Individual Direct Enroll Renewal 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 2020 coverage. Not sure? Use our Find a Plan Tool to see what plan best meets your health care needs.
  • If you only making a Plan Change for 2020, please use the "Simple Renewal" button below
  • If you are new to BCBSVT for 2020, 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
Adding or removing dependents