reglab/housing_qa huggingface dataset:
8 V.S.A. § 4084
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4084. Advertising practices

§ 4084. Advertising practices|No company doing business in this State, and no insurance agent or broker shall use in connection with the solicitation of health insurance any advertising copy or advertising practice or any plan of solicitation which is materially misleading or deceptive. An advertising copy or advertising practice or plan of solicitation shall be considered to be materially misleading or deceptive if by implication or otherwise it transmits information in such manner or of such substance that a prospective applicant for health insurance may be misled thereby to his or her material damage. If the Commissioner finds that any such advertising copy or advertising practice or plan of solicitation is materially misleading or deceptive he or she shall order the company or the agent or broker using such copy or practice or plan to cease and desist from such use. Before making any such finding and order, the Commissioner shall give notice, not less than 10 days in advance, and a hearing to the company, agent, or broker affected. If the Commissioner finds, after due notice and hearing, that any authorized insurer, licensed insurance agent, or licensed insurance broker has wilfully violated any such order to cease and desist he or she may suspend or revoke the license of such insurer, agent, or broker.
8 V.S.A. § 4085a
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4085a. Rebates prohibited for group insurance policies

§ 4085a. Rebates prohibited for group insurance policies|(a) As used in this section, "group insurance" means any policy described in section 4079 of this title, except that it shall not include any small group policy issued pursuant to section 4080a or 4080g of this title or to 33 V.S.A. § 1811.(b) No insurer doing business in this State and no insurance agent or broker shall offer, promise, allow, give, set off, or pay, directly or indirectly, any rebate of or part of the premium payable on a group insurance policy, or on any group insurance policy or agent's commission thereon or earnings, profits, dividends, or other benefits founded, arising, accruing or to accrue thereon or therefrom, or any special advantage in date of policy or age of issue, or any paid employment or contract for services of any kind or any other valuable consideration or inducement to or for insurance on any risk in this State, now or hereafter to be written, or for or upon any renewal of any such insurance, which is not specified in the policy contract of insurance, or offer, promise, give, option, sell, purchase any stocks, bonds, securities, or property or any dividends or profits accruing or to accrue thereon, or other thing of value whatsoever as inducement to insurance or in connection therewith, or any renewal thereof, which is not specified in the policy.(c) No insured person under a group insurance policy or party or applicant for group insurance shall directly or indirectly receive or accept or agree to receive or accept any rebate of premium or of any part thereof or all or any part of any agent's or broker's commission thereon, or any favor or advantage, or share in any benefit to accrue under any policy of insurance, or any valuable consideration or inducement, other than such as is specified in the policy.(d) Nothing in this section shall be construed as prohibiting the payment of commission or other compensation to any duly licensed agent or broker; or as prohibiting any insurer from allowing or returning to its participating policyholders dividends, savings, or unused premium deposits; or as prohibiting any insurer from returning or otherwise abating, in full or in part, the premiums of its policyholders out of surplus accumulated from nonparticipating insurance, or as prohibiting the taking of a bona fide obligation, with interest not exceeding six percent per annum, in payment of any premium.(e) An insurer that pays a commission, fee, or other compensation, directly or indirectly, to a licensed or unlicensed agent, broker, or other individual other than a bona fide employee of the insurer in connection with the sale of a group insurance policy shall clearly disclose to the purchaser of such group policy the amount of any such commission, fee, or compensation paid or to be paid. (Added 2011, No. 171 (Adj. Sess.), § 2f.)
8 V.S.A. § 4086
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4086. Exemption from attachment and trustee process

§ 4086. Exemption from attachment and trustee process|So much of any benefits under all policies of health insurance as does not exceed $200.00 for each month during any period of disability covered thereby shall not be liable to attachment, trustee process, or other process, or to be seized, taken, appropriated, or applied by any legal or equitable process or by operation of law, either before or after payment of such benefits, to pay any debt or liabilities of the person insured under such policy. However, this exemption shall not apply where an action is brought to recover for necessaries contracted for during such period and the writ or bill of complaint contains a statement to that effect. When a policy provides for a lump sum payment because of a dismemberment or other loss insured, such payment shall be exempt from execution of the insured's creditors.
8 V.S.A. § 4087
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4087. Penalties for violations

§ 4087. Penalties for violations|Any person, partnership, or corporation wilfully violating any provision of this chapter or order of the Commissioner made in accordance with this chapter shall pay an administrative penalty to the people of the State a sum not to exceed $750.00 for each such violation. The Commissioner may also suspend or revoke the license of an insurer or agent for any such wilful violation. (Amended 1995, No. 167 (Adj. Sess.), § 9.)
8 V.S.A. § 4088
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4088. Appeal

§ 4088. Appeal|Any person, partnership, or corporation aggrieved by any action of the Commissioner may obtain a review by appeal to the Superior Court within and for the County of Washington. Such appeal shall be on the basis of the record of the proceedings before the Commissioner and shall not be limited to questions of law. If the appeal is from an order of the Commissioner, such order shall not take effect during the pendency of the appeal unless the court shall determine otherwise. The court may review all the facts and in disposing of any issue before it may modify, affirm, or reverse any order of the Commissioner in whole or in part. Either party may appeal from the decision of the Superior Court to the Supreme Court in the manner provided by law.
8 V.S.A. § 4088a
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4088a. Chiropractic services

§ 4088a. Chiropractic services|(a)(1) 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 adjunctive therapies to physiotherapy modalities and rehabilitative exercises. A health insurance plan does not have to provide coverage for the treatment of any visceral condition arising from problems or dysfunctions of the abdominal or thoracic organs.  (2) A health insurer may require that the chiropractic services be provided by a licensed chiropractic physician under contract with the insurer or upon referral from a health care provider under contract with the insurer. (3) Health care services provided by chiropractic physicians may be subject to reasonable deductibles, co-payment and coinsurance amounts, fee or benefit limits, practice parameters, and utilization review consistent with any applicable regulations published by the Department of Financial Regulation; provided that any such amounts, limits, and review shall not function to direct treatment in a manner unfairly discriminative against chiropractic care and collectively shall be no more restrictive than those applicable under the same policy to care or services provided by other health care providers but allowing for the management of the benefit consistent with variations in practice patterns and treatment modalities among different types of health care providers. (4) For silver- and bronze-level qualified health benefit plans and any reflective health benefit plans offered at the silver or bronze level pursuant to 33 V.S.A. chapter 18, subchapter 1, health care services provided by a chiropractic physician may be subject to a co-payment requirement, provided that any required co-payment amount shall be between 125 and 150 percent of the amount of the co-payment applicable to care and services provided by a primary care provider under the plan. (5) Nothing contained in this section shall be construed as impeding or preventing either the provision or coverage of health care services by licensed chiropractic physicians, within the lawful scope of chiropractic practice, in hospital facilities on a staff or employee basis.   (b) As used in this section, "health insurance plan " means any individual or group health insurance policy, any hospital or medical service corporation or health maintenance organization subscriber contract, or any other health benefit plan offered, issued, or renewed for any person in this State by a health insurer, as defined by 18 V.S.A. § 9402. The term shall not include benefit plans providing coverage for specific disease or other limited benefit coverage. (Added 1999, No. 16, § 1; amended 2011, No. 78 (Adj. Sess.), § 2, eff. April 2, 2012; 2018, No. 7 (Sp. Sess.), § 2, eff. Jan. 1, 2020; 2019, No. 19, § 1, eff. Jan. 1, 2020.)
8 V.S.A. § 4088c
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4088c. Chemotherapy treatment

§ 4088c. Chemotherapy treatment|(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) As used in this section, "health insurance plan" means an individual or group health insurance policy, hospital or medical service corporation service contract, or health maintenance organization health benefit plan offered, issued, or renewed in this State. (Added 2003, No. 124 (Adj. Sess.), § 3.)
8 V.S.A. § 4088d
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4088d. Coverage for covered services provided by naturopathic physicians

§ 4088d. Coverage for 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 practice described in 26 V.S.A. chapter 81 and shall recognize naturopathic physicians who practice primary care to be primary care physicians. Health care services provided by naturopathic physicians may be subject to reasonable deductibles, co-payment and coinsurance amounts, and fee or benefit limits consistent with those applicable to other primary care physicians under the plan, as well as practice parameters, cost-effectiveness and clinical efficacy standards, and utilization review consistent with any applicable rules published by the Department of Financial Regulation. Any amounts, limits, standards, and review shall not function to direct treatment in a manner unfairly discriminative against naturopathic care, and collectively shall be not more restrictive than those applicable under the same policy to care or services provided by other primary care physicians, but may allow for the management of the benefit consistent with variations in practice patterns and treatment modalities among different types of health care providers. A health insurance plan may require that the naturopathic physician's services be provided by a licensed naturopathic physician under contract with the insurer or shall be covered in a manner consistent with out-of-network provider reimbursement practices for primary care physicians; however, this shall not relieve a health insurance plan from compliance with the applicable network adequacy requirements adopted by the Commissioner by rule. Nothing contained in this section shall be construed as impeding or preventing either the provision or the coverage of health care services by licensed naturopathic physicians, within the lawful scope of naturopathic practice, in hospital facilities on a staff or employee basis.(b) As used in this section, "health insurance plan" means Medicaid and any other public health care assistance program, any individual or group health insurance policy, any hospital or medical service corporation or health maintenance organization subscriber contract, or any other health benefit plan offered, issued, or renewed for any person in this State by a health insurer, as defined by 18 V.S.A. § 9402. The term shall not include benefit plans providing coverage for a specific disease or other limited benefit coverage. (Added 2007, No. 59, § 1, eff. Oct. 1, 2007; amended 2007, No. 88 (Adj. Sess.), § 1, eff. March 6, 2008; 2011, No. 78 (Adj. Sess.), §§ 2, 30, eff. April 2, 2012; 2011, No. 96 (Adj. Sess.), § 1, eff. Oct. 1, 2012; 2015, No. 97 (Adj. Sess.), § 15; 2017, No. 113 (Adj. Sess.), § 43.)
8 V.S.A. § 4088e
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4088e. Notice of preferred drug list changes

§ 4088e. Notice of preferred drug list changes|On a periodic basis, no less than once per calendar year, a health insurer as defined in 18 V.S.A. § 9471(2)(A), (C), and (D) shall notify beneficiaries of changes in pharmaceutical coverage and provide access to the preferred drug list maintained by the insurer. (Added 2007, No. 80, § 11.)
8 V.S.A. § 4088f
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4088f. Prosthetic parity

§ 4088f. Prosthetic parity|(a) As used in this section:  (1) "Health insurance plan" means any health insurance policy or health benefit plan offered 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 or administered by the State or by any subdivision or instrumentality of the State. The term shall not include policies or plans providing coverage for a specific disease or other limited benefit coverage. (2) "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 in all health plans at least equivalent to that provided by the federal Medicare program. Coverage may be limited to the prosthetic device that is the most appropriate model that is medically necessary to meet the patient's medical needs. Any dispute between the insured and the carrier concerning coverage and the application of this section shall be subject to independent external review under section 4089f of this title.(c) A health insurance plan may require prior authorization for prosthetic devices in the same manner and to the same extent as prior authorization is required for any other covered benefit.(d) A health insurance plan shall provide coverage under this section for the medically necessary repair or replacement of a prosthetic device.(e) A health insurance plan shall not impose any annual or lifetime dollar maximum on coverage for prosthetics that is less than the annual or lifetime dollar maximum that applies generally to all terms and services covered under the plan.(f) The coverage required may not be subject to a deductible, co-payment, or coinsurance provision that is less favorable to a covered individual than the deductible, co-payment, or coinsurance provisions that apply generally to other non-primary care items and services under the health plan. (Added 2007, No. 103 (Adj. Sess.), § 1, eff. Oct. 1, 2008; amended 2015, No. 97 (Adj. Sess.), § 16.)
8 V.S.A. § 4088g
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4088g. Coverage for covered services provided by athletic trainers

§ 4088g. Coverage for covered services provided by athletic trainers|(a) To the extent a health insurance plan provides coverage for a particular type of health service or for any particular medical condition that is within the scope of practice of athletic trainers, a licensed athletic trainer who acts within the scope of practice authorized by law shall not be denied reimbursement by the health insurer for those covered services if the health insurer would reimburse another health care provider for those services. A health insurer may require that the athletic trainer services be provided by a licensed athletic trainer under contract with the insurer. Services provided by athletic trainers may be subject to reasonable deductibles, co-payment and co-insurance amounts, fee or benefit limits, practice parameters, and utilization review consistent with applicable rules adopted by the Department of Financial Regulation; provided that the amounts, limits, and review shall not function to direct treatment in a manner unfairly discriminative against athletic trainer care, and collectively shall be no more restrictive than those applicable under the same policy for care or services provided by other health care providers but allowing for the management of the benefit consistent with variations in practice patterns and treatment modalities among different types of health care providers. Nothing in this section shall be construed as impeding or preventing either the provision or coverage of health care services by licensed athletic trainers within the lawful scope of athletic trainer practice.(b) As used in this section, "health insurance plan" means an individual or group health insurance policy, a hospital or medical service corporation or health maintenance organization subscriber contract, or another health benefit plan offered, issued, or renewed for a person in this State by a health insurer, as defined in 18 V.S.A. § 9402(8). The term shall not include benefit plans providing coverage for specific disease or other limited benefit coverage. (Added 2007, No. 141 (Adj. Sess.), § 1, eff. July 1, 2008; amended 2011, No. 78 (Adj. Sess.), § 2, eff. April 2, 2012.)
8 V.S.A. § 4088h
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4088h. Health insurance and the Blueprint for Health

§ 4088h. Health insurance and the Blueprint for Health|(a)(1) A health insurance plan shall be offered, issued, and administered consistent with the Blueprint for Health established in 18 V.S.A. chapter 13, as determined by the Commissioner.  (2) As used in this section, "health insurance plan" means any individual or group health insurance policy, any hospital or medical service corporation or health maintenance organization subscriber contract, or any other health benefit plan offered, issued, or renewed for any person in this State by a health insurer, as defined in 18 V.S.A. § 9402. The term shall include the health benefit plan offered by the State of Vermont to its employees and any health benefit plan offered by any agency or instrumentality of the State to its employees. The term shall not include benefit plans providing coverage for specific disease or other limited benefit coverage unless so directed by the Commissioner.   (b) Health insurers as defined in 18 V.S.A. § 701 shall participate in the Blueprint for Health as specified in 18 V.S.A. § 706. In consultation with the Director of the Blueprint for Health and the Director of Health Care Reform, the Commissioner may establish procedures to exempt or limit the participation of health insurers offering a stand-alone dental plan or specific disease or other limited-benefit coverage. A health insurer shall be exempt from participation if the insurer offers only benefit plans which are paid directly to the individual insured or the insured's assigned beneficiaries and for which the amount of the benefit is not based upon potential medical costs or actual costs incurred. (Added 2007, No. 204 (Adj. Sess.), § 2; amended 2009, No. 128 (Adj. Sess.), § 15.)
8 V.S.A. § 4088k
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4088k. Physical therapy co-payments for certain plans

§ 4088k. Physical therapy co-payments for certain plans|For silver- and bronze-level qualified health benefit plans and any reflective health benefit plans offered at the silver or bronze level pursuant to 33 V.S.A. chapter 18, subchapter 1, health care services provided by a licensed physical therapist may be subject to a co-payment requirement, provided that any required co-payment amount shall be between 125 and 150 percent of the amount of the co-payment applicable to care and services provided by a primary care provider under the plan. (Added 2018, No. 7 (Sp. Sess.), § 3, eff. Jan. 1, 2020; amended 2019, No. 19, § 2, eff. Jan. 1, 2020.)
8 V.S.A. § 4089
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4089. Services for victims of sexual assault

§ 4089. Services for victims of sexual assault|(a) A health insurer shall not impose any co-payment or coinsurance or, to the extent permitted under federal law, deductible or other cost-sharing requirement for the sexual assault examination of a victim of alleged sexual assault for health care services associated with specific procedure codes identified in a memorandum of understanding between the health insurer and the Vermont Center for Crime Victim Services.(b) As used in this section:  (1) "Health insurer" shall have the same meaning as in 18 V.S.A. § 9402. (2) "Sexual assault examination" means either or both of the following:  (A) a physical examination of the patient, documentation of biological and physical findings, and collection of evidence; and (B) treatment of the patient's injuries; providing care for sexually transmitted infections; assessing pregnancy risk; discussing treatment options including reproductive health services, screening for the human immunodeficiency virus, and prophylactic treatment when appropriate; and providing instructions and referrals for follow-up care. (Added 2015, No. 34, § 1, eff. Oct. 1, 2015.)
8 V.S.A. § 4089c
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4089c. Diabetes treatment

§ 4089c. Diabetes treatment|(a)(1) A health insurer shall provide coverage for the equipment, supplies, and outpatient self-management training and education, including medical nutrition therapy, for the treatment of insulin dependent diabetes, insulin using diabetes, gestational diabetes, and noninsulin using diabetes if prescribed by a health care professional legally authorized to prescribe such items under law. A health insurer may require that such prescriptions be made, and care be given, by a health care professional under contract with the insurer.  (2) Diabetes outpatient self-management training and education required to be covered by this section shall be provided by a certified, registered, or licensed health care professional with specialized training in the education and management of diabetes. (3) Benefits required to be covered by this section shall be subject to the same dollar limits, deductibles, and coinsurance factors within the provisions of the health insurance policy.   (b) For the purposes of this section, "insurer" means any health insurance company, nonprofit hospital and medical service corporation, and health maintenance organization. The term does not apply to coverage for specified disease or other limited benefit coverage. (Added 1997, No. 14, § 1.)