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Retirees aged 65+ are Medicare eligible and may enroll in Vermont Blue Advantage PPO (VBA) for comprehensive medical insurance. To enroll, retirees must be enrolled in Medicare Part A and Part B. The Vermont Blue Advantage PPO (VBA) offers medical coverage, as well as prescription drug coverage through Optum Rx®, vision coverage through �ճ���®, and hearing coverage through �����پ��DzԲ���𲹰����Բ�®.

Plan Information

Additional Resources:

• Medicare Advantage Specialists - Vermont Blue Advantage Medicare specialists will help answer any questions you have. Call 1-800-572-0280 (TTY: 711). For pharmacy questions, call our prescription drug specialists at 1-855-489-0646 (TTY: 711).
• - This is the slide show presented on Wednesday, Oct 16th during the in-person and virtual information sessions. 
• - This guide breaks down care by age for the recommended age-appropriate screenings and tests.
• - Enter the plan prefix "V4B" with your zip code to find a doctor or pharmacy in your area.
• - Free interpreter services to answer any questions you may have. To get an interpreter, just call us at 1-833-668-0280.
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Reimbursement Forms

Vermont Blue Advantage utilizes different forms for reimbursement, depending on the care you received. When seeking reimbursement, please choose the appropriate form below.

• Medical Form | is used to request reimbursement of covered medical expenses when payment was made directly to your provider.
• Vision From | is used for vision services from an out-of-network eye doctor.
• Hearing Form | is used to request reimbursement of covered hearing expenses.  

Coverage Change Forms

How to enroll: You are eligible to enroll in VBA if you are turning 65 years old or if you experience a qualifying life event. To enroll, complete and return the . 

How to opt-out: You are eligible to opt-out if you experience a qualifying life event. To opt-out, complete and return the .

Retirees under the age of 65 who are Medicare ineligible may enroll in the Blue Cross Blue Shield Open PPO 1 Plan (BCBS).

Plan Information

Coverage Change Form

Complete the enrollment/change form to enroll or opt-out of the BCBS plan. You are eligible to enroll in this plan if you are under the age of 65 and if you experience a qualifying life event. You are eligible to opt-out are turning 65 years old or if you experience a qualifying life event.

• Blue Cross Blue Shield VT Medical Enrollment/Change Request Form (PDF) 

����̽̽ offers two levels of dental coverage through Delta Dental to eligible retirees, base option and high option.

Plan Information

• Delta Dental - Outline of Coverage (PDF)
• Delta Dental - Summary Plan Description (PDF)
• Delta Dental Enrollment/Change Form (PDF)

Monthly Dental Premiums

1. Base Option - No cost for most retirees.
2. High Option - If applicable, United Academics retirees may be responsible for paying 10% of the Base coverage cost and a High Option premium (if enrolled).*

How to Calculate Your Medical Premium 

The total monthly premium is the amount shared between both you and ����̽̽. Each retiree has a different cost share percentage that is applied to the total monthly premium calculate your specific cost. 

• For retirees or dependents aged 64 or under, the total monthly premium for an individual on Blue Cross Blue Shield is $1,380.19.
• For retirees or dependents aged 65+, the total monthly premium for an individual on Vermont Blue Advantage plan is $414.00.

To determine your cost share for medical insurance coverage, multiply the total monthly premium by your cost share percentage.  

• Example Calculation: If your cost share is 22%, you would do the following calculation: 
  • Aged 64 and under (Blue Cross Blue Shield): $1,380.19 × 0.22 = $303.64 per month
  • Aged 65+ (Vermont Blue Advantage): $414.00 × 0.22 = $91.08 per month

How to Make a Payment

����̽̽ handles the billing and accounting for all retiree healthcare premium invoices and bills on a monthly basis. If you are able, ����̽̽ strongly encourages you to pay 6 to 12 months in advance. If you do, you will not receive a monthly invoice until your credit balance is fully used. If a retiree fails to pay their account on time, Education Computer Systems, Inc. (ECSI) will work with the retiree to complete payments.

There are two ways to make a payment: 

Mail a check: Personal, cashier, certified, money orders, or traveler's checks made payable to ����̽̽ with your ID (95 number) included in the memo may be mailed to: ����̽̽ P.O. Box 1306 Williston, VT 05495

Automatic bank withdrawals: If your bank has an electronic bill paying service, you may wish to set up your bank account to make automatic payments to ����̽̽ for your healthcare premiums on a certain date. There is processing time on the bank’s side that should be taken into consideration when choosing the payment date. Automatic payments are typically the easiest and safest way to ensure that your bill gets paid. Many banks offer this service for free. 

What you need to provide your bank:

1. Payee Name: University of Vermont

2. Mailing Address: ����̽̽, P.O. Box 1306, Williston, VT 05495

3. Student ID #: This is a nine-digit number that begins with “95”.

a. This ID# needs to be indicated on all payments in order for it to be credited to your account.

4. The date you want the bill paid each month.

Please note: At this time, ����̽̽ has no way to set up a monthly debit to withdraw funds from your account.

Plan information

The summary of benefits offers a description of your benefits under this plan. Bookmark this page or keep this plan accessible for reference.

Additional Resources:

Reimbursement forms

Cigna Medicare Advantage Plan utilizes different forms for reimbursement, depending on the care you received. When seeking reimbursement, please choose the appropriate form below.

• Medical Form | is used to request reimbursement of covered medical expenses.
• Vision From | is used for vision services from an out-of-network eye doctor.
• Hearing Form | is used to request reimbursement of covered hearing expenses.