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The Vermont Freedom Plan The Vermont Freedom Plan is a Preferred Provider Organization (PPO) health benefits plan that offers you the freedom to choose your own doctors. You get a higher level of benefits if you use Preferred providers. You share more of the cost if you use Nonpreferred providers. Benefit highlights include first-dollar coverage for office visits with Preferred providers Precertification Program, which ensures that you're provided high-quality, cost-effective care. Office Visits Under the Vermont Freedom Plan, you have first-dollar coverage for office visits, including chiropractic visits and mental health and substance abuse treatment visits. You pay a small co-payment for each visit to a Preferred provider. The rest we pay in full. Visits to Nonpreferred providers are subject to deductible and coinsurance, which is usually higher for Nonpreferred providers than for Preferred providers. Your Outline of Coverage lists your co-payment amount. Mental health and substance abuse treatment visits The payment terms for mental health and substance abuse treatment are the same as those described for other office visits, above. Your coverage may require that you use a provider in our behavioral health care network and also that you call for prior approval to initiate care. If your coverage includes Open Network Mental Health, you don't need prior approval for Outpatient care and you don't have to use network providers to receive benefits. Your Outline of Coverage indicates if you have Open Network Mental Health benefits. Chiropractic visits We cover chiropractic visits to treat neuromusculoskeletal conditions if you use a Preferred provider. Any visits after 12 in a calendar year require Prior Approval. Your chiropractor must send us a treatment plan to secure approval for additional visits in that year. We do not cover chiropractic services rendered by Nonpreferred providers. Surgery Your plan's deductible and coinsurance apply to benefits for surgery performed in a doctor's office and to procedures performed in an outpatient hospital setting. Remember that your out-of-pocket expenses will likely be much higher if you use a Nonpreferred provider. Maternity We cover maternity services including prenatal care, delivery and the baby's nursery charges. Your Outline of Coverage will indicate if your plan's deductible applies to maternity services. Your maternity benefits include our popular Better Beginnings Program for expectant parents. Emergency Care We cover emergency room services when you show symptoms severe enough that a "prudent layperson" would believe your health would be threatened without treatment. Your symptoms must meet our criteria for an emergency medical condition.If you go to the emergency room when you could have safely received care somewhere else, your care may not be covered. |
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