Individuals who need answers to specific questions about their eligibility for Catamount Health should speak to a state certified enrollment specialist at the Vermont Department for Children and Families at 1 (800) 287-0589 or at Maximus Member Services at 1 (800) 250-8427. The State of Vermont is the final authority on all matters related to Catamount.

Any Vermonter who experiences difficulty enrolling in Catamount Health should call the Vermont Health Care Ombudsman's Office at 1 (800) 917-7787.

When Can A Person apply for Catamount Health?

Enrollment applications for Catamount Health can be submitted beginning October 1, 2007. Actual health benefits will begin on November 1, 2007.

After the application process begins on October 1, 2007, individuals can sign up for the plan monthly.

Who is eligible for Catamount Health?

Vermont residents 18 years old or older are eligible for Catamount Health if they are uninsured or have insurance that only provides hospital care or doctors’ visits (but not both), and if they have not had insurance for the past 12 months.

If you have insurance, you must be uninsured for 12 months before you can enroll in Catamount Health. This 12-month waiting period will NOT prevent you from enrolling, however, if you lost your health insurance for one of the following reasons:

1. loss of a job
2. the death of a household’s principle insurance policy holder
3. divorce or dissolution of a civil union
4. no longer qualifying as a dependent under the insurance plan of a parent or relative
5. no longer qualifying for, or voluntarily choosing to end, COBRA coverage
6. college or university-sponsored health insurance is no longer available because of graduation, a leave of absence or the termination of studies.
7. the lack of access to health insurance through your employer, or because the insurance offered by your employer does not cover hospital and physician services.

How much does Catamount Health cost?

What eligible Vermonters pay for Catamount is determined by their income. Many uninsured Vermonters will qualify for premium assistance from the state so they can afford Catamount.

The Cost of Catamount Health without Premium Assistance

Vermonters whose gross household income is more than $2,553 a month or more can buy into Catamount Health for its full price—$393.11/mo.

The Cost of Catamount Health with Premium Assistance

Vermonters whose gross household income is between $1,742 and $2,613 a month may be eligible for a premium subsidy from the state.  These figures are different for 2 person households, 3 person households, etc.

Click here for a table that can help you calculate your premium subsidy.

Who sells Catamount Health in Vermont?

Catamount Health can be purchased from two private insurance companies in the state:

• Blue Cross Blue Shield: Catamount Blue
• MVP: Catamount Choice
  

What does Catamount Health cover in the way of health benefits?

The core benefits of the plan offered by both insurance carriers are comprehensive and mandated by the State of Vermont . They include hospitalization and drug benefits, doctor visits for primary and specialty care, and mental health and substance abuse treatment.

Are the plans offered by Blue Cross Blue Shield and MVP identical?

The core benefits are the same in both plans, but there are differences in some benefits offered by each company.  These differences might be significant, depending on your personal situation.  Be sure to read the detailed information provided by the carriers about their plans before you choose.

Does Catamount Health have office visit fees, deductibles and co-insurance charges?

There are out-of-pocket costs, in addition to premium payments. In some cases, these costs will be waived.

Deductibles and Co-Insurance:

• Annual in-network, maximum out-of-pocket costs for deductibles and co-insurance combined are $800 for single coverage and $1,600 for a family plan.  

Office Visit Fees

• There is a $10 office visit fee. 

Prescription Out of Pocket Costs:

There is a three-tier program helps keep prescription drug costs down. You pay:

• $10 for each generic drug prescription
• $30 for a brand-name drug on our Preferred brand-name Drug List
• $50 for a brand-name drug that is NOT on our Preferred brand-name Drug List

Waiver of Out-of-Pocket Costs

Out-of-pocket costs are waived (no deductible, no co-insurance, no co-payments) for patients who need clinically recommended treatment for a chronic condition or disease. 

Chronic Care Management Programs offered

Catamount Blue (Blue Cross Blue Shield of Vermont):

• Asthma
• Chronic Obstructive Pulmonary Disease (COPD)
• Diabetes
• Heart Disease
• Anxiety Disorder
• Bipolar Disorder
• Major Depression
• Post-traumatic Stress Disorder
• Schizophrenia
• Substance Abuse

Catamount Choice (MP):

• Asthma
• Diabetes
• Heart Disease
• Depression
• Lower Back Pain

Conditions that do not have a Care management program yet, but will in the future are:

• Chronic Renal Failure
• Hyperlipidemia
• Hypertension

**Please check with the providers as management programs may have been added

You can contact Blue Cross Blue Shield and MVP directly if you don’t qualify for a premium subsidy.

• Blue Cross Blue Shield 1 (800) 255-4550
• MVP Health Care 1 (888) 687-6277

If you do qualify for a premium subsidy, contact the Vermont Department for Children and Families at 1 (800) 287-0589 or from Maximus Member Services at 1 (800) 250-8427.

How does a person enroll in Employer Sponsored Insurance (ESI)?

An uninsured Vermonter who is employed may be required to participate in their employer sponsored health insurance (ESI) plan. While there are many details, in general, a person who is employed and who applies for Catamount Health may be required by the State to enroll in their employers plan, IF the State determines that the ESI plan is comparable in cost and benefits to Catamount Health.

If employees make under $30,600 per year, they may also qualify for premium assistance to help pay for their employer’s plan.