This document provides information about health insurance plans offered by VEHI (Vermont Education Health Initiative) for the 2022 plan year. It discusses premium costs, deductibles, out-of-pocket maximums, and employer contributions toward premiums and out-of-pocket costs for the four VEHI plans (Platinum, Gold, Gold CDHP, Silver CDHP). For most employees, choosing the Gold CDHP plan paired with an HRA will provide the lowest financial exposure due to lower premiums and maximum out-of-pocket costs compared to the other plans. The document also provides directions for finding more details on calculating costs and financial exposure for different plan options and coverage tiers.

1. An Introduction to VEHI
Health Plans, Cost-Sharing
under Statewide Bargaining
& Health Spending
Accounts
Vermont-NEA

2. I have VEHI coverage now.
Do I have to change plans in 2022?
• You may remain in the same plan you
are in now.
• All four VEHI plans will still be
offered.
• Unless required by your central
office, you don’t need to sign-up
again to keep the same plan.
No employee
is required to
CHANGE
benefit plans
in 2022.

3. VEHI’s 4 Health Benefit Plans
• Platinum (non-CDHP)
• Gold (non-CDHP)
• Gold CDHP
• Silver CDHP
• CDHP = Consumer-Directed Health
Plan. Can be paired with a health
savings account (HSA).
All VEHI plans offer
the same medical
and Rx benefits, and
medical networks.
They differ in
premium and out-of-
pocket costs.

4. Preventive Care Coverage
The Affordable Care Act expanded coverage of preventive care – below are
examples of benefits covered at 100% on all VEHI health plans.
• Annual exam for all family members
• Well-baby and well child office visits
• Immunizations
• Colorectal screening
• Services for women also include:
• Annual OBGYN exam and pap test
• Screening mammogram
• Generic oral birth control, as well as implantable and injectable contraceptives
• Standard breast pump from a durable medical equipment network provider
• Lactation support from a network lactation consultant
• For a full list of covered services, please see www.bcbsvt.com/preventive.
4

5. Wellness Prescriptions
• Applicable to the Gold CDHP & Silver CDHPs only.
• Prescription drugs on the Wellness Rx list are not subject to a deductible
and are covered at 100%.
• Categories on the Wellness Rx list include:
• Asthma/COPD
• Diabetes
• Hyperlipidemia
• Hypertension
• Osteoporosis
• Prenatal
• Full list of Wellness medications are found at www.bcbsvt.com/wellnessrx.
• Please note: Platinum/Gold non-CDHP plans are subject to copay/coinsurance except for diabetic
medications
5

6. VEHI Monthly Premium Rates: FY 22
Monthly Rates
FY 22
Platinum Gold Gold CDHP Silver CDHP
Single $889.59 $868.05 $796.32 $754.38
Two Person (Two
Adults)
$1,779.18 $1,736.09 $1,495.54 $1,508.77
Parent/Child(ren) $1,487.53 $1,452.73 $1,231.15 $1,271.68
Family $2,516.63 $2,457.21 $2,205.83 $2,146.73

7. Overview of Cost-Sharing Terms
1. Co-payment – A fixed dollar amount “you” must pay at the time of service for
specific services; for example, a $25 copay for an office visit.
2. Deductible – The amount “you” must pay toward the cost of specific services
each calendar year before VEHI makes a payment.
3. Coinsurance – A percentage “you” must pay after your deductible is met;
after deductible VEHI pays for 80% and “you” are responsible for 20% of the
charges.
• All of the above, taken together, add up to an annual, Out-of-Pocket (OOP)
Maximum per calendar year.
• “YOU” = employee, employer, or employer and employee, depending on
negotiated cost-sharing terms.
7

8. Out-of-Pocket
Maximum
Copayments
Co-insurance
Deductible
How is Out-of-Pocket Maximum Costs
Calculated?
8

9. VEHI Health Plans
VEHI Platinum
Cost Share
VEHI Gold
Cost Share
HRA or HSA Compatible HRA only HRA only
Medical Deductible (Single/Dependents) $500 / $1,000 (stacked) $1,200 / $2,400 (stacked)
Medical Out-of-Pocket Maximum $1,500 / $3,000 $1,800 / $3,600
Prescription Deductible $0 $0
Prescription Out-of-Pocket Maximum $1,300 / $2,600 $1,300 / $2,600
Total Out-of-Pocket Exposure
(Medical and Rx)
$2,800 / $5,600 $3,100 / $6,200
Preventive PCP Visit $0 $0
Primary Care Physician /
Mental Health or Substance Abuse Visit
$25 $25
Specialist Visit $35 $35
Urgent Care Facility $75
Deductible, then 20%
coinsurance
Emergency Room $250
Deductible, then 20%
coinsurance
Inpatient, Outpatient, Radiology, DME, Ambulance, Deductible, then 20% Deductible, then 20%9

10. VEHI Health Plans
VEHI Gold CDHP
Cost Share
VEHI Silver CDHP
Cost Share
HRA or HSA Compatible HRA/HSA HRA/HSA
Medical Deductible $1,800/$3,600 (aggregate) $3,000/$6,000 (stacked)
Medical Out-of-Pocket Maximum
(including Rx Costs)
$2,500/$5,000 (aggregate) $4,000/$8,000 (stacked)
Prescription Deductible Included in medical deductible Included in medical deductible
Prescription Out-of-Pocket Maximum $1,400/$2,800 $1,400/$2,800
Total Out-of-Pocket Exposure
(Medical and Rx)
$2,500/$5,000 $4,000/$8,000
Preventive PCP Visit $0 $0
Primary Care Physician /
Mental Health or Substance Abuse
Visit
Deductible, then 20% coinsurance Deductible, then 20% coinsurance
Specialist Visit Deductible, then 20% coinsurance Deductible, then 20% coinsurance
Urgent Care Facility Deductible, then 20% coinsurance Deductible, then 20% coinsurance

11. 3 Major Health Spending Accounts:
Tax-Favored Arrangements to Pay OOP Costs
• Health Reimbursement Arrangement (HRA)
• Health Savings Account (HSA)
• Flexible Spending Account (FSA)
11

12. Health Savings Account (HSA)
• Must be paired with a Consumer-Directed Health Plan (or CDHP) per IRS
regulations
• Can be funded by the employer and/or employee; however, IRS rules
prohibit contributions by employees or employers in some cases and
restrict use of HSA funds for some dependents.
• Money deposited pre-tax, grows pre-tax and withdrawn pre-tax for
qualified expenses
• Use HSA dollars to pay for member’s share of cost
• Accounts and funds belong to the employee
• Accounts stay with employee even after employment ends
12

13. Health Reimbursement Arrangement
(HRA)
• Eligible to be paired with any health plan
• Funded exclusively by the employer pre-tax
• Can cover deductibles, copayments or coinsurance as
determined in collective bargaining
• Funds not used stay with the employer
• HRAs are NOT subject to IRS rules that prohibit contributions by
employees or employers to HSAs and that restrict the use of HSA
funds for certain dependents.
13

14. Medical Flexible Spending Account (FSA)
• Generally funded by the employee through payroll deductions
• Election done before the beginning of the plan year
• Typically has “use it or lose it” provisions
To avoid or lessen the impact of the use it-or-lose-it rule, the IRS permits employers
to allow employees to use FSA funds that were deducted for one plan year and use
them in the next plan year. These rules cover two major categories: (1) Grace
Periods and (2) Rollover
• Cannot have a Medical FSA with an HSA, but you can have a Limited-Purpose FSA with
an HSA.
A Limited-Purpose FSA can be used for services such as dental, eye-glasses or
contacts.
14

15. Are VEHI Plans
changing in
2022?
VEHI’s benefit plans are NOT changing on January
1, 2022.
 Same four plans (Platinum, Gold, Gold CDHP &
Silver CDHP):
 Same medical benefits
 Same medical networks
 Same four tiers of coverage (single, two-person,
parent/child[ren] and family)
All four plans have IDENTICAL benefits and
medical networks (same doctors and hospitals).
Review the plans at this link.

16. Which
dependents can
be covered on
your VEHI plan?
• Your spouse, civil union partner, or
domestic partner are eligible for
coverage under all VEHI plans, as are
your children up to age 26.

17. Am I eligible
for health
insurance
coverage?
 You are if you work an average of at least
17.5 hours a week during the school or
calendar year.
 Your employer will make full contributions
to out-of-pocket costs, and your premium
amounts will be pro-rated based on
worktime requirements of your local
contract. This applies even if you are in
your contractual probationary period.

18. Most school
employees are
now enrolled in
the Gold CDHP
The Statewide Bargaining decision
on cost-sharing – for premiums
and out-of-pocket (OOP) costs –
shows that being enrolled in the
Gold CDHP is your safest bet if you
want the lowest possible medical
financial exposure.

19. Managing
Out-of-Pocket
Costs (OOP)
You can choose a health reimbursement
arrangement (HRA) with any VEHI plan. This
will generally make the most sense to most
of you.
You can also choose a medical flexible
spending account (FSA) with any VEHI plan,
provided an FSA is offered in your collective
bargaining agreement or by school district
policy. You cannot, however, choose a
medical FSA if you elect an HSA.

20. The benefits of
choosing an
HRA are
significant.
With an HRA:
Your spouse or partner can be in
Medicaid, TRICARE, Social Security;
adult children up to 26 can have their
OOP costs reimbursed; and you can
have access to a debit card for
prescription costs and have your
provider paid directly.

21. What about
health savings
accounts
(HSA)?
 That option is available, but presently only
with the Silver CDHP plan.
 Additionally, HSAs have some pretty big
exceptions. Not everyone can receive or make
a contribution to an HSA under IRS rules.
 You cannot have a Medical FSA with an HSA;
only a Limited-Purpose FSA.
 Check out HSA eligibility restrictions for
employees and their dependent adult children
at General Guidance.HRA and HSA.June
2020.Final with Links.pdf (vehi.org).

22. If I had an HSA
in FY21 (or
earlier) and I
move to an
HRA in 2022,
will I lose the
money in my
HSA?
• The money in your HSA from 2018 -2021 is
yours to keep if you move to an HRA in 2022.
• But you cannot contribute to an HSA if you are
receiving HRA contributions from your
employer.
• And you cannot “double dip”: you cannot use
your employer’s HRA money and your HSA
money to be reimbursed for the same medical
expenses.

23. Spoiler Alert
•Based on our calculations,
the Gold CDHP plan will
provide the lowest medical
financial exposure to
teachers and ESP. Here’s
why…

24. Employer & Employee
Premium Payments for
Licensed Staff

25. Employer &
Employee
Premium
Payment
Formula for
Licensed Staff
Districts will pay 80 percent of
the premium for the Gold CDHP
and the Silver CDHP.
•
Districts will pay a dollar
amount equal to 80 percent of
the Gold CDHP premium toward
enrollment in the Platinum and
Gold [non-CDHP] plans.

26. More on
Employer &
Employee
Premium
Payment
Formula for
Licensed Staff
 Employees in the Gold CDHP or Silver
CDHP will pay 20 percent of the premium.
 Employees in the Platinum or Gold [non-
CDHP] plans will pay the difference
between 80 percent of the cost of Gold
CDHP and the cost of the same coverage in
the Platinum and Gold [non-CDHP] plans.
WARNING!
You will pay much higher premiums if you
enroll in the Platinum and Gold [non-CDHP]
plans.

27. Employer & Employee
Premium Payments for
Non-Licensed ESP Staff

28. Employer &
Employee
Premium
Payment
Formula for
ESP
Premium Cost Sharing Varies Across the
State for ESP:
 Between January 1 – December 31, 2021,
ESP contributions were the same as they
were in each district on December 30,
2020.
 On January 1, 2022, support staff who are
not already paying 20 percent of their
premium will pay 2 percent more, but not
more than 20 percent.

29. Employer & Employee
Out-of-Pocket (OOP)
Costs for Licensed Staff

30. What will the
employer pay
toward out-of-
pocket (OOP)
expenses?
If you choose an HRA (with any VEHI plan) or an
HSA (with Silver CDHP Only), your employer will
contribute $2,100 toward OOP costs for single
coverage and $4,200 for all other tiers. These are
first-dollar contributions, meaning they must be
allocated before you pay any OOP costs.
Generally, choosing a Gold CDHP plan will make
the most financial sense for most members.

31. Employer & Employee
Out-of-Pocket (OOP)
Costs for Non-Licensed
ESP Staff

32. What will
employer pay
toward
out-of-pocket
(OOP)
expenses in
FY22?
If you choose an HRA (with any VEHI plan) or
an HSA (with Silver CDHP only), your
employer will contribute $2,200 toward your
OOP costs for single coverage and $4,400 for
all other tiers. These are first-dollar
contributions, meaning they must be allocated
before you pay any OOP costs.
Generally, choosing a GOLD CDHP plan with an
HRA will make the most financial sense for
most members.

33. Maximum Financial Exposure, or
What’s it Gonna Cost Me?
What is it?
Why should
you care?

34. Maximum
Financial
Exposure
(MFE) Defined
MFE = Your premium share +
YOUR Portion of out-of-pocket
(OOP) costs after the district’s
HRA/HSA funds have been
spent.
MFE will vary from year to
year depending on your
personal medical experiences
and the VEHI plan you are in.

35. MFE for
Licensed
Educators in
FY22 (if they
“max out”
their OOP
costs)
Single Coverage (FY 22): Rounded to nearest dollar
Platinum: $3,730
Gold: $3,772
Gold CDHP: $2,311
Silver CDHP: $3,711

36. MFE for
Licensed
Educators in
FY22 (if they
“max out”
their OOP
costs)
Two-Person Coverage: (FY22): Rounded to Nearest
Dollar
Platinum: $8,393
Gold: $8,800
Gold CDHP: $4,389
Silver CDHP: $7,421

37. MFE for
Licensed
Educators in
FY22 (if they
“max out”
their OOP
costs)
Parent/Child[ren] (FY22): Rounded to Nearest Dollar
Platinum: $7,431
Gold: $7,614
Gold CDHP: $3,755
Silver CDHP: $6,852

38. MFE for
Licensed
Educators in
FY22 (if they
“max out”
their OOP
costs)
Family (FY22): Rounded to Nearest Dollar
Platinum: $10,424
Gold: $9,711
Gold CDHP: $6,094
Silver CDHP: $8,952

39. Where licensed
educators will
find more
information on
MFE and other
insurance costs
Click on: https://vehi.org/licensed-
employee/
On the right, you will see the words
“Cost Comparison Chart.”
Click on this, and it will take you to a
detailed Excel spreadsheet for FY21.

40. How About
ESP? It’s More
Complicated.
1. ESP, unlike licensed educators,
have different premium co-shares
across the state.
2. So we can’t generate MFE
numbers that would apply to
every ESP no matter where they
work.
3. But we can show you how it was
done for FY21. See the next slide
for directions.

41. ESP: Calculate
your Medical
Financial
Exposure
1. Click on this link:
https://vehi.org/non-licensed-
employee/
2. Read the directions. Then, on the far
right, click on “Cost Comparison Chart.”
This will take you to an Excel
spreadsheet.
3. Fill Cell A-2 on the spreadsheet with
your district’s premium co-share. Find
your maximum financial exposure per
VEHI plan/coverage tier in Column K.

42. No matter how
you cut it: the
Gold CDHP plan
offers the
lowest financial
exposure for
ESP, as it does
for teachers.
Your maximum financial exposure
in the Gold CDHP, if you max out
your out-of-pocket (OOP) costs, are
substantially lower than the Silver
CDHP.
For ESP with chronic conditions,
high Rx costs, or facing expensive
medical procedures, enrolling in
the Silver CDHP could be be a very
costly decision, even with an HSA.

43. Questions?
Check out all the details at
vtnea.org/openenrollment2020.
If you have questions about statewide bargaining
or local contractual matters, speak with your local
union representatives.
If you have questions about VEHI benefit plans,
contact Mark Hage, your Vermont-NEA Director
of Benefit Programs, at mhage@vtnea.org.
Read more about statewide health insurance at
vthealthbargainingteam.org.