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Agency of Human Services Department of Vermont Health Access

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Home
About Us
Administration
Advisory Committees and Boards
Apply for Health Insurance and Member Resources
Budget, Reports, Rules and Regulatory Info
MMIS Department Initiatives
Forms and Manuals
Provider Resources and Clinical Programs
Quality, Outcomes, Customer Satisfaction
Stay Informed and Protect Your Health
DVHA Procedures and Guidance Documents

Out-of-Network Elective Office Visit Request Form

Monday, February 24, 2025 - 12:00

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Out-of-Network Elective Office Visit Request Form (182.62 KB)

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Department of Vermont Health Access

280 State Drive, NOB 1 South
Waterbury, Vermont 05671-1010
Phone: 802-879-5900
Fax: 802-241-0260
For Telecommunications Relay Service: Dial 711

Questions about your health coverage?
Call Customer Service: 1-855-899-9600

Department Contact List for customer service, program telephone and fax numbers, and staff email

Hours of Operation: Monday-Friday (Excluding Holidays) 7:45am - 4:30pm

Media Requests
Alex McCracken
Director of Communications and Legislative Affairs
Alex.Mccracken@vermont.gov

Public Record Requests
Jessica Ploesser
Department of Vermont Health Access
Jessica.Ploesser@vermont.gov
Visit the Agency of Administration site for the Public Records Database

Quick Links

Agency of Human Services (AHS)
Department for Children and Families (DCF)
Department of Disabilities, Aging and Independent Living (DAIL)
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Vermont Department of Health (VDH)
Department of Human Resources Career Site

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