Strategic Insurance Planning and Education

Welcome Vermont State Dental Society

Below you will find the plan designs that give greater detail and correlate to the overview you received in your open enrollment packet. Directions for new enrollments or changes are below the plan designs.  If after careful review you have questions please contact Affiliated Associates at 802-861-2900.

Plan Designs:

• MVP PPO 500 - 1 (PDF)
• MVP PPO 1000 - 2 (PDF)
• MVP Preferred PPO 500 - 3 (PDF)
• MVP Preferred PPO 1000 - 4 (PDF)
• MVP Preferred EPO 2000 - 5 (PDF)
• MVP High Deductible HMO - 6 (NOT Avail. to new subscribers) (PDF)
• MVP Preferred High Deductible EPO 2500 - 7 (PDF)
• MVP Preferred High Deductible EPO 5000 - 8 (PDF)
• MVP Preferred High Deductible PPO 2500 - 9 (PDF)

  MVP Preferred High Deductible Preventive Drug List (PDF)

Sample Detail EPO and HMO Contracts

• Preferred EPO Contract     High Deductible HMO Contract

 

Please Note: Student coverage for VSDS is to the age 25 not 23 as stated on the above plan designs.

Instructions:

1. If remaining on existing plan print Practice Enrollment/Change Form, circle "RENEW AS IS" and fax to MVP at 1-802-264-6507.

2. If the entire practice opts to change from your existing plan to a new plan. Print the the Practice Enrollment/Change Form, circle the plan of your choice and fax to MVP at 1-802-264-6507.

3. If your practice offers two plan designs and would like to make a change. Print Practice Enrollment/Change Form and circle the plans for the practice.  Be sure to include an Employee Enrollment Form for each subscriber.  Each subscriber must write plan identification # at the top of the form.  Fax to MVP at 1-802-264-6507.

4. If your practice is not currently enrolled in one of the VSDS endorsed plans and your practice would like to join. Please complete the Practice Enrollment/Change Form, indicating the 1 or 2 plans you would like to offer.  Have your participating employees complete the Employee Enrollment Form and have them hand write the plan identification # at the top of their form. Please fax to Affiliated Associates at 802-419-3091 or MVP at 1-802-264-6507.  Be sure to include a copy of your Schedule C tax form required by MVP as proof of business.

 

• Practice Enrollment/Change Form (PDF)
• Employee Enrollment Form (PDF)

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Links and Information:

• MVP Healthcare Homepage

• www.medco.com Mail Order Pharmacy
• Glossary of Terms (PDF)
• COBRA Notification Form (PDF)
• How Does Medicare Work With My MVP Plan (PDF)