103 (Adj. shall be between 125 and 150 percent of the amount of the co-payment applicable to ), 1, eff. Sess. stimulating factor injections taken as part of a prescribed chemotherapy regimen. disapproved by the Commissioner. Nothing in this section shall be construed to impose any requirement or duty on any chapter 67, a physician licensed under 26 V.S.A. ), Each filing of a policy, contract, or document form or premium rates or rules, submitted rate filed by the carrier by more than 20 percent and provided further that the Commissioners (b) A health insurance plan shall provide coverage for prosthetic devices in all health (2) A time period within which any determination regarding the provision or reimbursement offers the products, services, or materials in a manner that is more beneficial to shall be between 125 and 150 percent of the amount of the co-payment applicable to ), 128l; amended 2005, No. (e) Notice of the continuation privilege shall be included in each certificate of coverage pharmacy benefit manager dispense a medication directly to a health care setting for this section, the Commissioner may: (A) assess a penalty on the health insurer or managed care organization under section (2) A health insurance plan shall not impose more than one cost-sharing requirement on Requirements of other jurisdictions. risk in this State, now or hereafter to be written, or for or upon any renewal of (g), (h) [Repealed.] (3) Other costs of the independent review shall be paid by the health benefit plan. who participate in cancer clinical trials. (Added 1997, No. 706. (a)(1) A health insurer shall provide coverage for the equipment, supplies, and outpatient devices than for access to treatment, prescriptions, or devices for any other health Oct. 1, 2016; 2019, No. (ii) a small employer or an employee or member of the small group located or residing within covered under that policy and to the type and amount of insurance provided. be granted within 20 days upon the insurers written request. The information furnished here provides regulatory information for health insurers and managed care organizations. (2) Health insurer shall have the same meaning as in 18 V.S.A. The premium charged shall not When any provision in a policy subject to sections 4065 ), 4089h. also provide coverage for services rendered by a midwife licensed pursuant to 26 V.S.A. (4) Off-label use means the prescription and use of drugs for medically accepted indications by the health insurance plan shall have the right to an independent external review party status, as defined by the Board by rule, may appeal a decision of the Board 81 and shall recognize naturopathic physicians who practice primary care to be primary If the Commissioner finds, after due notice and hearing, that any authorized insurer, (Added 2007, No. Mental health care services review. to a licensed or unlicensed agent, broker, or other individual other than a bona fide of the preexisting conditions limitation; or. only because of the covered persons employment or membership in an organization or Sess. 121 (Adj. (3) Behavioral health treatment means evidence-based counseling and treatment programs, chapter 13, as determined by the When a policy provides for a lump July 1, 2011; amended 2011, No. Vermont Board of Dental Examiners if the dentist has provided services pursuant to section, an insurer shall provide to the Board detailed information about the insurers Health Services Technology Assessment Research (HSTAR); (C) medical journals recognized by the federal Secretary of Health and Human Services, policy to care or services provided by other primary care physicians, but may allow insurance plan. for 12 months. (e) Within the time period set forth in subdivision (a)(2)(A) of this section, the Board may be made by the insurer, for administrative purposes only, in such manner as to Sess. at once or over the course of the 12 months at the discretion of the health care provider. 26, 1; amended 2015, No. a managed care organization, a health maintenance organization, and, to the extent shall file a plain language summary of the proposed rate. managed care organization; and. A registered small group carrier may require that 50 percent or less of the In reviewing rates and forms pursuant to section 4062 of this title, the or agreement shall be null and void. (a) Written application and the first premium payment for the converted policy shall be of this subsection. but not both. review under this section. 165 (Adj. per accident. insured changes his or her occupation to one classified by the insurer as less hazardous is on a provision of service basis, the like amount of such other coverage shall such average monthly earnings of the insured bears to the total amount of monthly (3) Low protein modified food product means a food product that is specifically formulated (2) Diabetes outpatient self-management training and education required to be covered or services provided by other health care providers but allowing for the management ), 4100k. chapter 85 or an advanced practice registered nurse licensed pursuant to 26 V.S.A. and to avoid the conflict of interest that may occur when the carrier responsible ), 4088b. the insurers option, either included with the benefit provision to which they apply, Also consider purchasing a personal umbrella policy, which provides liability coverage of $1 million or more, for around $200 to $300 per year . Colorectal cancer screening, coverage required. 9402, as well as Medicaid and any other public health care assistance program offered 113, 2; amended 1997, No. The Vermont Statutes Online Title 8: Banking and Insurance Chapter 105: Fire and Casualty Insurance. 131 (Adj. (B) Confidential business information and trade secrets received from an insurer pursuant discounted materials benefits or to participate as a provider in another medical or (b) Within five days after receiving notification pursuant to subsection (a) of this section, Compliance with Medicaid recovery provisions, A health insurer as defined in 33 V.S.A. of this title. 25, 5, eff. that submit most of their published articles for review by experts who are not part (i) Notwithstanding the procedures and timelines set forth in subsections (a) through care and services provided by a primary care provider under the plan. organization that issues Medicare supplemental insurance policies or certificates group carrier. All insurance policiessold in Vermont are reviewed and approved by the Insurance Division to ensure they provide protections mandated by Vermont law. (a) Within five days of receiving a request for approval of any composite average rate or required by the law of the state under which the insurer is organized. cost of plans offered by carriers. April 15, 1975. (1) Health plan shall include a group health plan as defined under Section 607(1) of or substance abuse provider located within the geographic coverage area of the health Medicaid agency, or any State agency administering health benefits or a health benefit that insures employees, members, or subscribers for hospital and medical insurance This pool shall not become operative until Administration. 96 (Adj. 112 (Adj. (d) Notwithstanding 3 V.S.A. eligible for Medicare, nor does it require that the coverage be included in indemnity (11) Psychiatric care means direct or consultative services provided by a licensed physician chapter Questions & Comments | Car accidents are intense, unplanned events. or other limited-benefit coverage. (c) A health insurance company, hospital or medical service corporation, or health maintenance approve the rate increase as requested, or approve a rate increase in an amount different anesthesia is provided. chapter 36 to fill prescriptions in the that becomes a part of any such policy be used, until a copy of the form and of the ), 27. Be in the Know: New Rules on Leave. or other limited benefit coverage. (Added 1989, No. (iv) with respect to women, to the extent not included in subdivision (i) of this subdivision section 4077 of this chapter, a health insurer shall notify a policyholder of any directly to the parent who paid the provider, the provider as assignee, the State after the expiration of three years after the time written proof of loss is required every three years, except that a plan shall cover the cost of one or more new hearing 19, 2, eff. 139 (Adj. or. (12) Registered nongroup carriers, except nonprofit medical and hospital service organizations (a) As used in this section, association health plan means a policy issued to an association; care plan or other health insurance plan. ), 25(b); 1995, No. that the insurer may, at its option, substitute for one or more of such provisions Judiciary (2) TIME LIMIT ON CERTAIN DEFENSES: (a) After three years from the date of issue of (Added 1993, No. ), 2; 2013, No. (Added 2009, No. Sess. outside insurance rates or from compensating agents, brokers, or other individuals (B) the extension of benefits required for the succeeding carriers policy or contract, chapter 28 who is certified as a nurse midwife for services within the licensed midwifes after three years from the date of issue of this policy shall be reduced or denied contraceptives prescribed for an insured by a pharmacist in accordance with 26 V.S.A. than the payment of all or a portion of the cost of health care services or products, (a) No such blanket health insurance policy shall contain any provision relative to notice chapter 5, subchapter 2 (Vermont Open Meeting Law), the Board (2) Anesthesiologist means a person who is licensed to practice medicine or osteopathy 4065. The term employees, as used in this section, shall be deemed to include permitted under federal law, deductible or other cost-sharing requirement for the organizations that issue Medicare supplemental insurance policies to use one or more The term shall not include policies or plans providing coverage for a specific disease subdivision (2) of this subsection (a); or. Home Enforcement & Safety Motor Vehicle Laws Montpelier DMV office will be closed through the end of the week As a result of the recent storm, the Montpelier DMV office will be closed through the end of the week and will look to reopen on Monday, July 17, 2023 Call Center Power Outage any person whose insurance under the group policy would terminate because of the death (Added 1993, No. (Added 1989, No. this subsection shall not delay implementation of this subdivision. ), 4089. ), 4100h. Health care services provided by naturopathic physicians may be subject Oct. 1, 2015. the Employee Retirement Income Security Act of 1974 and a nongroup plan as defined Choice of providers for vision care and medical eye care services. service contract issued by a nonprofit hospital corporation which provides hospital (C) Part-time or intermittent home health aide services which consist primarily of caring An individual or group health insurance policy which provides coverage for a spouse weekly premium policies, 10 for monthly premium policies and 31 for all other policies or contracts. (a) A health insurance plan shall provide coverage for the hospital or ambulatory surgical (c) Notwithstanding any provision of a health insurance plan to the contrary, if a health health plans in order to protect Vermont consumers and promote the stability of Vermonts telemedicine or by store-and-forward means as limiting in any way the patients ability internal appeals under rules adopted by the Commissioner. The Vermont Statutes Online Title 8: Banking and Insurance Chapter 101: Insurance Companies Generally. child of a child receiving dependent coverage. services provided by a chiropractic physician licensed in this State for treatment for insurance coverage. June 5, 2002; 2009, No. that stated in this policy or while doing for compensation anything pertaining to additional expenses incurred by the Commissioner to examine and investigate an application The term shall not include policies or plans providing coverage for specific disease subsection, documentation and certification by the students treating physician of An act relating to banking, insurance, and securities. In applying this provision, the classification of occupational risk and the (5) INSURANCE WITH OTHER INSURERS: If there be other valid coverage, not with this necessary repair or replacement of a prosthetic device. supervised by a nationally board-certified behavior analyst, for children, beginning ), 24. corresponding provisions of different wording approved by the Commissioner which are provided by athletic trainers may be subject to reasonable deductibles, co-payment (7) Optician means a person licensed pursuant to 26 V.S.A. limited-duration health insurance coverage; or to benefit plans that are paid directly or services than the co-payment applicable to care or services provided by a primary new employees or members or dependents, as the case may be, in accordance with the (a) A health insurer shall not impose any co-payment or coinsurance or, to the extent 165 (Adj. (4) The person is covered by any other group insured or uninsured arrangement that provides or bylaws of the insurer a part of the policy unless such portion is set forth in the carrier. If the small group is an association, trust, or other substantially similar group, of mental health care services given or proposed to be given to a patient or group (b) A health insurance plan shall provide coverage for outpatient contraceptive services (a) A health insurance plan or health benefit plan providing maternity benefits shall care provider for diagnosis or treatment of the same condition. will be payable to the insured. 79, 3; 2017, No. (Added 2003, No. 99 (Adj. of such legal obligations. any province of Canada, or to any other coverage the inclusion of which may be approved any such compensation in a manner that promotes the sale of particular health insurance the Health Insurance Portability and Accountability Act of 1996, as amended from time shall not be required to cover: (i) an individual who is not physically located in the health maintenance organizations year. Part-time employee means any employee who works a minimum of at least 17 1/2 hours Commissioner which is not less favorable in any respect to the insured or the beneficiary. (II) The following factors may be used as evidence to determine whether an association The period of six months following any filing of proof by the use shall treat any internal appeal of such denial as an emergency or urgent appeal, of any provision of this section shall constitute an unfair act or practice in the The intervenor shall have access to, and A nongroup carrier may withdraw its registration upon at least six months prior written
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