Title 08, Banking and Insurance

§ 4020. Age limits (a) If a health insurance plan contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the plan will not be effective, and if that date falls within a period for which the health insurer has accepted a premiu…

§ 4021. Termination of coverage (a)(1) A major medical insurance policy issued by a health insurer that insures employees, members, or subscribers for hospital and medical insurance on an expense-incurred, service, or prepaid basis shall: (A) provide notice to the policyholder or…

§ 4022. Rebates and commissions prohibited for nongroup and small group policies and plans offered through the Vermont Health Benefit Exchange (a) No health insurer doing business in this State and no insurance agent or broker shall: (1) offer, promise, allow, give, set off, or p…

§ 4022a. Rebates prohibited for group insurance policies (a) As used in this section, “group insurance” means any policy described in section 4041 of this title, except that it shall not include any small group policy issued pursuant to 33 V.S.A. § 1811. (b) No health insurer doi…

§ 4023. Provisions applying to policies delivered in another state If any policy is issued by a health insurer domiciled in this State for delivery to a person residing in another state, and if the official having responsibility for the administration of the insurance laws of the…

§ 4024. Coordination of insurance coverage with Medicaid and compliance with Medicaid recovery provisions (a) No health insurer shall consider the availability of or eligibility for medical assistance in this or any other state under Title XIX of the Social Security Act (Medicaid…

§ 4025. Health insurance and the Blueprint for Health (a) All major medical insurance plans shall be offered, issued, and administered consistent with the Blueprint for Health established in 18 V.S.A. chapter 13. (b) Health insurers offering major medical insurance plans shall pa…

§ 4026. Filing and approval of policy forms and premiums (a)(1) No policy of health insurance or certificate under a policy filed by a health insurer and not exempted by subdivision 3368(a)(4) of this title shall be delivered or issued for delivery in this State, nor shall any en…

§ 4027. Filing fees Each filing of a policy, contract, or document form or premium rates or rules, submitted pursuant to section 4026 of this title, shall be accompanied by payment to the Commissioner or the Green Mountain Care Board, as appropriate, of a nonrefundable fee of $15…

§ 4028. Form and contents of policy No policy of individual health insurance shall be delivered or issued for delivery to any person in this State unless all of the following conditions are met: (1) The policy sets forth all of the monetary and other considerations for the policy…

§ 4029. Required standard policy provisions Except as provided in section 4031 of this title, each health insurance policy delivered or issued for delivery to any person in this State shall contain the provisions specified in this section using the language set forth in this sect…

§ 4030. Optional standard policy provisions Except as provided in section 4031 of this title, no health insurance policy delivered or issued for delivery to any person in this State shall contain provisions respecting the matters set forth in this section unless the provisions us…

§ 4031. Omission of inapplicable or inconsistent standard provisions If any provision of sections 4029 and 4030 of this title is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the health insurer, with the approval of…

§ 4032. Order of standard policy provisions The provisions specified in sections 4029 and 4030 of this title, or any corresponding provisions used in lieu of those provisions as permitted by those sections, shall either be printed in the same order as the provisions are set forth…

§ 4033. Discretionary clauses prohibited (a) The purpose of this section is to ensure that health insurance benefits, disability income protection coverage, and life insurance benefits are contractually guaranteed and to avoid the conflict of interest that may occur when the carr…

§ 4034. Requirements of other jurisdictions (a) Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this State, may contain any provision that is not less favorable to the covered individual than the provisions of this chapter and that…

§ 4035. Policies not affected Nothing in sections 4018–4020, 4023, 4028–4032, 4034, 4036, and 4037 of this title shall apply to or affect: (1) any policy of workers’ compensation insurance or any policy of liability insurance, with or without supplementary coverage; (2) any polic…

§ 4036. Nonconforming policies (a) A health insurance policy shall not contain any provision that makes the policy or any portion of the policy less favorable in any respect to the covered individual than the provisions of the policy that are regulated by sections 4029 and 4030 o…

§ 4037. Applications for insurance (a)(1) A covered individual shall not be bound by any statement made in an application for a policy unless a copy of the application is attached to or endorsed on the policy as a part of the policy when issued. (2) If a policy delivered or issue…

§ 4038. Rulemaking on policy filings The Commissioner may adopt such reasonable rules concerning the procedure for the filing or submission of policies subject to sections 4023 and 4028–4030 of this title as are necessary, proper, or advisable for the administration of these sect…

§ 4041. Group health insurance policies; definitions (a) As used in this section: (1) “Employees” includes the officers, managers, and employees of the employer; the partners, if the employer is a partnership; the officers, managers, and employees of subsidiary or affiliated corp…

§ 4042. Group insurance policies; required policy provisions (a) Terms and conditions. No group health insurance policy shall contain any provision relating to notice of claim, proofs of loss, time of payment of claims, or time within which legal action must be brought upon the p…

§ 4043. Association health plans (a)(1) As used in this section, “association health plan” means a policy issued to an association; to a trust; or to one or more trustees of a fund established, created, or maintained for the benefit of the members of one or more associations or a…

§ 4047a. Continuation of group (a) All group major medical insurance and dental insurance policies shall provide that any person whose insurance under the group policy would terminate because of the occurrence of a qualifying event as defined in subsection (b) of this section sha…

§ 4047b. Continuation; notice; terms (a) A person electing continuation shall notify the health insurer, or the policyholder, or the contractor, or agent for the group if the policyholder did not contract for the policy directly with the health insurer, of such election in writin…

§ 4047c. Termination of coverage Continuation of insurance under the group policy shall terminate upon the occurrence of any of the following: (1) The date 18 months after the date that insurance under the policy would have terminated due to a qualifying event, as defined in subs…

§ 4048a. Definitions; policies and contracts covered (a) As used in this subchapter, “group health insurance policy or subscriber contract” means a policy or contract that meets the following conditions: (1) coverage is provided through insurance policies or subscriber contracts …

§ 4048b. Termination for nonpayment of premium or subscription charges (a) If a group health insurance policy or subscriber contract provides for automatic termination of the policy or contract after a premium or subscription charge has remained unpaid through the grace period al…

§ 4048c. Notice of termination (a) A notice of termination of a health insurer’s group health insurance policy or subscriber contract shall: (1) request the group policyholder or other entity involved to notify employees or members covered under the policy or subscriber contract …

§ 4048d. Extension of benefits (a) Each group health insurance policy or subscriber contract shall provide a reasonable extension of benefits in the event that the employer or member is in a condition of total disability on the date of termination of the group policy or contract …

§ 4048e. Replacement coverage (a) General. When the group health insurance policy or subscriber contract of a health insurer replaces a policy or contract providing similar benefits of another health insurer, the liability of both health insurers shall be as provided in this sect…

§ 4051. Medicare supplement insurance policies [Effective January 1, 2026; see also 8 V.S.A. § 4051 effective until January 1, 2026 set out above] (a) Community rating. (1) A health insurer shall use a community rating method acceptable to the Commissioner for determining premium…

§ 4052. Blanket health insurance (a) Blanket health insurance is a form of health insurance that, to the extent permitted under federal law, is supplemental to major medical health insurance or provides coverage other than the payment of all or a portion of the cost of health car…

§ 4053. Short-term, limited-duration health insurance (a) As used in this section, “short-term, limited-duration health insurance” means health insurance that provides medical, hospital, or major medical expense benefits coverage pursuant to a policy or contract with a health ins…

§ 4057. Coverage of children (a) Definition. “Health insurance plan” has the same meaning as in section 4011 of this chapter and shall be subject to the same excepted benefits, in each case, as set forth in 45 C.F.R. § 146.145, as in effect as of December 31, 2017. (b) Newborn co…

§ 4058. Medical support orders (a) As used in this section: (1) “Dependent coverage” means family coverage, or coverage for one or more persons as long as the coverage for one or more persons is greater than or equal to the coverage available under family coverage. (2) “Health in…

§ 4059. Coverage for civil unions (a) As used in this section: (1) “Dependent coverage” means family coverage or coverage for one or more persons. (2) “Party to a civil union” has the same meaning as in 15 V.S.A. § 1201. (b) Notwithstanding any provision of law to the contrary, h…

§ 4060. Coverage for employees of an employer domiciled outside Vermont (a) As used in this section: (1) “Marriage” has the same meaning as in 15 V.S.A. § 8. (2) “Party to a civil union” has the same meaning as in 15 V.S.A. § 1201. (b) To the extent permitted under federal law, h…

§ 4063. Independent external review of health care service decisions (a) As used in this section, “covered individual” includes a member of a health insurance plan not otherwise subject to the Department’s jurisdiction that has voluntarily agreed to use the external review proces…

§ 4064. Mental health services review (a) The purposes of this section are to: (1) promote the delivery of quality mental health services in a cost-effective manner; (2) foster the practice of mental health services review as a professional collaborative process, the primary obje…

§ 4067. Application of subchapter (a) Unless otherwise specified and to the extent not inconsistent with federal law, the benefits required in this subchapter: (1) apply only to major medical insurance plans; (2) may be subject to deductibles, co-payment and coinsurance amounts, …

§ 4068. Chiropractic services (a) A health insurance plan shall provide coverage for clinically necessary health care services provided by a chiropractic physician licensed in this State for treatment within the scope of practice described in 26 V.S.A. chapter 10, but limiting ad…

§ 4069. Prosthetic devices (a) As used in this section, “prosthetic device” means an artificial limb device to replace, in whole or in part, an arm or a leg. (b) A health insurance plan shall provide coverage for prosthetic devices that is at least equivalent to the coverage prov…

§ 4070. Hearing aid coverage in large group health insurance plans (a) As used in this section: (1) “Hearing aid” means any small, wearable electronic instrument or device designed and intended for the ear for the purpose of aiding or compensating for impaired human hearing and a…

§ 4071. Gender-affirming health care services (a) As used in this section, “gender-affirming health care services” has the same meaning as in 1 V.S.A. § 150. (b)(1) A health insurance plan shall provide coverage for gender-affirming health care services that: (A) are medically ne…

§ 4072. Mental health and substance use disorder services (a) No policy provision which is not subject to section 4065 or 4066 of this title shall make a policy, or any portion thereof, less favorable in any respect to the insured or the beneficiary than the provisions thereof wh…