Application for Health Care Programs and WIC (includes Catamount Health Premium Assistance)

Complete this application for:

• Catamount Health Premium Assistance
  • If you are unsure whether to apply for Catamount Health Premium Assistance or Catamount Health, please fill out this application.
• Vermont Health Access Plan (VHAP)
• Dr. Dynasaur
• Prescription Assistance
  • Includes VHAP-Pharmacy, VScript, VPharm and Healthy Vermonters.
  • If you are only applying for Prescription Assistance, please instead use the "Pharmacy Programs Application."

Catamount Health Application (for applicants NOT applying for Premium Assistance)

Complete this application for:

• Catamount Health (without premium assistance)
  • If you believe you qualify for Premium Assistance, please complete the "Application for Health Care Programs and WIC.”

Application for Health Care Assistance

Complete this application for:

• Medicaid
  • Although this application can also be used to apply for Catamount Health Premium Assistance, Vermont Health Access Plan (VHAP), Dr. Dynasaur and/or Prescription Assistance, it requires more detailed information than necessary.

Pharmacy Programs Application

Complete this application for:

• Prescription Assistance
  • This application is only for Prescription Assistance programs including VHAP-Pharmacy, VScript, VPharm and Healthy Vermonters.

For information or assistance at any time, call Green Mountain Care at 1-800-250-8427.