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2023 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.)
2023 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.)
2023 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).)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 107 - Health Insurance › § 4099e. Coverage for abortion and abortion-related services [Effective January 1, 2024]

§ 4099e. Coverage for abortion and abortion-related services [Effective January 1, 2024]
(a) Definitions. As used in this section:
(1) “Abortion” means any medical treatment intended to induce the termination of, or to terminate, a clinically diagnosable pregnancy except for the purpose of producing a live birth.
(2) “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. For purposes of this section, health insurance plan shall include any health benefit plan offered or administered by the State or any subdivision or instrumentality of the State. The term shall not include benefit plans providing coverage for a specific disease or other limited benefit coverage, except that it shall include any accident and sickness health plan.
(b) Coverage. A health insurance plan shall provide coverage for abortion and abortion-related care.
(c) Cost sharing. The coverage required by this section shall not be subject to any co-payment, deductible, coinsurance, or other cost-sharing requirement or additional charge, except:
(1) to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to 26 U.S.C. § 223; and
(2) for coverage provided by Medicaid. (Added 2023, No. 15, § 4, eff. January 1, 2024.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 109 - Credit Life Insurance and Credit Accident and Health Insurance › § 4102. Scope

§ 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 issuance of that insurance is an isolated transaction on the part of the insurer not related to an agreement or a plan for insuring debtors of the creditor. (Added 1959, No. 221, § 2(A); amended 1967, No. 58, § 1.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 109 - Credit Life Insurance and Credit Accident and Health Insurance › § 4103. Definitions

§ 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 indemnity for payments becoming due on a specific loan or other credit transaction while the debtor is disabled as defined in the policy.
(3) “Creditor” means the lender of money or vendor or lessor of goods, services, property, right, or privileges, for which payment is arranged through a credit transaction or any successor to the right, title, or interest of any such lender, vendor, or lessor, and an affiliate, associate, or subsidiary of any of them or any director, officer, or employee of any of them or any other person in any way associated with any of them.
(4) “Debtor” means a borrower of money or a purchaser or lessee of goods, services, property, rights, or privileges for which payment is arranged through a credit transaction.
“Indebtedness” means the total amount payable by a debtor to a creditor in connection with a loan or other transaction.
(5) “Commissioner” means the Commissioner of Financial Regulation. (Added 1959, No. 221, § 2(B); amended 1989, No. 225 (Adj. Sess.), § 25(b); 1995, No. 180 (Adj. Sess.), § 38(a); 2011, No. 78 (Adj. Sess.), § 2, eff. April 2, 2012.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 109 - Credit Life Insurance and Credit Accident and Health Insurance › § 4104. Forms and plans

§ 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 debtors on a term plan or disability benefit provisions in individual policies of credit life insurance;
(3) group policies of life insurance issued to creditors providing insurance upon the lives of debtors on the term plan;
(4) group policies of accident and health insurance issued to creditors on a term plan insuring debtors or disability benefit provisions in group credit life insurance policies to provide such coverage. (Added 1959, No. 221, § 3.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 109 - Credit Life Insurance and Credit Accident and Health Insurance › § 4105. Amount of insurance

§ 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 insurance shall at no time exceed the scheduled amount of indebtedness and, where secured by a group policy of credit life insurance shall at no time exceed the amount of unpaid indebtedness. Notwithstanding the provisions of this subsection, agricultural loans not exceeding one year may be written up to the amount of the loan commitment on a nondecreasing or level term plan.
(b) Credit accident and health insurance. The amount of periodic indemnity payable by credit accident and health insurance in the event of disability, as defined in the policy, shall not exceed the aggregate of the periodic scheduled unpaid installments of indebtedness and shall not exceed the original indebtedness divided by the number of periodic installments. (Added 1959, No. 221, § 4.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 109 - Credit Life Insurance and Credit Accident and Health Insurance › § 4106. Term

§ 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 existing obligations, the insurance on a debtor with respect to such indebtedness shall commence on the effective date of the policy. The term of such insurance shall not extend more than 15 days beyond the scheduled maturity date of the indebtedness except when extended without additional cost to the debtor. If the indebtedness is discharged due to renewal or refinancing prior to the scheduled maturity date, the insurance in force shall be terminated before any new insurance may be issued in connection with the renewed or refinanced indebtedness. In all cases of termination prior to scheduled maturity, a refund shall be paid or credited as provided in section 4109 of this title. (Added 1959, No. 221, § 5.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 109 - Credit Life Insurance and Credit Accident and Health Insurance › § 4107. Provisions of policies and certificates; disclosure to debtors

§ 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 or group certificate of insurance shall be delivered to the debtor.
(b) Each individual policy or group certificate of credit life insurance or credit accident and health insurance shall, in addition to other requirements of law, set forth the name and home office address of the insurer, the name or names of the debtor, the premium or amount of payment, if any, by the debtor separately for credit life insurance and credit accident and health insurance, a description of the coverage including the amount and term thereof, and any exceptions, limitations, or restrictions, and shall state that the benefits shall be paid to the creditor to reduce or extinguish the unpaid indebtedness and, wherever the amount of insurance may exceed the unpaid indebtedness, that any such excess shall be payable to a beneficiary, other than the creditor, named by the debtor or to his estate.
(c) Said individual policy or group certificate of insurance shall be delivered to the insured debtor at the time the indebtedness is incurred except as hereinafter provided.
(d) If said individual policy or group certificate of insurance is not delivered to the debtor at the time the indebtedness is incurred, a copy of the application for such policy or a notice of proposed insurance, signed by the debtor and setting forth the name and home office address of the insurer, the name or names of the debtor, the premium or amount of payment by the debtor, if any, separately for credit life insurance and credit accident and health insurance, the amount, term, and a brief description of the coverage provided, shall be delivered to the debtor at the time such indebtedness is incurred. The copy of the application for, or notice of, proposed insurance shall refer exclusively to insurance coverage and shall be separate and apart from the loan, sale, or other credit statement of account, instrument, or agreement, unless the information required by this subsection is prominently set forth therein. Upon acceptance of the insurance by the insurer and within 30 days of the date upon which the indebtedness is incurred, the insurer shall cause the individual policy or group certificate of insurance to be delivered to the debtor. Said application or notice of proposed insurance shall state that upon acceptance by the insurer, the insurance shall become effective as of the date the indebtedness is incurred. (Added 1959, No. 221, § 6.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 109 - Credit Life Insurance and Credit Accident and Health Insurance › § 4108. Filing, approval, and withdrawal of forms

§ 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 the insurer. Each such filing shall be accompanied by a payment to the Commissioner of a nonrefundable fee of $50.00 per filing submission.
(b) The Commissioner shall, within 30 days after the filing of any such policies, certificates of insurance, notices of proposed insurance, applications for insurance, endorsements, and riders, disapprove any such form if the benefits provided therein are not reasonable in relation to the premium charge, or if it contains provisions which are unjust, unfair, inequitable, misleading, deceptive, or encourage misrepresentation of the coverage, or are contrary to any provision of the insurance law or of any rule or regulation promulgated thereunder.
(c) If the Commissioner notifies the insurer that the form is disapproved, it is unlawful thereafter for such insurer to issue or use such form. In such notice, the Commissioner shall specify the reason for his or her disapproval and state that a hearing will be granted within 20 days after request in writing by the insurer. No such policy, certificate of insurance, notice of proposed insurance, nor any application, endorsement, or rider, shall be issued or used until the expiration of 30 days after it has been so filed, unless the Commissioner shall give his or her prior written approval thereto.
(d) The Commissioner may, at any time after a hearing held not less than 20 days after written notice to the insurer, withdraw his or her approval of any such form on any ground set forth in subsection (b) above. The written notice of such hearing shall state the reason for the proposed withdrawal.
(e) It is not lawful for the insurer to issue such forms or use them after the effective date of such withdrawal.
(f) Any order or final determination of the Commissioner under the provisions of this section shall be subject to judicial review. (Added 1959, No. 221, § 7; amended 1985, No. 236 (Adj. Sess.), § 7; 1991, No. 166 (Adj. Sess.), § 3.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 109 - Credit Life Insurance and Credit Accident and Health Insurance › § 4109. Premiums and refunds

§ 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, and shall file such revised schedules with the Commissioner. No insurer shall issue any credit life insurance policy or credit accident and health insurance policy for which the premium rate exceeds that determined by the schedules of such insurer as then on file with the Commissioner. The Commissioner may require the filing of the schedule of premium rates for use in connection with and as a part of the specific policy filings as provided by section 4108 of this title. Each such filing shall be accompanied by payment to the Commissioner of a nonrefundable fee of $50.00 per schedule of premium rates.
(b) Each individual policy, group certificate, or notice of proposed insurance shall provide that in the event of termination of the insurance prior to the scheduled maturity date of the indebtedness, any refund of an amount paid by the debtor for insurance shall be paid or credited promptly to the person entitled thereto; provided, however, that the Commissioner shall prescribe a minimum refund and no refund which would be less than such minimum need be made. The formula to be used in computing such refund shall be filed with and approved by the Commissioner.
(c) If a creditor requires a debtor to make any payment for credit life insurance or credit accident and health insurance and an individual policy or group certificate of insurance is not issued, the creditor shall immediately give written notice to such debtor and shall promptly make an appropriate credit to the amount.
(d) The amount charged by the creditor to the debtor for any credit life or credit health and accident insurance shall not exceed the premiums charged by the insurer, as computed at the time the charge to the debtor is determined.
(e) Nothing in this chapter shall be construed to authorize any payments for insurance prohibited under any statute or rule governing credit transactions. However, in the case of a debtor under chapter 73 of this title, the collection of identifiable charges for group credit life insurance by the creditor shall not be deemed as a violation of said chapter if the transaction complies with this chapter and the payment of such identifiable charge is optional with the debtor. (Added 1959, No. 221, § 8; amended 1961, No. 195, § 2, eff. July 5, 1961; 1985, No. 236 (Adj. Sess.), § 8; 1991, No. 166 (Adj. Sess.), § 4.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 109 - Credit Life Insurance and Credit Accident and Health Insurance › § 4110. Issuance of policies

§ 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 licenses or authorizations issued by the Commissioner. (Added 1959, No. 221, § 9.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 109 - Credit Life Insurance and Credit Accident and Health Insurance › § 4111. Claims

§ 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 claims shall be paid either by draft drawn upon the insurer or by check of the insurer to the order of the claimant to whom payment of the claim is due pursuant to the policy provisions, or upon directions of such claimant to one specified.
(c) No plan or arrangement shall be used whereby any person, firm or corporation other than the insurer or its designated claim representative shall be authorized to settle or adjust claims. The creditor shall not be designated as claim representative for the insurer in adjusting claims; provided that a group policyholder may, by arrangement with the group insurer, draw drafts or checks in payment of claims due to the group policyholder subject to audit and review by the insurer. (Added 1959, No. 221, § 10.)