Title 08, Title 08: Banking and Insurance

§ 4080. Anesthesia for certain dental procedures (a) As used in this section: (1) “Ambulatory surgical center” has the same meaning as in 18 V.S.A. § 2141. (2) “Anesthesiologist” means a physician who is licensed under 26 V.S.A. chapter 23 or 33 and who either: (A) has completed …

§ 4081. Tobacco cessation (a) As used in this section, “tobacco cessation medication” means all therapies approved by the U.S. Food and Drug Administration for use in tobacco cessation. (b) A health insurance plan shall provide coverage of at least one three-month supply per year…

§ 4082. Early childhood development disorders (a) As used in this section: (1) “Applied behavior analysis” means the design, implementation, and evaluation of environmental modifications using behavioral stimuli and consequences to produce socially significant improvement in huma…

§ 4083. Services for victims of sexual assault (a) As used in this section, “sexual assault examination” means either or both of the following: (1) a physical examination of the patient, documentation of biological and physical findings, and collection of evidence; and (2) treatm…

§ 4091. Definitions As used in this subchapter: (1) “Direct solicitation” means direct contact, including telephone, computer, email, instant messaging, or in-person contact, by a pharmacy provider or its agent to an individual covered under a health insurance plan without the co…

§ 4092. Prescription drug coverage (a) A health insurance plan shall not include an annual dollar limit on prescription drug benefits. (b) A health insurance plan shall limit a covered individual’s out-of-pocket expenditures for all prescription drugs to not more for self-only an…

§ 4093. Retail pharmacies; filling of prescriptions (a) A health insurer or pharmacy benefit manager doing business in Vermont shall permit a retail pharmacist licensed under 26 V.S.A. chapter 36 to fill prescriptions for all prescription drugs in the same manner and at the same …

§ 4095a. Colorectal cancer screening (a) As used in this section, “colonoscopy” means a procedure that enables a health care professional to examine visually the inside of a patient’s entire colon and includes the concurrent removal of polyps or biopsy, or both. (b) A health insu…

§ 4095b. Mammography and other breast imaging services (a)(1) A health insurance plan shall provide coverage for screening mammography and for other medically necessary breast imaging services upon recommendation of a health care professional as needed to detect the presence of b…

§ 4095c. Prostate cancer screenings A health insurance plan shall provide coverage for prostate cancer screenings consistent with the recommendations of the Centers for Disease Control and Prevention or upon recommendation of the covered individual’s health care professional. Ben…

§ 4095d. Chemotherapy treatment and oral anticancer medications (a) A health insurance plan shall provide coverage for medically necessary growth cell stimulating factor injections taken as part of a prescribed chemotherapy regimen. (b) A health insurance plan shall provide cover…

§ 4095e. Clinical trials for cancer patients (a) The Commissioner shall, after notice and hearing, adopt rules requiring that all health insurance plans issued in this State provide coverage for routine costs for covered individuals who participate in cancer clinical trials. (1) …

§ 4095f. Off-label use of prescription drugs for cancer (a) As used in this section: (1) “Medical or scientific evidence” means one or more of the following sources: (A) peer-reviewed scientific studies published in or accepted for publication by medical journals that meet nation…

§ 4098a. Coverage of health care services delivered through telemedicine and by store-and-forward means (a) As used in this section: (1) “Distant site” means the location of the health care provider delivering services through telemedicine at the time the services are provided. (…

§ 4098b. Coverage of health care services delivered by audio-only telephone (a) As used in this section, “health care provider” means a person, partnership, or corporation, other than a facility or institution, that is licensed, certified, or otherwise authorized by law to provid…

§ 4098c. Covered services provided by naturopathic physicians (a) A health insurance plan shall provide coverage for medically necessary health care services covered by the plan when provided by a naturopathic physician licensed in this State for treatment within the scope of pra…

§ 4098d. Covered services provided by athletic trainers (a) To the extent a health insurance plan provides coverage for a particular type of health care service or for any particular medical condition that is within the scope of practice of athletic trainers, a licensed athletic …

§ 4098e. Choice of providers for vision care and medical eye care services (a) As used in this section: (1) “Covered services” means services and materials for which reimbursement from a vision care plan or other health insurance plan is provided by a member’s or subscriber’s pla…

§ 4101. Purpose The purpose of this chapter is to promote the public welfare by regulating credit life insurance and credit accident and health insurance. Nothing in this chapter is intended to prohibit or discourage reasonable competition. The provisions of this chapter shall be…

§ 4102. Scope All life insurance and all accident and health insurance sold in connection with loans or other credit transactions shall be subject to the provisions of this chapter, except such insurance sold in connection with a real estate first mortgage loan, or where the issu…

§ 4103. Definitions As used in this chapter: (1) “Credit life insurance” means insurance on the life of a debtor pursuant to or in connection with a specific loan or other credit transaction. (2) “Credit accident and health insurance” means insurance on a debtor to provide indemn…

§ 4104. Forms and plans Credit life insurance and credit accident and health insurance shall be issued only in the following forms: (1) individual policies of life insurance issued to debtors on the term plan; (2) individual policies of accident and health insurance issued to deb…

§ 4105. Amount of insurance (a) Credit life insurance. The amount of credit life insurance shall not exceed the initial indebtedness. Where an indebtedness repayable in substantially equal installments is secured by an individual policy of credit life insurance the amount of insu…

§ 4106. Term The term of any credit life insurance or credit accident and health insurance shall, subject to acceptance by the insurer, commence on the date when the debtor becomes obligated to the creditor, except that, where a group policy provides coverage with respect to exis…

§ 4107. Provisions of policies and certificates; disclosure to debtors (a) All credit life insurance and credit accident and health insurance sold shall be evidenced by an individual policy, or in the case of group insurance by a certificate of insurance, which individual policy …

§ 4108. Filing, approval, and withdrawal of forms (a) All forms of policies or contracts, certificates of insurance, notices of proposed insurance, applications for insurance, endorsements, and riders shall be filed with the Commissioner for approval prior to issuance or use by t…

§ 4109. Premiums and refunds (a) Each insurer issuing credit life insurance or credit accident and health insurance shall file with the Commissioner its schedules of premium rates for use in connection with such insurance. Any insurer may revise such schedules from time to time, …

§ 4110. Issuance of policies All policies of credit life insurance and credit accident and health insurance shall be delivered or issued for delivery in this State only by an insurer authorized to do an insurance business therein, and shall be issued only through holders of licen…

§ 4111. Claims (a) All claims shall be promptly reported to the insurer or its designated claim representative and the insurer shall maintain adequate claim files. All claims shall be settled as soon as possible and in accordance with the terms of the insurance contract. (b) All …

§ 4112. Existing insurance; choice of insurer When credit life insurance or credit accident and health insurance is required as additional security for any indebtedness, the debtor shall, upon request to the creditor, have the option of furnishing the required amount of insurance…

§ 4113. Enforcement The Commissioner may, after notice and hearing, issue such rules and regulations as he or she deems appropriate for the supervision of this chapter. Whenever the Commissioner finds that there has been a violation of this chapter or any rules or regulations iss…

§ 4114. Judicial review Any party to the proceeding affected by an order of the Commissioner shall be entitled to judicial review in the Supreme Court. (Added 1959, No. 221, § 13; amended 1995, No. 167 (Adj. Sess.), § 11; 1997, No. 161 (Adj. Sess.), § 6, eff. Jan. 1, 1998.)

§ 4115. Penalties In addition to any other penalty provided by law, any person who violates an order of the Commissioner after it has become final, and while such order is in effect, shall forfeit and pay to the State of Vermont an administrative penalty not to exceed $1,000.00, …

§ 4121. Definitions As used in this chapter: (1) “Covered individual” means an individual covered under a dental insurance plan or a health insurance plan. (2) “Covered service” means a dental service for which reimbursement is available under a covered individual’s dental insura…

§ 4122. Fees for covered dental services (a) No dental insurer, health insurer, or other similar entity that covers dental services and is subject to regulation by the Department of Financial Regulation, and no contract or participating provider agreement with a dentist, shall re…

§ 4141. Capital of foreign fidelity and surety companies A foreign stock fidelity and surety company shall not do business in this State unless it has a paid up and unimpaired capital, exclusive of stockholders’ obligations, of not less than $400,000.00. (Amended 1965, No. 59, § …

§ 4143. Law governing foreign fidelity, surety, and annuity companies The companies specified in section 4141 of this title are governed by and subject to the laws of this State relating to foreign insurance companies and their admission to do business in this State, as applicabl…

§ 4144a. Powers of fidelity companies; other entities; authority to meet bail and bond requirements (a) Any entity licensed or authorized to transact fidelity insurance or corporate suretyship business in this State may make bonds or contracts of insurance to guarantee the fideli…

§ 4145. Fidelity companies may act as sole surety Where by law two or more sureties are required upon an obligation that a fidelity insurance company is authorized to insure, the fidelity insurance company may act as sole surety upon the obligation and may be accepted as such by …

§ 4146. Limit of liability A foreign fidelity and surety company shall not incur in behalf or on account of any one person, partnership, association, or corporation a liability for an amount larger than one-tenth of its total admitted assets, after deducting from such liability a…

§ 4147. Fiduciaries may secure surety from loss A person, partnership, association, or corporation holding property for the benefit of another, except when acting under wills allowed or trusts created before November 27, 1894, may make such covenants with the sureties upon his or…

§ 4148. Copy of agreement to be filed and recorded A copy of such covenant, duly acknowledged in the manner required for the acknowledgment of deeds of real estate, may be filed and recorded as follows: in the office of the clerk or register of the court in which such fiduciary o…

§ 4149. Allowance of premium against estate Money paid to a company duly organized and authorized to act in this State in guaranteeing the fidelity of persons and in acting as surety on bonds, or to a person for acting as surety on an official bond given to the Judge of Probate, …

§ 4171. Short title This chapter shall be known and may be cited as the Vermont Life and Health Insurance Guaranty Association Act. (Added 2023, No. 32, § 9, eff. July 1, 2023.)

§ 4172. Purpose The purpose of this chapter is to protect, subject to certain limitations, the persons specified in subsection 4173(a) of this chapter against failure in the performance of contractual obligations under life, health, and annuity policies, plans, and contracts spec…

§ 4173. Scope (a) This chapter shall provide coverage for a policy or contract specified in subsection (b) of this section to a person who: (1) regardless of where the person resides, except for nonresident certificate holders under group policies or contracts, is the beneficiary…