for other coverage, you will need to provide VLS with a health insurance waiver form at the beginning of each academic year.
Q: May I change to a different plan?
A: Yes, however, you may change plans
only in August for an effective date of September 1st each year
. This time frame is referred to as the open enrollment period.Q: I’m getting married in October. May I add my spouse to my plan?
A: Yes, you must submit another enrollment form showing your spouses information and by checking the “add” box next to your spouse’s name.
Forms must be submitted within 30 days following your wedding.
Q: Does the VLS plan cover domestic partners?
A: Yes, but the partner may be added only during open enrollment period each year (Aug1-Aug 31). In addition to completing the enrollment form, you will need to request and complete a “Statement of Domestic Partnership” form
and provide us with proof showing ownership of dual checking account (include a copy of voided check) and showing that a residence has been shared for at least six (6) months prior to the application for domestic partnership coverage (copy of prior lease agreement). If further questions, please call Chantelle Blake at x 1236.
Q: How do I add my newborn to the plan?
A: BCBS will automatically cover your child for thirty days (with the same applicable deductibles, out-of-pocket minimums, etc). You must complete another enrollment form showing the child’s name and social security number and by checking the “add” box next to the child’s name within that 30 day period ( i.e., within 30 days after the birth or adoption of a child).