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Employee Benefits | Small Group Rates

Business Resource Services
Blue Cross Blue Shield of Vermont- Medical Plans and Rates
January 1, 2008- December 31, 2008

Vermont Freedom Plans Single 2-Person Family Medicare Carve-Out
$500 Deductible,
$30 OV,Rx $100 Ded. $5/$25/$50		 $557.88 $1,115.69 $1,506.19 $468.92
$1,000 Deductible,
$30 OV, Rx $100 Ded. $5/$25/$50		 $486.85 $973.73 $1,314.54 $449.43
$2,500 Deductible,
$30 OV, Rx $100 Ded. $5/40%/60% 		 $393.00 $786.07 $1,061.17 $317.74
$5,000 Deductible,
$30 OV, Rx $100 Ded. $5/40%/60%    		 $343.76 $687.53 $928.17 289.36
$10,000 Deductible, $30 OV, Rx $100 Ded. $5/40%/60%   $277.81 $277.81 $750.83 $246.34
Health Savings Accounts Single 2-Person Family Medicare Carve-Out
HSA:$2,250/$4,500 Ded,100% w/Preventive Care Benefit $356.01 $630.78 $912.31 $228.45
HSA:$1,500/$3,000 Ded,100% w/Preventive Care Benefit $418.39 $729.00 $1,055.00 $258.47
HSA:$2,500/$5,000 Ded,80/20% to $3,500/$7,000 OOP  $317.99 $504.18 $730.08 $199.36
HSA:$3,000/$6,000(stacked) 80/20% to $4000/8000 w/Prev   $300.81 $601.61 $812.18 $174.09
HSABlueCare$5,000/10,000 (stacked) 100% after Deductible   $226.90 $453.79 $612.62  
HSABlueCare$4,000/8,000 (stacked) 100% after Deductible $255.77 $511.52 $690.56  
HSABlueCare$4,000/8,000(stacked) 80/20% to $5000/10,000 $251.44 $502.86 $678.87  
HSABlueCare$3,000/6,000 Ded,80/20% to $4000/8000 OOP $296.33 $481.57 $694.85  
HSABlueCare$2,500/5,000 100% after Deductible $320.22 $532.91 $769.71  
HSABlueCare$2,500/5,000 Ded,80/20% to $3500/7000 OOP   $306.21 $509.66 $736.09  
HSABlueCare$2,000/4,000 100% after Deductible $344.37 $586.62 $848.11  
HSABlueCare$2,000/4,000 Ded,80/20% to $3000/6000 OOP $334.62 $570.04 $824.11  
HSABlueCare$1,500/3,000 100% after Deductible $373.41 $650.77 $941.71  
HSABlueCare$1,500/3,000 Ded,80/20% to $2500/5000 OOP  $353.97 $616.94 $892.71  
(All HSA BlueCare plans include the Preventive Care Benefit)    
HRA Qualified Plan: $2250/$4500, 100% after Ded, w/Prev  $360.98 $638.76 $924.58  
BLUECARE PLANS:    Single 2-Person Family Medicare Carve-Out
BlueCare D $20/30 OV, $500/200 IP/OP Copay,Rx $100 Ded,$5/$25/$50  $480.11 $960.22 $1,296.30  
BlueCare F $20/30 OV,$500 IP/OP Comb Ded, Rx $100 Ded,$5/$25/$50   $473.12 $946.24 $1,277.43  
BlueCare I $20/30 OV,$1000 IP/OP Comb Ded, Rx $100 Ded,$5/$25/$50   $454.15 $908.30 $1,226.21  
BlueCare J $20/30 OV, $1500/750 IP/OP Ded, Rx $100 Ded, $5/$25/$50   $443.85 $887.69 $1,198.39  
BlueCare K $20/30 OV, $2000/1000 IP/OP Ded,Rx $100 Ded, $5/$25/$50 $429.13 $858.26 $1,158.65  
BlueCare J (No Rx) $20/30 OV, $1500/750 IP/OP Ded $374.91 $749.82 $1,012.26  
VISION RIDER OPTION- AVAILABLE WITH BLUECARE PLANS ONLY:        
$20 Office Visit Co-pay and $20 Materials Co-pay $8.26 $16.52 $22.31  
       

 

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