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Vermont Freedom Plan Nongroup
Blue Cross and Blue Shield of Vermont offers five Vermont Freedom Plan Nongroup options, with varying deductibles and out-of-pocket limits. Rates for each option are listed below. For more information, please call (800) 909-8427.
3rd Quarter 2008 (July, August, September 2008)
Monthly Rates |
| |
Individual HSA Blue |
$3,500 Option |
$5,000 Option |
$7,500 Option |
$10,000 Option |
| Single |
$445.33 |
$597.77 |
$470.58 |
$392.59 |
$342.68 |
| Two-Person |
$890.66 |
$1,195.54 |
$941.16 |
$785.18 |
$685.36 |
| Family |
$1,202.40 |
$1,613.98 |
$1,270.56 |
$1,059.99 |
$925.24 |
| Monthly subscription rates are subject to final approval by
the Department of Banking, Insurance, Securities and Health Care Administration.
|
2nd Quarter 2008 (April, May, June 2008)
Monthly Rates |
| |
Individual HSA Blue |
$3,500 Option |
$5,000 Option |
$7,500 Option |
$10,000 Option |
| Single |
$414.57 |
$556.49 |
$438.07 |
$365.48 |
$319.01 |
| Two-Person |
$829.14 |
$1,112.98 |
$876.14 |
$730.96 |
$638.02 |
| Family |
$1,119.35 |
$1,502.52 |
$1,182.80 |
$986.78 |
$861.33 |
| Monthly subscription rates are subject to final approval by
the Department of Banking, Insurance, Securities and Health Care Administration.
|
Annual Deductible Choices |
| |
Individual HSA Blue |
$3,500 Option |
$5,000 Option |
$7,500 Option |
$10,000 Option |
| Deductibles |
Individual Plan / Two-person or Family
$5,000 / $10,000 |
Individual/Family
$3,500/$7,000 |
Individual/Family
$5,000/$10,000 |
Individual/Family
$7,500/$15,000 |
Individual/Family
$10,000/$20,000 |
| Office Visit Fee* |
Preventive office visits covered at 100% of our Allowed Price.
All other visits subject to deductible.
|
$30 |
$30 |
$30 |
$30 |
*Office visits with Preferred and Network providers are not
subject to deductibles. However, each time you see your physician in the office, you pay a Visit Fee.
Office Visits with Nonpreferred providers are subject to your deductible and coinsurance. Also, Non preferred
providers are not required to accept our allowed price as payment in full.
|
Individual/Family Out-of-Pocket Limits |
| |
Individual HSA Blue |
$3,500 Option |
$5,000 Option |
$7,500 Option |
$10,000 Option |
| Preferred and Network Providers |
Non- Preferred Providers |
Preferred and Network Providers |
Non- Preferred Providers |
Preferred and Network Providers |
Non- Preferred Providers |
Preferred and Network Providers |
Non- Preferred Providers |
Preferred and Network Providers |
Non- Preferred Providers |
| Individual Out-of-Pocket Limit |
*$5,000 | *$7,000 |
*$9,500 | *$12,500 |
*$11,000 | *$14,000 |
*$13,500 | *$18,750 |
*$17,000 | *$23,500 |
| Family Out-of-Pocket Limit |
*$10,000 | *$14,000 |
*$19,000 | *$25,000 |
*$22,000 | *$28,000 |
*$27,000 | *$37,500 |
*$34,000 | *$47,000 |
| *Amounts you pay towards your Preferred/Network Out-of-Pocket
limit also apply to your Nonpreferred Out-of-Pocket limit, and vice versa.
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