reglab/housing_qa huggingface dataset:
8 V.S.A. § 4089d
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4089d. Coverage; dependent children

§ 4089d. Coverage; dependent children|(a) As used in this section, "health insurance plan" has the same meaning as "group health plan" 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) A health insurance plan that provides dependent coverage of children shall continue to make that coverage available for an adult child until the child attains 26 years of age, provided that this subsection shall not apply to a plan providing coverage for a specified disease or other limited benefit coverage, and further provided that nothing in this subsection shall require a plan to make coverage available for the child of a child receiving dependent coverage.(c)(1) A health insurance plan that provides for terminating the coverage of a dependent child upon attainment of the limiting age for dependent children specified in the policy shall not limit or restrict coverage with respect to an unmarried child who:   (A) is incapable of self-sustaining employment by reason of a mental or physical disability that has been found to be a disability that qualifies or would qualify the child for benefits using the definitions, standards, and methodology in 20 C.F.R. Part 404, Subpart P; (B) became so incapable prior to attainment of the limiting age; and (C) is chiefly dependent upon the employee, member, subscriber, or policyholder for support and maintenance.  (2) Coverage under subdivision (1) of this subsection shall not be denied any person based upon the existence of such a condition; however a health insurance plan may require reasonable periodic proof of a continuing condition no more frequently than once every year.   (d) A health insurance plan that covers dependent children who are full-time college students beyond 18 years of age shall include coverage for a dependent's medically necessary leave of absence from school for a period not to exceed 24 months or the date on which coverage would otherwise end pursuant to the terms and conditions of the policy or coverage, whichever comes first, except that coverage may continue under subsection (b) of this section as appropriate. To establish entitlement to coverage under this subsection, documentation and certification by the student's treating physician of the medical necessity of a leave of absence shall be submitted to the insurer or, for self-insured plans, the health plan administrator. The health insurance plan may require reasonable periodic proof from the student's treating physician that the leave of absence continues to be medically necessary. (Added 1975, No. 237 (Adj. Sess.), § 1, eff. April 7, 1976; amended 1983, No. 165 (Adj. Sess.), § 2; 2005, No. 199 (Adj. Sess.), § 1; 2019, No. 63, § 5, eff. Jan. 1, 2020; 2019, No. 103 (Adj. Sess.), § 27.)
8 V.S.A. § 4089e
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4089e. Treatment of inherited metabolic diseases

§ 4089e. Treatment of inherited metabolic diseases|(a) For the purposes of this section:  (1) "Inherited metabolic disease" means a disease caused by an inherited abnormality of body chemistry for which the State screens newborn infants. (2) "Insurer" means any health insurance company, nonprofit hospital and medical service corporation, managed care organization, and health maintenance organization. The term does not apply to coverage for specified disease or other limited benefit coverage. (3) "Low protein modified food product" means a food product that is specifically formulated to have less than one gram of protein per serving and is intended to be used under the direction of a physician for the dietary treatment of a metabolic disease. (4) "Medical food" means an amino acid modified preparation that is intended to be used under the direction of a physician for the dietary treatment of an inherited metabolic disease.   (b) An insurer shall provide coverage for medical foods prescribed for medically necessary treatment for an inherited metabolic disease.(c) Coverage for low protein modified food products prescribed for medically necessary treatment of an inherited metabolic disease shall be at least $2,500.00 during any continuous period of 12 months for any insured individual. (Added 1997, No. 128 (Adj. Sess.), § 1, eff. April 27, 1998)
8 V.S.A. § 4089g
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4089g. Craniofacial disorders

§ 4089g. Craniofacial disorders|(a) A health insurance plan shall provide coverage for diagnosis and medically necessary treatment, including surgical and nonsurgical procedures, for a musculoskeletal disorder that affects any bone or joint in the face, neck, or head and is the result of accident, trauma, congenital defect, developmental defect, or pathology. Subject to subsection (b) of this section, this coverage shall be the same as that provided under the health insurance plan for any other musculoskeletal disorder in the body and may be provided when prescribed or administered by a physician or a dentist. This section shall not be construed to require coverage for dental services for the diagnosis or treatment of dental disorders or dental pathology primarily affecting the gums, teeth, or alveolar ridge.(b) A health insurance plan may require a referral from a health care provider under contract with the plan.(c) 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. Health insurance plan includes any health benefit plan offered or administered by the State, or any subdivision or instrumentality of the State. (Added 1997, No. 95 (Adj. Sess.), § 1.)
8 V.S.A. § 4089h
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4089h. Cancellation or nonrenewal of health insurance coverage

§ 4089h. Cancellation or nonrenewal of health insurance coverage|(a) Except as otherwise provided for comprehensive major medical insurance coverage in section 4077 of this chapter, a health insurer shall notify a policyholder of any premium payment due on a policy at least 21 days before the due date. If an insurer does not receive payment by the due date, an insurer shall send a termination notice to the policyholder notifying the policyholder that the insurer will terminate the policy effective on the due date if payment is not received within 14 days from the date of mailing of the termination notice. If an insurer does not receive payment within 14 days from the date of mailing of the termination notice, an insurer may cancel coverage effective on the due date.(b) As used in this section, "health insurer" means a health insurance company, a hospital or medical service corporation, or a health maintenance organization that issues or renews any individual policy, service contract, or benefit plan in this State. (Added 1997, No. 112 (Adj. Sess.), § 1; amended 2021, No. 25, § 20, eff. May 12, 2021.)
8 V.S.A. § 4089j
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4089j. Retail pharmacies; filling of prescriptions

§ 4089j. Retail pharmacies; filling of prescriptions|(a) As used in this section:  (1) "Health insurer" shall have the same meaning as in 18 V.S.A. § 9402 and shall also include Medicaid and any other public health care assistance program. (2) "Pharmacy benefit manager" means an entity that performs pharmacy benefit management. "Pharmacy benefit management" means an arrangement for the procurement of prescription drugs at negotiated dispensing rates, the administration or management of prescription drug benefits provided by a health insurance plan for the benefit of beneficiaries, or any of the following services provided with regard to the administration of pharmacy benefits:  (A) mail service pharmacy; (B) claims processing, retail network management, and payment of claims to pharmacies for prescription drugs dispensed to beneficiaries; (C) clinical formulary development and management services; (D) rebate contracting and administration; (E) certain patient compliance, therapeutic intervention, and generic substitution programs; and (F) disease management programs.  (3) "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.   (b) A health insurer and pharmacy benefit manager doing business in Vermont shall permit a retail pharmacist licensed under 26 V.S.A. chapter 36 to fill prescriptions in the same manner and at the same level of reimbursement as they are filled by mail order pharmacies with respect to the quantity of drugs or days' supply of drugs dispensed under each prescription.(c) Notwithstanding any provision of a health insurance plan to the contrary, if a health insurance plan provides for payment or reimbursement that is within the lawful scope of practice of a pharmacist, the insurer may provide payment or reimbursement for the service when the service is provided by a pharmacist. (Added 2003, No. 122 (Adj. Sess.), § 128e; amended 2013, No. 79, § 9, eff. Jan. 1, 2014; 2015, No. 173 (Adj. Sess.), § 7, eff. June 8, 2016.)
8 V.S.A. § 4090a
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4090a. Continuation of group

§ 4090a. Continuation of group|(a) All group health insurance policies, including dental policies, issued by an insurance company or a nonprofit hospital or medical service corporation; self-insured group plans; and prepaid health insurance plans, delivered or issued for delivery in this State, which insure employees or members for dental insurance or hospital and medical insurance on an expense incurred, service basis, or prepaid basis, other than policies covering specific diseases or accidental injuries only, 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 shall be entitled to continue his or her health insurance under that group policy.(b) For purposes of this subchapter, "qualifying event" means:  (1) loss of employment, including a reduction in hours that results in ineligibility for employer-sponsored coverage; (2) divorce, dissolution, or legal separation of the covered employee from the employee's spouse or civil union partner; (3) a dependent child ceasing to qualify as a dependent child under the generally applicable requirements of the policy; or (4) death of the covered employee or member.   (c) The provisions of this section shall not apply if:  (1) The deceased person or employee was not insured under the group policy on the date of the qualifying event. (2) The person is covered by Medicare. (3) The person is covered by any other group insured or uninsured arrangement which provides dental coverage or hospital and medical coverage for individuals in a group and under which the person was not covered immediately prior to such qualifying event, and no preexisting condition exclusion applies; provided, however, that the person shall remain eligible for continuation coverages which are not available under the insured or uninsured arrangement. (4) The person has a loss of employment due to misconduct as defined in 21 V.S.A. § 1344.   (d) The continuation required by this section only applies to dental, hospital, and medical benefits.(e) Notice of the continuation privilege shall be included in each certificate of coverage and shall be provided by the employer to the employee within 30 days following the occurrence of any qualifying event. (Added 1983, No. 165 (Adj. Sess.), § 1; amended 1985, No. 184 (Adj. Sess.), § 1; 2001, No. 121 (Adj. Sess.), § 3, eff. June 5, 2002; 2009, No. 61, § 14, eff. June 2, 2009.)
8 V.S.A. § 4090b
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4090b. Continuation; notice; terms

§ 4090b. Continuation; notice; terms|(a) A person electing continuation shall notify the insurer, or the policyholder, or the contractor, or agent for the group if the policyholder did not contract for the policy directly with the insurer, of such election in writing within 60 days after receiving notice following the occurrence of a qualifying event pursuant to subsection 4090a(e) of this title. Notice of election to continue under the group policy shall be accompanied by the initial contribution, which shall include payment for the period from the qualifying event through the end of the month in which the election is made.(b) Contributions shall be due on a monthly basis in advance to the insurer or the insurer's agent, and shall not be more than 102 percent of the group rate for the insurance being continued under the group policy on the due date of each payment. (Added 1983, No. 165 (Adj. Sess.), § 1; amended 1985, No. 184 (Adj. Sess.), § 2; 2001, No. 121 (Adj. Sess.), § 4, eff. June 5, 2002; 2009, No. 61, § 15, eff. June 2, 2009.)
8 V.S.A. § 4090c
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4090c. Termination of coverage

§ 4090c. 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 subsection 4090a(b) of this title. (2) The person fails to make timely payment of the required contribution. (3) The person is covered by Medicare. (4) The person is covered by any other group insured or uninsured arrangement that provides dental coverage or hospital and medical coverage for individuals in a group, under which the person was not covered immediately prior to the occurrence of a qualifying event, as defined in subsection 4090a(b) of this title, and no preexisting condition exclusion applies; provided, however, that the person shall remain eligible for continuation coverages which are not available under the insured or uninsured arrangement. (5) The date on which the group policy is terminated or, in the case of an employee, the date the decedent's or terminated employee's employer terminates participation under the group policy. If such coverage is replaced by similar coverage under another group policy:  (A) the person shall have the right to become covered under that replacement policy, for the balance of the period that he or she would have remained covered under the prior group policy; (B) the minimum level of benefits to be provided by the replacement policy shall be the applicable level of benefits of the prior group policy reduced by any benefits payable under that prior group policy; and (C) the prior group policy shall continue to provide benefits to the extent of its accrued liabilities and extensions of benefits as if the replacement has not occurred. (Added 1983, No. 165 (Adj. Sess.), § 1; amended 1985, No. 184 (Adj. Sess.), § 3; 2001, No. 121 (Adj. Sess.), § 5, eff. June 5, 2002; 2009, No. 61, § 16, eff. June 2, 2009.)
8 V.S.A. § 4090d
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4090d. Right of conversion

§ 4090d. Right of conversion|All group health insurance policies, issued by an insurance company, a nonprofit hospital or medical service corporation, a self-insured group plan, and prepaid health insurance plans delivered or issued for delivery in this State which insure employees or members for hospital and medical insurance on an expense incurred, service or prepaid basis, other than for specific diseases or for accidental injuries only, shall provide that any person whose insurance under the group policy would terminate because of the death or loss of employment of the employee or member shall be entitled to have a converted policy issued to him or her by the insurer under whose group policy he or she was insured, without evidence of insurability. (Added 1983, No. 165 (Adj. Sess.), § 1; amended 1985, No. 184 (Adj. Sess.), § 4.)
8 V.S.A. § 4090e
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4090e. Conversion; notice; terms

§ 4090e. Conversion; notice; terms|(a) Written application and the first premium payment for the converted policy shall be made to the insurer not later than 30 days prior to the date termination of the continuation of the group policy under section 4090a of this title would have occurred due to the death or termination of the employee or member. Its effective date shall be the day following the termination of the continued insurance under the group policy under subdivision 4090c(1) of this title.(b) The premium for the converted policy shall be determined in accordance with the insurer's table of premium rates applicable to the age and class of risk of each person to be covered under that policy and to the type and amount of insurance provided.(c) The converted policy shall cover any person who was covered by the continued group policy. At the option of the insurer, a separate converted policy may be issued to cover any dependent. Qualified beneficiaries could be charged premiums up to 102 percent of the group rate.(d) The converted policy shall not exclude as a preexisting condition any condition covered by the group policy.(e) The converted policy may provide:  (1) for a reduction of its hospital and medical benefits by the amount of any such benefits payable under the group policy; (2) that during the first policy year, the benefits payable under the converted policy, together with the benefits payable under the group policy, shall not exceed those that would have been payable had the person's insurance under the group policy remained in force and effect.   (f) The insurer may elect to provide group insurance coverage in lieu of the issuance of a converted individual policy. (Added 1983, No. 165 (Adj. Sess.), § 1; amended 1985, No. 184 (Adj. Sess.), § 5.)
8 V.S.A. § 4090f
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4090f. Exemptions; termination

§ 4090f. Exemptions; termination|(a) The insurer shall not be required to issue a converted policy if:  (1) termination under the group policy occurred because the person:  (A) was not entitled to continuation of group coverage under section 4090a of this title; or (B) failed to elect continuation as provided in section 4090b of this title;  (2) the person is or could be covered by Medicare; (3) the person is covered for similar benefits by another individual policy; or (4) the person is or could be covered for similar benefits under any arrangement of coverage for individuals in a group, whether insured or uninsured or similar benefits are provided for or available to such person, by reason of any state or federal law and together with the converted policy's benefits, would result in overinsurance according to the insurer's standards for overinsurance.   (b) The converted policy may provide that as of any premium due date the insurer may refuse to renew or to cancel the policy if the person:  (1) would be overinsured or the person fails to provide the insurer with information upon which it can make a determination as to overinsurance; (2) would be eligible for coverage under Medicare or under any other state or federal law providing for benefits similar to those provided by the converted policy; or (3) is in default of any required contribution.   (c) Notice of the conversion privilege shall be included in each certificate of coverage. (Added 1983, No. 165 (Adj. Sess.), § 1.)
8 V.S.A. § 4090g
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4090g. Options required

§ 4090g. Options required|(a) If the group policy from which conversion is made provides basic hospital and medical insurance, the person shall be entitled to obtain a converted policy providing, at his or her option, coverage similar to the coverage provided by the group policy or lesser coverage at lesser premiums.(b) If the group policy from which conversion is made provides major medical expense insurance, the person shall be entitled to obtain a converted policy providing at his or her option coverage similar to the catastrophic or major medical coverage provided by the group policy or lesser coverage at lesser premiums.(c) If any insurer customarily offers individual policies on a service basis, that insurer may, in lieu of converted policies on an expense incurred basis, make available converted policies on a service basis which, in the opinion of the Commissioner of Financial Regulation, satisfy the intent of this subchapter.(d) The Commissioner of Financial Regulation may adopt rules describing the lesser coverages that may be offered under this section. (Added 1983, No. 165 (Adj. Sess.), § 1; amended 1985, No. 184 (Adj. Sess.), § 6; 1989, No. 225 (Adj. Sess.), § 25(b); 1995, No. 180 (Adj. Sess.), § 38(a).)
8 V.S.A. § 4091a
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4091a. Definitions

§ 4091a. Definitions|As used in this subchapter:  (1) "Carrier" means an insurance company, a nonprofit medical or hospital service corporation, or a health maintenance organization which issues or provides a group health insurance policy or subscriber contract. (2) "Group health insurance policy or subscriber contract" means a policy or contract which meets the following conditions:  (A) coverage is provided through insurance policies or subscriber contracts to classes of employees or members of an organization or group; (B) the coverage is not available to the general public and can be obtained and maintained only because of the covered person's employment or membership in an organization or group; (C) there are arrangements for bulk payment of premiums or subscription charges to the insurer, nonprofit service corporation, or health maintenance organization; and (D) there is sponsorship of the plan by the employer, organization, or group. (Added 1989, No. 113, § 2.)
8 V.S.A. § 4091b
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4091b. Policies and contracts covered

§ 4091b. Policies and contracts covered|A group health insurance policy or subscriber contract shall not be issued or provided by a carrier unless the policy or contract complies with the provisions of this subchapter and the rules adopted pursuant to this subchapter. (Added 1989, No. 113, § 2.)
8 V.S.A. § 4091c
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 107 - Health Insurance|§ 4091c. Termination for nonpayment of premium or subscription charges

§ 4091c. 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 allowed for such payment, the carrier shall be liable for valid claims for covered losses incurred prior to the end of the grace period.(b) If the actions of the carrier after the end of the grace period indicate that it considers the policy or contract to be continuing in force beyond the end of the grace period, including actions such as continuing to recognize claims subsequently incurred, or in some other manner, the carrier shall be liable for valid claims for losses incurred prior to the effective date of written notice of termination to the policyholder or other entity responsible for making payments or submitting subscription charges to the carrier.(c) The carrier shall notify a policyholder or other responsible entity of any premium payment due on a policy at least 21 days before the due date. The effective date of termination of a policy or contract shall not be prior to midnight at the end of the 14th day following mailing of notice of termination. (Added 1989, No. 113, § 2; amended 1997, No. 112 (Adj. Sess.), § 2.)