Health Insurance Forms

• FY 26 BCBS Health Costs
  • FY 26 Health Rates
  • Plan Comparison Grid VEHI Health Plans FY 26
• BCBS Health Plans
  • Platinum and Gold Benefit Description
  • Gold and Silver CDHP Benefit Description
  • 2026 Platinum SBC
  • 2026 Gold CDHP SBC
  • 2026 Gold SBC
  • 2026 Silver CDHP SBC
• VEHI/Enrollment/Change Form
• BCBS-NEDD-DataPath Contact Info Sheet
• Medicare Notice of Creditable Coverage by District
  • FY26 FBUD Notice of Creditable Coverage
  • FY26 RSUD Notice of Creditable Coverage
  • FY26 SHARON Notice of Creditable Coverage
  • FY26 STRAFFORD Notice of Creditable Coverage
  • FY26 WRUD Notice of Creditable Coverage
  • FY26 WRVSU Notice of Creditable Coverage
• VEHI - Vermont Education Health Initiative
  • FY26 VEHI Benefit Booklet
• Domestic Partners
  • Domestic Partners FAQS
  • Statement of Domestic Partnership
  • VEHI Enrollment/Change Form
  • Delta Dental Enrollment/Change Form
  • HRA Enrollment Form

Beneliance Third Party Admin - Contact Lisa Blair 802-763-3895

• Beneliance (f/k/a DataPath) -VT Flyer
• Beneliance- Account Information/Tutorials
• Beneliance.com/Vermont
• Summary Plan/Descriptions
  • HRA Summary Plan Description
  • HRA Plan Document
• Enrollment Forms
  • Health Reimbursement Account (HRA) Enrollment
  • FSA/DCA Election Form - Vermont
• HSA Health Savings Account - Avail. w/Silver CDHP ONLY
  • HSA Booklet 2026
  • HSA Application
  • HSA Today - Take a Tour
  • HSA Enrollment online

Delta Dental

• Northeast Delta Dental Plan Information
  • FY 26 Northeast Delta Dental Rates
  • Northeast Delta Dental Plan Outline
  • Northeast Delta Dental Benefit Flyers
• Northeast Delta Dental Forms
  • NEDD Claim Form
  • Northeast Delta Dental Enrollment/Change Form

COBRA

• COBRA General Notice
• Cobra - An Employees Guide to Health Benefits under Cobra

Alternative Insurance

• Alternative Health Insurance Coverage Statement
• VT Declaration of Coverage (HC-2)
• Terms Of Medical Plan Cash In Lieu w/Certification

Voluntary Benefits

• **New Employee Benefit Flyer
• Employee Navigator (Benefit Platform)
• Path to Employee Financial Wellness
• Plan Summaries
  • MetLife Vision and Lincoln Financial Plan Summaries