Individual & Family Direct-Enrollment Form

Things to know or have handy before you start:

  • If you choose to direct enroll through Blue Cross and Blue Shield of Vermont, you are not eligible for any subsidies (like premium tax credits and cost-sharing reductions). Please use the Vermont Health Connect Plan Comparison Tool to see if you may be eligible for subsidies before proceeding.
  • Determine what Qualified Health Plan (QHP) you would like to enroll in for 2021 coverage. Not sure? Review our 2021 Plan Comparison Chart or use our Find a Plan Tool to see what plan best meets your health care needs.
  • If you are only making a Plan Change for 2021, please use the "Simple Renewal" button below
  • If you are new to BCBSVT for 2021, please choose "New Application" button below
  • If you need to add or remove any of your dependents OR any your information has changed, please choose the "New Application" button below

Plan changes only
New to BCBSVT or add/remove dependents