reglab/housing_qa huggingface dataset:
8 V.S.A. § 4091d
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4091d. Notice of termination

§ 4091d. Notice of termination|(a) A notice of termination of a carrier'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 of the date of termination of the policy or contract and to advise the employees or members that, unless otherwise provided in the policy or contract, the carrier shall not be liable for claims for losses incurred after such date; (2) advise, in any instance in which the plan involves employee contributions, that if the policyholder or other entity continues to collect contributions for the coverage beyond the date of termination, the policyholder or other entity may be held solely liable for the benefits with respect to which the contributions have been collected.   (b) The carrier giving notice of termination shall prepare and furnish to the policyholder or other entity at the time of notice a supply of a notice form to be distributed to covered employees or members. The form shall state the fact of termination and the effective date of termination. The form shall contain a statement directing employees or members to refer to their certificates or contracts in order to determine their rights.(c) The provisions of this section shall not be construed to relieve any nonprofit medical or hospital service corporation of its obligation to notify subscribers directly of a termination under this subchapter. (Added 1989, No. 113, § 2.)
8 V.S.A. § 4091e
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4091e. Extension of benefits

§ 4091e. Extension of benefits|(a) Every group health insurance policy or subscriber contract issued on or after July 1, 1989, or under which the level of benefits is altered, modified, or amended on or after July 1, 1989, shall provide a reasonable extension of benefits in the event of total disability of the employee or member on the date of termination of the group policy or contract in accordance with the provisions of this section.(b) A policy or contract providing benefits for loss of time from work or specific indemnity during hospital confinement shall provide that termination of the policy or contract during a loss of time or confinement shall have no effect on benefits payable for the loss of time or confinement.(c) A policy or contract providing hospital or medical expense coverage benefits shall provide an extension of benefits of at least 12 months under "major medical" and "comprehensive medical" type coverages, and at least 90 days under other types of hospital or medical expense coverages.(d) The provisions of a policy or contract relating to extension of benefits or accrued liability shall be described in the policy or contract as well as in group insurance certificates. The benefits payable during a period of extension or accrued liability may be subject to the policy's or contract's regular benefit limits.(e) The provisions of this section do not require an extension of dental benefits. (Added 1989, No. 113, § 21.)
8 V.S.A. § 4091f
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4091f. Replacement coverage

§ 4091f. Replacement coverage|(a) General. When the group health insurance policy or subscriber contract of a carrier replaces a policy or contract providing similar benefits of another carrier, the liability of both carriers shall be as provided in this section and rules adopted pursuant to this section.(b) Liability of prior carrier. A prior carrier remains liable after termination of its policy or contract only to the extent of its accrued liabilities and extensions of benefits.(c) Liability of succeeding carrier.  (1) A succeeding carrier shall offer a group health insurance policy or subscriber contract to replace a prior carrier's policy or contract in accordance with the provisions of this subsection. (2) A succeeding carrier shall offer a policy or contract to cover all persons who:  (A) are covered or are a member of a class eligible for coverage under the prior carrier's policy or contract on the date of termination of the prior carrier's policy or contract; or (B) are a member of a class eligible for coverage under the succeeding carrier's policy or contract on the date of termination of the prior carrier's policy or contract.  (3) The succeeding carrier is not liable under this subsection for benefits required to be paid by the prior carrier. (4) When replacing a prior carrier's plan that is not subject to section 4091e of this title, the succeeding carrier shall, in addition to the coverage required to be offered under subdivision (2) of this subsection, offer a policy or contract that provides a level of benefit equal to the lesser of:  (A) the extension of benefits that would have been required if the prior carrier's policy or contract was subject to section 4091e of this title; or (B) the extension of benefits required for the succeeding carrier's policy or contract, except that any such benefits may be reduced by benefits actually payable under the prior carrier's plan.  (5) The preexisting condition limitation of a succeeding carrier's policy or contract shall provide a level of benefits equal to the lesser of:  (A) the benefits of the succeeding carrier's policy or contract determined without application of the preexisting conditions limitation; or (B) the benefits of the prior carrier's policy or contract.  (6) The succeeding carrier, in applying a deductible or waiting-period provision in its policy or contract, shall give credit for the satisfaction of the same or similar provisions under the prior carrier's policy or contract. (7) At the succeeding carrier's request the prior carrier shall furnish all information needed to determine the benefits available under the prior carrier's policy or contract.   (d) Rules. The Commissioner shall adopt rules necessary to carry out the purposes of this section. (Added 1989, No. 113, § 2; amended 2019, No. 14, § 10, eff. April 30, 2019.)
8 V.S.A. § 4092
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4092. Newborn infants; coverage

§ 4092. Newborn infants; coverage|(a) An individual or group health insurance policy providing coverage on an expense incurred basis and an individual or group service or indemnity contract issued by a nonprofit corporation which provides coverage for a family member of the insured or subscriber shall, as to those family members' coverage, also provide that health insurance benefits applicable for children are payable with respect to a newly born child of the insured or subscriber from the moment of birth. Coverage for a newly born child shall include coverage of injury, sickness, necessary care and treatment of medically diagnosed congenital defect or birth abnormality, or any combination of these.(b) Coverage for a newly born child shall be provided without notice or additional premium for no less than 60 days after the date of birth. If payment of a specific premium or subscription fee is required in order to have the coverage continue beyond such 60-day period, the policy may require that notification of birth of newly born child and payment of the required premium or fees be furnished to the insurer or nonprofit service or indemnity corporation within a period of not less than 60 days after the date of birth.(c) The requirements of this section shall apply to all insurance policies and subscriber contracts delivered or issued for delivery in this State more than 120 days after April 15, 1975. (Added 1975, No. 53, § 1, eff. April 15, 1975; amended, 1989, No. 113, § 1; 2013, No. 79, § 4, eff. Jan. 1, 2014.)
8 V.S.A. § 4095
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4095. Definitions

§ 4095. Definitions|As used in this subchapter:  (1) "Home health agency" means a nonprofit home health agency which has been certified under Title 18 of the Social Security Act (42 U.S.C.A. § 1395 et seq.). (2) "Home health care" means care and treatment provided by a home health agency and designed and supervised by a physician, without which care and treatment a person would require institutionalization in a hospital or skilled nursing facility as those are defined by Medicare regulations. The care and treatment shall consist of one or more of the following:  (A) Part-time or intermittent skilled nursing care. (B) Physical therapy. (C) Part-time or intermittent home health aide services which consist primarily of caring for the patient. (D) Medical supplies, drugs and equipment, and laboratory services to the extent that laboratory services would have been covered if the patient had been institutionalized. The medical necessity of equipment may be reviewed by reference to the Medicare guidelines for durable medical equipment. (Added 1975, No. 205 (Adj. Sess.), § 1.)
8 V.S.A. § 4096
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4096. Home health care; insurance

§ 4096. Home health care; insurance|(a) An individual or group health insurance expense policy and an individual or group service contract issued by a nonprofit hospital corporation which provides hospital or medical coverage shall provide as an option coverage for home health care. An insurer may require evidence of insurability as a prerequisite to coverage. The coverage shall consist of at least 40 visits by a home health agency in any calendar year, or in any continuous period of 12 months, for each person covered under the policy or contract. Each visit by a member of a home health care agency, other than a home health aide, shall be considered one home health care visit, and four hours of home health aide service shall be considered one home health care visit. Coverage shall be provided for maternity and childbirth, but such coverage may be provided subject to a waiting period of nine months.(b) This subchapter does not require that home health care coverage be provided to persons eligible for Medicare, nor does it require that the coverage be included in indemnity policies or contracts.(c) Home health care coverage may be subject to a co-insurance provision of not less than 80 percent of reasonable charges and a deductible provision of $50.00 annually; however, if less restrictive benefits are provided by the basic hospital or medical coverage, as the case may be, these lesser restrictions shall apply to the home health care coverage.(d) A benefit provided pursuant to this subchapter may be subject to utilization review by the nonprofit hospital service corporation. A nonprofit hospital service corporation may require a home health agency to enter into a contract as a condition of providing benefits. (Added 1975, No. 205 (Adj. Sess.), § 1.)
8 V.S.A. § 4099d
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4099d. Midwifery coverage; home births

§ 4099d. Midwifery coverage; home births|(a) A health insurance plan or health benefit plan providing maternity benefits shall also provide coverage for services rendered by a midwife licensed pursuant to 26 V.S.A. chapter 85 or an advanced practice registered nurse licensed pursuant to 26 V.S.A. chapter 28 who is certified as a nurse midwife for services within the licensed midwife's or certified nurse midwife's scope of practice and provided in a hospital or other health care facility or at home.(b) Coverage for services provided by a licensed midwife or certified nurse midwife shall not be subject to any greater co-payment, deductible, or coinsurance than is applicable to any other similar benefits provided by the plan.(c) A health insurance plan may require that the maternity services be provided by a licensed midwife or certified nurse midwife under contract with the plan.(d) As used in this section, "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 specific disease or other limited benefit coverage. (Added 2011, No. 35, § 1, eff. Oct. 1, 2011; amended 2013, No. 79, § 11, eff. Jan. 1, 2014.)
8 V.S.A. § 4100a
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4100a. Mammograms; coverage required

§ 4100a. Mammograms; coverage required|(a) Insurers shall provide coverage for screening by mammography for the presence of breast cancer. In addition, insurers shall provide coverage for screening by ultrasound for a patient for whom the results of a screening mammogram were inconclusive or who has dense breast tissue, or both. Benefits provided shall cover the full cost of the mammography service or ultrasound, as applicable, and shall not be subject to any co-payment, deductible, coinsurance, or other cost-sharing requirement or additional charge.(b) [Repealed.](c) This section shall apply only to screening procedures conducted by test facilities accredited by the American College of Radiologists.(d) As used in this subchapter:  (1) "Insurer" means any insurance company that provides health insurance as defined in subdivision 3301(a)(2) of this title, nonprofit hospital and medical service corporations, and health maintenance organizations. The term does not apply to coverage for specified diseases or other limited benefit coverage. (2) "Mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, and digital detector. The term includes breast tomosynthesis. (3) "Screening" includes the mammography or ultrasound test procedure and a qualified physician's interpretation of the results of the procedure, including additional views and interpretation as needed. (Added 1991, No. 40, § 1, eff. Sept. 1, 1991; amended 2007, No. 160 (Adj. Sess.), § 1, eff. Oct. 1, 2008; 2013, No. 25, §§ 1, 4; 2017, No. 141 (Adj. Sess.), § 1, eff. Jan. 1, 2019.)
8 V.S.A. § 4100c
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4100c. Adopted child coverage

§ 4100c. Adopted child coverage|(a) As used in this section:  (1) "Child" means, in connection with any adoption, or placement for adoption of the child, an individual who has not attained age 18 as of the date of the adoption or placement for adoption. (2) "Placement for adoption" means the assumption and retention by a person of a legal obligation for total or partial support of a child in anticipation of the adoption of the child. The child's placement with a person terminates upon the termination of such legal obligations.   (b) In any case in which a health plan provides coverage for dependent children of participants or beneficiaries, the plan shall provide benefits to dependent children placed with participants or beneficiaries for adoption under the same terms and conditions as apply to the natural, dependent children of the participants and beneficiaries, irrespective of whether the adoption has become final.(c) A health plan may not restrict coverage under the plan of any dependent child adopted by a participant or beneficiary, or placed with a participant or beneficiary for adoption, solely on the basis of a preexisting condition of the child at the time that the child would otherwise become eligible for coverage under the plan, if the adoption or placement for adoption occurs while the participant or beneficiary is eligible for coverage under the plan. (Added 1993, No. 231 (Adj. Sess.), § 2.)
8 V.S.A. § 4100d
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4100d. Child vaccine benefits

§ 4100d. Child vaccine benefits|No insurer shall reduce its coverage for pediatric vaccines below the coverage provided as of May 1, 1993. (Added 1993, No. 231 (Adj. Sess.), § 2.)
8 V.S.A. § 4100f
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4100f. Prostate screenings; coverage required

§ 4100f. Prostate screenings; coverage required|(a) Health insurers shall provide coverage for prostate cancer screenings consistent with the recommendations by the Centers for Disease Control and Prevention or upon recommendation of a health care provider. Benefits provided shall be at least as favorable as coverage for other cancer screening procedures and subject to the same dollar limits, deductibles, and coinsurance factors within the provisions of the policy.(b) For purposes of this section, "health insurer" is defined by 18 V.S.A. § 9402. The term does not apply to coverage for specified disease or other limited benefit coverage. (Added 2007, No. 59, § 3, eff. Oct. 1, 2007.)
8 V.S.A. § 4100g
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4100g. Colorectal cancer screening, coverage required

§ 4100g. Colorectal cancer screening, coverage required|(a) For purposes of this section:  (1) "Colonoscopy" means a procedure that enables a physician to examine visually the inside of a patient's entire colon and includes the concurrent removal of polyps or biopsy, or both. (2) "Insurer" means insurance companies that provide health insurance as defined in subdivision 3301(a)(2) of this title, nonprofit hospital and medical services corporations, and health maintenance organizations. The term does not apply to coverage for specified disease or other limited benefit coverage.   (b) Insurers shall provide coverage for colorectal cancer screening, including:  (1) Providing an insured 50 years of age or older with the option of:  (A) annual fecal occult blood testing plus one flexible sigmoidoscopy every five years; or (B) one colonoscopy every 10 years.  (2) For an insured who is at high risk for colorectal cancer, colorectal cancer screening examinations and laboratory tests as recommended by the treating physician.   (c) For the purposes of subdivision (b)(2) of this section, an individual is at high risk for colorectal cancer if the individual has:  (1) a family medical history of colorectal cancer or a genetic syndrome predisposing the individual to colorectal cancer; (2) a prior occurrence of colorectal cancer or precursor polyps; (3) a prior occurrence of a chronic digestive disease condition such as inflammatory bowel disease, Crohn's disease, or ulcerative colitis; or (4) other predisposing factors as determined by the individual's treating physician.   (d) Colorectal cancer screening services performed under contract with the insurer shall not be subject to any co-payment, deductible, coinsurance, or other cost-sharing requirement. In addition, an insured shall not be subject to any additional charge for any service associated with a procedure or test for colorectal cancer screening, which may include one or more of the following:  (1) removal of tissue or other matter; (2) laboratory services; (3) physician services; (4) facility use; and (5) anesthesia.   (e) [Repealed.]  (Added 2009, No. 34, § 2, eff. October 1, 2009; amended 2013, No. 25, § 2, eff. May 13, 2013; 2013, No. 25, § 5, eff. Oct. 1, 2013.)
8 V.S.A. § 4100h
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4100h. Orally administered anticancer medication; coverage required

§ 4100h. Orally administered anticancer medication; coverage required|(a) A health insurer that provides coverage for cancer chemotherapy treatment shall provide coverage for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells that is no less favorable on a financial basis than intravenously administered or injected anticancer medications covered under the insured's plan.(b) As used in this section, "health insurer" means any insurance company that provides health insurance as defined in subdivision 3301(a)(2) of this title, nonprofit hospital and medical service corporations, and health maintenance organizations. The term does not apply to coverage for specified disease or other limited benefit coverage. (Added 2009, No. 34, § 2, eff. October 1, 2009; 2009, No. 61, § 47, eff. April 1, 2010.)
8 V.S.A. § 4100j
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4100j. Coverage for tobacco cessation programs

§ 4100j. Coverage for tobacco cessation programs|(a) A health insurance plan shall provide coverage of at least one three-month supply per year of tobacco cessation medication, including over-the-counter medication, if prescribed by a licensed health care practitioner for an individual insured under the plan. A health insurance plan may require the individual to pay the plan's applicable prescription drug co-payment for the tobacco cessation medication.(b) As used in this subchapter:  (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 does not include policies or plans providing coverage for specified disease or other limited benefit coverage. (2) "Tobacco cessation medication" means all therapies approved by the federal Food and Drug Administration for use in tobacco cessation. (Added 2009, No. 128 (Adj. Sess.), § 35, eff. Oct. 1, 2010; amended 2013, No. 79, § 14, eff. Jan. 1, 2014.)
8 V.S.A. § 4100l
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4100l. Coverage of health care services delivered by audio-only telephone

§ 4100l. Coverage of health care services delivered by audio-only telephone|(a) As used in this section:  (1) "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 provide professional health care services in this State to an individual during that individual's medical care, treatment, or confinement. (2) "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; Medicaid, to the extent permitted by the Centers for Medicare and Medicaid Services; 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 does not include policies or plans providing coverage for a specified disease or other limited benefit coverage.   (b)(1) A health insurance plan shall provide coverage for all medically necessary, clinically appropriate health care services delivered remotely by audio-only telephone to the same extent that the plan would cover the services if they were provided through in-person consultation. Services covered under this subdivision shall include services that are covered when provided in the home by home health agencies.  (2) A health insurance plan may charge an otherwise permissible deductible, co-payment, or coinsurance for a health care service delivered by audio-only telephone, provided that it does not exceed the deductible, co-payment, or coinsurance applicable to an in-person consultation. (3) A health insurance plan shall not require a health care provider to have an existing relationship with a patient in order to be reimbursed for health care services delivered by audio-only telephone. (Added 2021, No. 6, § 4, eff. March 29, 2021.)
8 V.S.A. § 4101
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 109 - Credit Life Insurance and Credit Accident and Health Insurance|§ 4101. Purpose

§ 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 liberally construed. (Added 1959, No. 221, § 1.)