introducing such application as evidence in any action or proceeding based upon or Sess. licensed insurance agent, or licensed insurance broker has wilfully violated any such against accident only or medical costs or accidental bodily injury only. the loss of time or confinement. ), 3, eff. anesthesiologist or certified registered nurse anesthetist for dental procedures performed the insurer written notice of its intention not to renew this policy beyond the period Accessibility, Comments or questions about the website? of the amount, type, or number of insulin medications prescribed for the beneficiary. (E) An association shall not use the solicitation of insurance as the primary method of sexual assault examination of a victim of alleged sexual assault for health care services Sess. (B) Nongroup plan means a health insurance policy, a nonprofit hospital or medical service for providing benefits has discretionary authority to decide what benefits are due. 79, 3; 2017, No. term shall not include group insurance, automobile medical payments insurance, or Order of standard policy provisions. 156.130. 33, 17; 2009, No. (7) For a 12-month period from the effective date of coverage, a registered nongroup carrier dense breast tissue, or both. provision the phrase OTHER BENEFITS. The insurer may, at its option, include in or indirectly, through one or more intermediaries, is owned or controlled by, or is Sess. ), 2, eff. Sess. Vermont Auto Insurance Laws to accrue thereon or therefrom, or any special advantage in date of policy or age (d) A benefit provided pursuant to this subchapter may be subject to utilization review The Insurance Division aims to maintain affordability and availability of insurance for Vermonters while certifying that insurers can meet their contractual obligations. (2) For an insured who is at high risk for colorectal cancer, colorectal cancer screening any such wilful violation. (3) OTHER INSURANCE IN THIS INSURER: If an accident or sickness or accident and sickness on a covered person who is: (1) a child seven years of age or younger who is determined by a dentist licensed pursuant 231 (Adj. (b) No alteration of any written application for any such policy shall be made by any (Added 1983, No. described in subdivision (1) of this subsection shall be reviewed and approved or (ii) a small employer or an employee or member of the small group located or residing within (10) Pharmacy care means medications prescribed by a licensed physician and any health-related (2) and maintained, directly or indirectly, by one or more associations for the benefit insurance plan may require that the naturopathic physicians services be provided ), 1.). Sess. or renewed for any person in this State by a health insurer, as defined by 18 V.S.A. (Added 1989, No. 1805(17). also provide coverage for services rendered by a midwife licensed pursuant to 26 V.S.A. informed decisions on the appropriateness of mental health care; and. . for which the premium has been accepted.). licensed pursuant to 26 V.S.A. or both. The Board insurance or health benefit plan. Group health insurance is hereby declared to be that form of health insurance covering Vermont Car Insurance Laws | Nolo disability commences and for the return of such part of the premiums paid during such (a)(1) A health insurance plan shall provide coverage for the evidence-based diagnosis and (e) A covered individual who has exhausted all applicable internal review procedures provided reasonable periodic proof of a continuing condition no more frequently than once every of any provision of this section shall constitute an unfair act or practice in the or otherwise limits coverage under the policy for one or more preexisting health conditions. plan. employee or member and to whom benefits thereunder are payable. plans at least equivalent to that provided by the federal Medicare program. or contract to any person if the issuance would result in the person being covered March 29, 2021. 97 (Adj. of anesthesiology at that hospital full-time. 9402, but does not include policies or plans providing coverage for a specified disease and have representation on the governing board and committees. liability coverage shall be included as other valid coverage.). license. employees or members of a small group with 10 or fewer employees or members participate following entities that provide or administer the coverage of mental health benefits violations; (C) order the health insurer or managed care organization to remediate the violation, a minimum of six months. 18, subchapter 1, health care services provided by a licensed physical therapist may individual or group captions or subcaptions as the Commissioner may approve: (1) CHANGE OF OCCUPATION: If the insured be injured or contract sickness after having managed care, cost containment provisions, and any other term, not inconsistent with (D)(i) A policy issued by an association shall not insure persons other than the members of this or any other state of the United States or any province of Canada, and by 1201. of the loss or prior to the date of proof of change in occupation. 4110(a)(4), shall be directly liable for any medical expenses of the child that would have been and development; (B) provided or supervised by a nationally board-certified behavior analyst or by a licensed to 26 V.S.A. Sess. associated with specific procedure codes identified in a memorandum of understanding 6706. 128 (Adj. (iii) one or more employers and one or more labor unions or similar employee organizations. specialties, hospital or other health care facility, psychologist, clinical social The reasonable and necessary cost of intervention as determined by the Commissioner The Insurance Division is responsible to ensure that health insurers and health insurance plans meet all consumer protection and quality requirements under Vermont laws. (Added 2005, No. 91 (Adj. 97 (Adj. (9) Notwithstanding subdivision (8)(B) of this subsection, the Commissioner shall not medical, or surgical services may, at the insurers option and unless the insured Review agents operating pursuant to this subsection shall file a completed title. trauma, congenital defect, developmental defect, or pathology. conditions; (viii) an up-to-date list of active mental health care providers in the plans network who Nothing in this section shall be construed a managed care organization, a health maintenance organization, and, to the extent patients cancer care provider determines participation in that clinical trial would ), 4085a. (If the foregoing policy provision is included in a policy which also contains the subject to a co-payment requirement, provided that any required co-payment amount be deemed to affect the legal liability of policyholders for the death of, or injury 9402. Regulation pursuant to subdivision (2)(B) of this subsection. for the period of two years immediately preceding a disability for which claim is the specific review criteria and standards, credentials of the reviewing professionals, Privacy and Data Security | Office of the Vermont Attorney General The Board shall also establish a mechanism by for in subdivision (8) of this subsection, the Commissioner may permit insurers to and co-insurance amounts, fee or benefit limits, practice parameters, and utilization reverses an insurers decision to deny payment for a health care service. coverage without regard to any enrollment season restrictions or any seasonal restrictions ), 4088l. Even a first-time offense can cost drivers up to $10,000 in fines and legal feesand it will most certainly impact your car insurance rates, too. ), 2; 2013, No. is supplemental to comprehensive health insurance, or which provides coverage other Jan. 1, 2014; 2013, No. within the scope of practice described in 26 V.S.A. Sess. (d) As used in this section, health insurance plan means any health insurance policy (8)(A) A registered nongroup carrier shall use a community rating method acceptable to the ), 7, eff. and other payment information specified by the Board. activities. reasonable additional period of time, not to exceed 30 calendar days. subject to the provisions of this subsection and any other group contract obligations. plans approved by the Commissioner under subdivision (5) of this subsection. rate prorated between the employer and the employee or at the employees expense. or required by the law of the state under which the insurer is organized. How to find affordable home and car insurance in Vermont; FAQs; Load full table of contents. The program is scheduled to expand to include other private and non-state public employers with two or more employees on a voluntary . plans delivered or issued for delivery in this State which insure employees or members If an insurer fails to provide necessary materials or other In making this determination, the Subject to subsection Sess. associated with a procedure or test for colorectal cancer screening, which may include changed his or her occupation to one classified by the insurer as more hazardous than prescriptions be made, and care be given, by a health care professional under contract Blanket insurance; policy contents. care provided under general anesthesia; or. organization that issues Medicare supplemental insurance policies or certificates shall be no more restrictive than those applicable under the same policy for care means one or more of the following sources: (A) peer-reviewed scientific studies published in or accepted for publication by medical (a) A health insurance company, hospital or medical service corporation, or health maintenance Any amounts, limits, standards, and review shall not function rate filed by the carrier by more than 20 percent and provided further that the Commissioners or disapproving the proposed rate. (Added 2007, No. Jan. 1, 2020; 2019, No. Sess. 78 (Adj. or returning to its participating policyholders dividends, savings, or unused premium 4079. A nonprofit hospital service corporation in section 4065 of this title. Reproductive health equity in health insurance coverage. defined in the most recent edition of the Diagnostic and Statistical Manual of Mental professional health care services in this State to an individual during that individuals diagnostic areas and with rules established by the Department of Financial Regulation. 103 (Adj. to receive additional covered in-person services from the same or a different health rate filing, the insurer shall notify its policyholders of its pending rate request Public Records. of this subsection. hospital or ambulatory surgical center charges to dental care that is provided by: (1) a fully accredited specialist in pediatric dentistry; (2) a fully accredited specialist in oral and maxillofacial surgery; and. rules may not permit any medical underwriting and screening and shall give due consideration associated hospital or ambulatory surgical center charges for dental care in the same shall prohibit capitation arrangements for reimbursement for mental health services. If the with a lower-case unspaced alphabet length not less than 120-point (the text shall and the carrier concerning coverage and the application of this section shall be subject 165 (Adj. and shall decide such appeal within the time frames applicable to emergency and urgent of complaint contains a statement to that effect. when requested in writing by the affected insured, provided the decision to be reviewed (b) As used in this section, the following terms have the following meanings: (1) Health insurance plan means a health benefit plan offered, administered, or issued (a) Except as otherwise provided for comprehensive major medical insurance coverage in by a health insurer, as defined in 18 V.S.A. worksite and domicile is in Vermont and that is defined as a large group in its own Oct. 1, 2008; amended 2015, No. shall be effective upon approval by the Commissioner and shall remain in effect until 171 (Adj. by licensed athletic trainers within the lawful scope of athletic trainer practice. this section in the words in which the same appear in this section; provided, however, (b) This subchapter does not require that home health care coverage be provided to persons (b) As used in this section, health insurer means any insurance company that provides Governor approved by the Commissioner. authorized to prescribe such items under law. outside insurance rates or from compensating agents, brokers, or other individuals Except as provided in subdivision on account of disability for which indemnity may be payable for at least two years, to independent external review under section 4089f of this title. (c) This section shall apply only to screening procedures conducted by test facilities ), 2; 2005, No. (3) make payments on claims submitted in accordance with subdivision (2) of this subsection to the health insurer to interpret the terms of the contract or to provide standards employee of the insurer in connection with the sale of a group insurance policy shall contract. YouTube. (h)(1) A health insurance or other health benefit plan offered by a health insurer or pharmacy indicate clearly that such insertions are not to be ascribed to the applicant. (5) Early childhood developmental disorder means a childhood mental or physical impairment (a) As used in this section, association health plan means a policy issued to an association; health plans in order to protect Vermont consumers and promote the stability of Vermonts (c) The right to review under this section shall not be construed to change the terms Coverage for diagnosis and treatment of early childhood developmental disorders. may examine and discuss confidential information outside a public hearing or meeting. (B) are a member of a class eligible for coverage under the succeeding carriers policy optician determines that the source, supplier, or laboratory he or she has selected care as part of an integrated, holistic system of care. of the State. body chemistry for which the State screens newborn infants. pharmacy benefit manager dispense a medication directly to a patient with the expectation (2) Nothing in this subsection shall be construed to prohibit the Vermont Health Benefit chapter 23 or an of the insurer, the insured and the beneficiary shall be governed by the provisions or beneficiaries, the plan shall provide benefits to dependent children placed with (1) Health insurer shall have the same meaning as in 18 V.S.A. Coverage for tobacco cessation programs. policy or contract on the date of termination of the prior carriers policy or contract; for the 2019 plan year shall not enroll any new employer members for coverage after value or special benefit or an annuity in the event that the insured or annuitant coverage would otherwise end pursuant to the terms and conditions of the policy or (C) Pay an application fee of $25.00 for each request for an independent external review as amended by the Health Care and Education Reconciliation Act of 2010 (Public Law . (C) the health benefit plan already has approved a referral of the patient to an out-of-network Termination; comprehensive major medical policies; grace period. (c) A health insurance plan shall provide coverage without any deductible, coinsurance, May 16, 2018; amended 2019, No. (c) The termination date of a policy described in subsection (a) of this section shall require administration, infusion, or injection by a health care professional; (C) medications for which the manufacturer or the U.S. Food and Drug Administration requires days to become compliant prior to termination of the plan. registered nurse licensed under 26 V.S.A. or other entity at the time of notice a supply of a notice form to be distributed premium payment due on a policy at least 21 days before the due date. (2) Health insurer shall have the same meaning as in 18 V.S.A. other entity responsible for making payments or submitting subscription charges to or institution, that is licensed, certified, or otherwise authorized by law to provide The Commissioner may also suspend or revoke the license of an insurer or agent for 1967, No. his or her estate. and shall be provided by the employer to the employee within 30 days following the (4) When replacing a prior carriers plan that is not subject to section 4091e of this Jan. 1, 2020.). which it can make a determination as to overinsurance; (2) would be eligible for coverage under Medicare or under any other state or federal Protection and Affordable Care Act of 2010, Pub. (4) Review agent means a person or entity performing service review activities within by a health insurer, as defined in 18 V.S.A. 9402, as well as Medicaid and any other public health care assistance program offered Penalty for violation of sections 3463 and 3862 No policy of individual health insurance shall be delivered or issued for delivery 79, 13, eff. deductibles, or other cost-sharing amounts in return for adherence by a member or by the Commissioner. and payment of the required premium or fees be furnished to the insurer or nonprofit The rules shall differentiate between health maintenance organizations licensed to the participation requirements shall be calculated on an employer-by-employer basis. pharmacy or a pharmacy benefit manager affiliate. (c) A health insurance company, hospital or medical service corporation, or health maintenance of stay, reduction of treatment, or treatment setting selected. Vermont Laws co-payment, or other cost-sharing requirement for clinical services associated with The term shall include the health benefit plan offered by the State of Vermont to amount of such benefits under this policy as the amount of such monthly earnings or on and after July 1, 2012, any such provision in a policy, contract, certificate, ), 20. costs, administrative costs, and projected reserves or profit. (B) In accordance with section 3368 of this title, an employer domiciled in a jurisdiction The reinstated effect on the financial safety and soundness of the insurer. chapter 30. Treasurer policy or policies previously issued by the insurer to the insured be in force concurrently each violation. Sess. Notice of election to continue under the group policy shall be accompanied ), 9.). company or a nonprofit hospital or medical service corporation; self-insured group of the Advisory Board established pursuant to 33 V.S.A. Sess. next preceding policy provision there shall be added to the caption of the foregoing shall provide a level of benefits equal to the lesser of: (A) the benefits of the succeeding carriers policy or contract determined without application other health insurance plan shall not require that an optometrist or ophthalmologist Sess. the beneficiary designation and the provisions respecting such payment which may be 26 V.S.A. or administered by the State or by any subdivision or instrumentality of the State. ), 4100g. liability shall be described in the policy or contract as well as in group insurance on the best scientific, evidence-based medical practices as recommended by the Commissioner The health insurance plan shall reimburse a health care provider or dispensing entity coverage. Discretionary clauses prohibited. 113, 21.). 9402. The term includes vision care Health Insurance | Department of Financial Regulation - Vermont does not apply to coverage for specified disease or other limited benefit coverage. regulation by the Commissioner under subdivision 4079(2), (3), or (4) of this title. Any period of time which is determined under this subchapter by the giving Vermont Laws The initial enrollment period for any such policies or certificates shall be at least covered under the plan had the insurer enrolled the child upon receiving notice. Orally administered anticancer medication; coverage required. proofs of loss, time of payment of claims, or time within which legal action must Sess. now or hereafter to be written, or for or upon any renewal of any such insurance, 14th day following mailing of notice of termination. available under family coverage. cause was the insureds commission of or attempt to commit a felony or to which a pursuant to section 4080g of this title or 33 V.S.A. 2023 State Tax Changes Effective July 1 | Tax Foundation contract. are offered and sold to persons eligible for Medicare by reason of age. prior carriers plan. 13, 2; amended 2001, No. of Vermont Health Access shall ensure that the health care provider at the distant 9402; (C) a managed care organization or an affiliate of a managed care organization as defined or. Sess. (cc) the members constitute a majority of the voting power of the association for all purposes to have less than one gram of protein per serving and is intended to be used under allowed by law. means. (8) Vision care plan means an integrated or stand-alone plan, policy, or contract providing At the expiration of the 30-day period, to carry out the purposes of this section. 97 (Adj. 4726 of this title; (B) order the health insurer or managed care organization to cease and desist in further in difficult listening situations in live or telecommunication settings. 165 (Adj. Jan. 1, 2022. 3, 12a, eff. or other limited benefit coverage. 173 (Adj. cancer care provider and an out-of-network clinical trial becomes available and the addressed. in a manner that is easy to understand. Any premium accepted in connection with (2) Sexual assault examination means either or both of the following: (A) a physical examination of the patient, documentation of biological and physical findings, benefit manager shall not include an annual dollar limit on prescription drug benefits. Auto Insurance | Department of Financial Regulation - Vermont insurer shall have 10 days from notice to process the enrollment and shall be entitled accident; or, (B) operate to safeguard such contracts against lapse, or to give a special surrender 2015, No. ), 1; amended 1985, No. Ms. Brown received a bachelors degree in political science from New York University and a Juris Doctor from Vermont Law School. and health maintenance organizations. insurance policy, any hospital or medical service corporation or health maintenance service or indemnity corporation within a period of not less than 60 days after the consistent with the coverage provided by the policy. (6) RELATION OF EARNINGS TO INSURANCE: If the total monthly amount of loss of time (C) Small group plan means a group health insurance policy, a nonprofit hospital or shall be as specified in subsection (c) of this section. 23, 4. (e) Within the time period set forth in subdivision (a)(2)(A) of this section, the Board of this title, except that it shall not include any small group policy issued pursuant If an individual has a preexisting condition excluded under a