Refer to your Outline of Coverage to determine which documents apply to your plan.

2010 Benefit Changes Rider (280.264)

2010 Benefit Changes Rider - Grandfathered (280.265)

2010 Direct-pay Benefit Changes Rider (280.266)

2010 Direct-pay Benefit Changes Rider - Grandfathered (280.267)

2012 BCBSVT Benefit Mandates Rider (280.316)

BCBSVT Acupuncture Benefits Rider (280.294)

BCBSVT Plan Year Accumulator Rider - 280.274

BCBSVT Prescription Drug Benefits w/Exclusions Rider - 280.281

BCBSVT Preventive Care Rider (280.303)

BCBSVT Small Group RX Rider - 280.276

BCBSVT Vision Exam Rider - 280.273

Benefit Enhancement Rider - 280.242

Deductible Carryover Rider - 280.230

(Addition of) Deductible Carryover Rider (NEW) - 280.245

Domestic Partnership Rider - 280.76
 

Expanded Mental Health and Substance Abuse Provider
Network Rider - 280.241

Grandfathered Benefits Rider (BCBSVT) - 280.289

Individual HSABlue Nongroup Health Savings Account Rider - 280.220

Naturopathic Physicians Endorsement - 280.232

Open Network Mental Health and Substance Abuse Rider - 280.175

Prescription Drug Benefit Rider - 280.171

Rider Removing Prescription Drug Coverage - 280.198

Three-tier Prescription Drug Benefits Rider - 280.187

Tiered Prescription Drug Benefits Rider V - 280.29

Vermont Freedom Plan Certificate of Coverage - 280.40 (2013)

Vermont Freedom Plan Certificate of Coverage - 284.40 (2012)

Vermont Freedom Plan Certificate of Coverage - 284.40 (2009)

Vermont Freedom Plan Nongroup Benefits Rider - 280.195

Vermont Freedom Plan Handbook - 284.215

Vermont Freedom Plan Safety Net Benefits Rider - 280.196

Vermont Freedom Plan Safety Net Benefits Rider w/ No Prescription Drug Coverage - 280.197

Waiver of Waiting Periods - 280.162

Wellness Drug Rider - 280.271

Updated: 03/29/13