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2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 147 - Legacy Insurance Transfers › § 7116. Fee; costs; transfer tax

§ 7116. Fee; costs; transfer tax
(a) To cover the costs of processing and reviewing a plan under this chapter, the assuming company shall pay to the Commissioner the following nonrefundable fees at the times set forth in subsections 7112(a) and 7114(a) of this chapter:
(1) an administrative fee in the amount of $30,000.00; and
(2) the reasonable costs of persons retained by the Commissioner under subsection 7113(a) of this chapter.
(b) When a plan is approved, the assuming company shall pay the Commissioner a transfer tax equal to the sum of:
(1) one percent of the first $100,000,000.00 of the gross liabilities transferred, including direct and assumed unpaid claims, losses, and loss adjustment expenses with no reductions for amounts ceded; and
(2) 0.5 percent of the gross liabilities transferred that exceed $100,000,000.00, including direct and assumed unpaid claims, losses, and loss adjustment expenses with no reductions for amounts ceded.
(c) All fees and payments received by the Department under subsection (a) of this section and 10 percent of the transfer tax under subsection (b) of this section shall be credited to the Insurance Regulatory and Supervision Fund under section 80 of this title. The remaining 90 percent of the transfer tax shall be deposited directly into the General Fund and reserved in the General Fund Balance Reserve established under 32 V.S.A. § 308c. (Added 2013, No. 93 (Adj. Sess.), § 3, eff. Feb. 19, 2014; amended 2013, No. 179 (Adj. Sess.), § E.228, eff. Feb. 19, 2014.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 147 - Legacy Insurance Transfers › § 7117. Examinations

§ 7117. Examinations
(a) The Commissioner has the authority to order any assuming company to produce any records, books, and papers in the possession of the assuming company or its affiliates necessary to ascertain the financial condition or legality of conduct of the assuming company.
(b) The Commissioner shall exercise his or her authority under subsection (a) of this section only if he or she has reason to believe the interests of the assuming company’s policyholders may be adversely affected under the plan.
(c) The Commissioner may retain, at the assuming company’s expense, attorneys, actuaries, accountants, and other experts not otherwise a part of the Commissioner’s staff reasonably necessary to assist with an examination under this section. Any persons so retained shall be under the direction and control of the Commissioner and shall act in a purely advisory capacity.
(d) Each assuming company that produces records, books, and papers for examination under this section shall pay the expense of such examination. (Added 2013, No. 93 (Adj. Sess.), § 3, eff. Feb. 19, 2014.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 147 - Legacy Insurance Transfers › § 7118. Applicable laws

§ 7118. Applicable laws
(a) Chapter 157 (transfer and novation of insurance contracts) of this title shall not apply to any legacy insurance transfer under this chapter.
(b) In the event of any conflict between a provision of this chapter and any other provision of this title, such provision of this chapter shall control.
(c) A proposed legacy insurance transfer shall be a “contested case” under 3 V.S.A. chapter 25, except that a “party” shall be limited as defined in subdivision 7111(16) of this chapter. (Added 2013, No. 93 (Adj. Sess.), § 3, eff. Feb. 19, 2014.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 147 - Legacy Insurance Transfers › § 7119. Assuming company; Board; principal place of business; registered agent

§ 7119. Assuming company; Board; principal place of business; registered agent
No assuming company shall be a party to a legacy insurance transfer under this chapter unless:
(1) its board of directors or committee of managers holds at least one meeting each year in this State;
(2) it maintains its principal place of business in this State; and
(3) it appoints a registered agent to accept service of process and to otherwise act on its behalf in this State, provided that whenever such registered agent cannot with reasonable diligence be found at the registered office of the assuming company, the Secretary of State shall be an agent of such assuming company upon whom any process, notice, or demand may be served. (Added 2013, No. 93 (Adj. Sess.), § 3, eff. Feb. 19, 2014.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 147 - Legacy Insurance Transfers › § 7120. Posting of plans on website

§ 7120. Posting of plans on website
The Commissioner shall require that all plans filed with the Department are posted on the Department’s website, along with any other notice or other information the Commissioner deems appropriate, excluding any information designated as confidential under subsection 7112(c) of this chapter. (Added 2013, No. 93 (Adj. Sess.), § 3, eff. Feb. 19, 2014.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 147 - Legacy Insurance Transfers › § 7121. Regulation of assuming companies and service providers

§ 7121. Regulation of assuming companies and service providers
(a) An assuming company shall be subject to all rules adopted by the Commissioner under this chapter and also shall be subject to:
(1) chapter 145 (supervision, rehabilitation, and liquidation of insurers) of this title;
(2) the market conduct and unfair trade practices provisions of chapter 129 (insurance trade practices) of this title, as deemed applicable by the Commissioner; and
(3) in addition to the initial transfer tax required under subsection 7116(b) of this chapter, an annual renewal fee of $300.00.
(b) An assuming company shall not be subject to the requirements of chapter 101, subchapter 9 (Property and Casualty Insurance Guaranty Association) of this title.
(c) The Commissioner may adopt rules regarding the provision of services to an assuming company by persons other than any director, officer, or employee of the assuming company with respect to the administration of policies and reinsurance agreements assumed by the assuming company under a legacy insurance transfer, including licensing or other requirements.
(d) The Commissioner may adopt any other rules necessary or appropriate to carry out the provisions of this chapter. (Added 2013, No. 93 (Adj. Sess.), § 3, eff. Feb. 19, 2014.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 148 - Travel Insurance › § 7122. Scope and purpose

§ 7122. Scope and purpose
(a) The purpose of this chapter is to promote the public welfare by creating a comprehensive legal framework within which travel insurance may be sold in Vermont.
(b) The requirements of this chapter apply to travel insurance that covers any resident of this State, and is sold, solicited, negotiated, or offered in this State, and the policies and certificates of which are delivered or issued for delivery in this State. It shall not apply to cancellation fee waivers or travel assistance services, except as expressly provided in this chapter.
(c) All other applicable provisions of this State’s insurance laws shall continue to apply to travel insurance except that the specific provisions of this chapter shall supersede any general provisions of law that would otherwise be applicable to travel insurance. (Added 2021, No. 139 (Adj. Sess.), § 10, eff. August 25, 2022.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 148 - Travel Insurance › § 7125. Premium tax

§ 7125. Premium tax
(a) A travel insurer shall pay premium tax, as provided in 32 V.S.A. § 8551, on travel insurance premiums paid by any of the following:
(1) a primary policyholder who is a resident of this State;
(2) a primary certificate holder who is a resident of this State who elects coverage under a group travel insurance policy; or
(3) a blanket travel insurance policyholder that is a resident in or has its principal place of business or the principal place of business of an affiliate or subsidiary that has purchased blanket travel insurance in this State for eligible blanket travel insurance group members, subject to any apportionment rules that apply to the insurer across multiple taxing jurisdictions or that permit the insurer to allocate premium on an apportioned basis in a reasonable and equitable manner in those jurisdictions.
(b) A travel insurer shall:
(1) document the state of residence or principal place of business of the policyholder or certificate holder, as required in subsection (a) of this section; and
(2) report as premium only the amount allocable to travel insurance and not any amounts received for travel assistance services or cancellation fee waivers. (Added 2021, No. 139 (Adj. Sess.), § 10, eff. August 25, 2022.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 148 - Travel Insurance › § 7126. Travel protection plans

§ 7126. Travel protection plans
A travel protection plan may be offered for one price for the combined features that the travel protection plan offers in this State if:
(1) the travel protection plan clearly discloses to the consumer, at or prior to the time of purchase, that it includes travel insurance, travel assistance services, or cancellation fee waivers, as applicable, and provides information and an opportunity, at or prior to the time of purchase, for the consumer to obtain additional information regarding the features and pricing of each;
(2) the person offering the travel protection plan that includes a travel insurance policy complies with section 7127 of this title; and
(3) the fulfillment materials:
(A) describe and delineate the travel insurance, travel assistance services, and cancellation fee waivers in the travel protection plan; and
(B) include the travel insurance disclosures and the contact information for persons providing travel assistance services and cancellation fee waivers, as applicable. (Added 2021, No. 139 (Adj. Sess.), § 10, eff. August 25, 2022.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 148 - Travel Insurance › § 7128. Travel administrators

§ 7128. Travel administrators
(a) A person shall not act or represent themself as a travel administrator for travel insurance in this State unless that person:
(1) is a licensed property and casualty insurance producer in this State for activities permitted under that producer license;
(2) holds a valid managing general agent license in this State; or
(3) holds a valid third-party administrator license in this State.
(b) A travel administrator and its employees are exempt from the licensing requirements of section 4803 of this title for travel insurance it administers.
(c) An insurer is responsible for the acts of a travel administrator administering travel insurance underwritten by the insurer and is responsible for ensuring that the travel administrator maintains all books and records relevant to the insurer to be made available by the travel administrator to the Commissioner upon request. (Added 2021, No. 139 (Adj. Sess.), § 10, eff. August 25, 2022.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 148 - Travel Insurance › § 7129. Policy

§ 7129. Policy
(a) Notwithstanding any other provision of this title to the contrary, travel insurance shall be classified and filed for purposes of rates and forms under an inland marine line of insurance; provided, however, that travel insurance that provides coverage for sickness, accident, disability, or death occurring during travel, either exclusively or in conjunction with related coverages such as emergency evacuation or repatriation of remains, or incidental limited property and casualty benefits such as baggage or trip cancellation, may be filed under either an accident and health line of insurance or an inland marine line of insurance.
(b) Travel insurance may be provided under an individual, group, or blanket policy.
(c) Eligibility and underwriting standards for travel insurance may be developed and provided based on travel protection plans designed for individual or identified marketing or distribution channels, provided those standards also meet the State’s underwriting standards for inland marine. (Added 2021, No. 139 (Adj. Sess.), § 10, eff. August 25, 2022.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 151 - Continuing Care Retirement Communities › § 8003. Sale or transfer of ownership

§ 8003. Sale or transfer of ownership
Any provider desiring to sell or transfer ownership of a continuing care facility shall notify the department 30 days in advance of completion of such sale or transfer. The Commissioner may revoke, after notice and hearing, and upon written findings of fact, the certificate of authority of any provider based on a substantial change in control or ownership of such provider, if such change is found not to be in the best interests of the residents of the facility in that:
(1) the facility is in danger of becoming insolvent;
(2) the care of current or prospective residents is threatened; or
(3) the monthly rates paid by residents would be adversely impacted. (Added 1987, No. 247 (Adj. Sess.), § 1; amended 2023, No. 6, § 70, eff. July 1, 2023.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 151 - Continuing Care Retirement Communities › § 8004. Lien on behalf of residents; rehabilitation or liquidation

§ 8004. Lien on behalf of residents; rehabilitation or liquidation
(a) Prior to the issuance of a certificate of authority under this chapter, or at such other time as the Commissioner may determine it is in the best interests of residents of a facility, the Commissioner may file a lien on the real and personal property of the provider or facility to secure the obligations of the provider pursuant to existing and future contracts for continuing care. A lien filed under this section shall be effective for a period of 10 years following such filing and may be extended by the Commissioner upon a finding that such extension is advisable for the protection of residents of the facility. The lien may be foreclosed upon the liquidation of the facility or the insolvency of the provider, and in such event the proceeds thereof shall be used in full or partial satisfaction of obligations of the provider pursuant to contracts for continuing care then in effect. The lien provided for in this section shall be subordinate to the lien of any mortgage on the property of the provider used to fund the costs of acquiring, developing, or constructing and funding the reserves thereof, and may be subordinated with the written consent of the Commissioner to the claims of other persons if the Commissioner shall determine such subordination to be advisable for the efficient operation of the facility. A lien filed by the Commissioner under this section does not displace any previously perfected lien.
(b)(1) If, at any time, the Commissioner determines, after notice and an opportunity for the provider to be heard, that:
(A) a portion of a reserve fund escrow required under this chapter has been or is proposed to be released;
(B) a provider has been or will be unable, in such a manner as may endanger the ability of the provider to fully perform its obligations pursuant to contracts for continuing care, to meet the most recent pro forma income or cash flow projections filed by the provider;
(C) a provider has failed to maintain the reserves required under this chapter; or
(D) a provider is insolvent or in imminent danger of becoming subject to a delinquency proceeding under chapter 145 of this title or insolvent;
(2) the Commissioner may apply to the appropriate court for an order directing or authorizing the Commissioner to seize the property of, to rehabilitate, or to liquidate a provider under chapter 145 of this title.
(c) In furtherance of the welfare of the persons who have previously contracted with the provider for continuing care, the proceeds of any lien obtained by the Commissioner pursuant to this section shall be distributed in the following order of priority:
(1) used on behalf of residents of a facility being liquidated;
(2) used in full or partial refund of entrance fees;
(3) used to pay other creditors as provided by law. (Added 1987, No. 247 (Adj. Sess.), § 1; amended 1999, No. 38, § 21, eff. May 20, 1999; 2023, No. 6, § 71, eff. July 1, 2023.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 151 - Continuing Care Retirement Communities › § 8006. Termination of contract; notice

§ 8006. Termination of contract; notice
(a) A person who enters into a continuing care contract with a provider may voluntarily terminate the contract within 30 days of executing such contract and shall receive a refund of all money paid according to the provisions of subdivision 8007(c)(1) of this title. A person may voluntarily terminate the contract at any other time subject to the applicable refund provisions of subdivisions 8007(c)(2) and (3) of this chapter.
(b) If the resident dies before the occupancy date or, through illness, injury, or incapacity, is precluded from becoming a resident under the terms of the continuing care contract, the contract shall terminate.
(c) A provider may terminate a contract only for good and sufficient cause. The provider shall give the resident at least 90 days’ written notice prior to termination and shall send a copy of the notice to the Department. Good and sufficient cause includes:
(1) a material failure on the part of the resident to abide by rules adopted for residents or a material breach by the resident of the continuing care contract, provided that failure to abide by the rules or contract that are caused, in whole or in part, by a diagnosable medical or psychiatric illness shall not be a basis for terminating the contract; and
(2) making any material misrepresentation or omission in connection with the application forms, financial statements, or other information submitted by the resident, except that the provisions of the contract, exclusive of financial statements, shall be incontestable after it has been in force during the lifetime of the resident for a period of two years from its date of execution. (Added 1987, No. 247 (Adj. Sess.), § 1.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 151 - Continuing Care Retirement Communities › § 8008. Escrow of entrance fees

§ 8008. Escrow of entrance fees
(a) In the event the facility is not in operation at the time entrance fees are paid, the entrance fees or portions thereof shall be deposited in an escrow account. Such escrowed fees shall not be released to the provider until the following conditions are satisfied:
(1) Commitments are received from persons who have entered into continuing care contracts for a minimum of 60 percent of the residential units. As used in this subdivision, “commitment” means payment of at least 10 percent of the entrance fee.
(2) One hundred percent of the financing for construction and operation of the facility has been arranged. As used in this subdivision, “financing” includes all funds that, when combined with entrance fees and periodic fees receivable under signed contracts, are sufficient to complete construction of the facility and to provide enough working capital to enable the facility to operate in a self-sufficient manner.
(3) The provider has obtained or caused to be obtained a guaranteed maximum price contract for construction of the facility.
(4) The provider has obtained or caused to be obtained all permits and regulatory approvals necessary for operation of the facility except those dependent upon completion of construction.
(b) In the case of a contract for a previously occupied residential unit, fees shall be held in escrow until 60 days prior to the occupancy date.
(c) If the provider is unable to satisfy the conditions set forth in subsection (a) of this section within a reasonable period of time, the Commissioner may order that escrowed fees be released and refunded. (Added 1987, No. 247 (Adj. Sess.), § 1.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 151 - Continuing Care Retirement Communities › § 8009. Reserve requirements

§ 8009. Reserve requirements
A provider shall maintain a reserve fund equal to annual principal and interest payments on all debt or 15 percent of annual operating expenses, whichever is greater. The Department may require that these funds be placed in an escrow account, or other similarly secure investment where the funds are protected. The Department shall approve any withdrawal or borrowing from these funds and shall monitor repayment. (Added 1987, No. 247 (Adj. Sess.), § 1.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 151 - Continuing Care Retirement Communities › § 8010. Disclosure

§ 8010. Disclosure
(a) A provider shall maintain financial records for the facility, including independently audited financial statements, and copies of all inspection reports pertaining to that facility that have been issued by any governmental agency and filed with the provider. A copy of each such report shall be retained in the facility’s records for not less than five years from the date the report is filed or issued. Each facility shall also maintain all annual reports and statements that have been filed with the Department or any state, local, or federal agency. The records and information required to be maintained under this section shall be available for review upon request by residents and applicants during normal business hours. Copies of these documents will be provided for a reasonable copying fee.
(b) Notwithstanding the provisions of subsection (a) of this section, records, reports, or documents, which by state or federal law or regulation are deemed confidential, shall not be distributed or made available until such confidential status has expired.
(c) Every provider shall prepare a summary of the most recent audited financial statement, indicating in the summary where the contents of the complete statement may be inspected. A copy of the statement shall be maintained at the facility, and a copy of the summary shall be prominently displayed in the facility.
(d) Proposed changes in policies, programs, and services shall be posted and explained to residents.
(e) Before entering into a contract to furnish continuing care, the provider, or the agent of the provider, shall provide the prospective resident or his or her legal representative with the following information:
(1) a copy of the continuing care contract form;
(2) a summary of the provider’s most recent annual financial statement; and
(3) such additional information as may be required by the Department. (Added 1987, No. 247 (Adj. Sess.), § 1.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 151 - Continuing Care Retirement Communities › § 8011. Resident associations; annual resident meeting

§ 8011. Resident associations; annual resident meeting
(a) Residents of a facility have the right to self-organization and the right to engage in activities for the purpose of keeping informed on the operation of the facility or for the purpose of other mutual aid.
(b) Annually, the governing body of a facility, or its designated representative, shall hold a meeting with the residents of that facility for the purpose of discussing, at a minimum, the following subjects: income and expenditures of the facility; financial trends and issues as they apply to the facility; and any proposed changes in policies, programs, or services. Upon request of the residents, a member of the board of directors, a general partner, or a principal owner shall attend such meeting. Residents shall be given at least seven days’ advance notice of the annual meeting. An agenda and any materials to be distributed by the governing body at the meeting shall be posted in a conspicuous place in the facility, and copies shall be available to residents upon request. (Added 1987, No. 247 (Adj. Sess.), § 1.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 151 - Continuing Care Retirement Communities › § 8012. Enforcement

§ 8012. Enforcement
(a) The Commissioner may, after notice and an opportunity for hearing, impose an administrative penalty of not more than $15,000.00 against any person who violates a provision of this chapter. The hearing before the Commissioner shall be a contested case subject to the provisions of 3 V.S.A. chapter 25.
(b) A provider who violates a provision of this chapter shall be subject to a fine not to exceed $15,000.00 or imprisonment for a period not to exceed one year, or both.
(c) The Department, or the Attorney General at the request of the Department, may bring an action to enforce the provisions of this chapter in the Superior Court. The court may grant temporary and permanent injunctive relief and may exercise all the powers available to it. (Added 1987, No. 247 (Adj. Sess.), § 1; 1995, No. 167 (Adj. Sess.), § 25.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 151 - Continuing Care Retirement Communities › § 8013. Hearing on denial of certificate or rate application

§ 8013. Hearing on denial of certificate or rate application
An adverse decision by the Commissioner under section 8002 of this title shall state the grounds and particulars on which the decision was based in such detail as to reasonably inform the affected party. Any party aggrieved by the decision may file a written notice and request a hearing before the Commissioner within 30 days of the decision. The appeal provisions set forth in 3 V.S.A. chapter 25 shall apply. (Added 1987, No. 247 (Adj. Sess.), § 1.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 151 - Continuing Care Retirement Communities › § 8015. Nondiscrimination

§ 8015. Nondiscrimination
The provisions of 9 V.S.A. § 4503 as they relate to age shall not apply to providers offering continuing care under the provisions of this chapter. (Added 1987, No. 247 (Adj. Sess.), § 1.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 151 - Continuing Care Retirement Communities › § 8016. Fees for administration of this chapter

§ 8016. Fees for administration of this chapter
(a) An application for a certificate of authority shall be accompanied by a fee of $1,500.00.
(b) The Department shall be reimbursed for any expenses it reasonably incurs itself or by its agents in pursuing the following statutory duties:
(1)(A) review of rates charged by operators;
(B) review of contract forms;
(C) monitoring compliance with statutory and regulatory requirements;
(D) general enforcement of statutory requirements; and
(E) preparation and publication of a consumers’ guide.
(2) The Commissioner shall annually, before August 16, apportion the expenses incurred in performing the enumerated duties among providers based on their annual gross revenue for their most recent fiscal year.
(c) The Department shall be reimbursed by a provider for any expenses reasonably incurred by the Department or by its agents, in pursuing its financial and market conduct examinations, reviewing the sale or transfer of a facility to another operator, conducting specific enforcement actions, and carrying out investigations and rehabilitation activities under this chapter. (Added 1987, No. 247 (Adj. Sess.), § 1; amended 2023, No. 6, § 73, eff. July 1, 2023.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 151 - Continuing Care Retirement Communities › § 8018. Resident Assistance Fund

§ 8018. Resident Assistance Fund
(a) A provider shall establish a Resident Assistance Fund for the purpose of assisting residents who are unable to meet a portion of periodic or other charges of the provider.
(b) The Fund shall be established by an initial contribution of at least $25,000.00 from the provider and may contain any additional amounts contributed by the provider or residents.
(c) The Fund, including any interest earned on monies in the Fund, shall be used for the sole purpose of assisting residents who have financial difficulties that impair their ability to meet monthly fees and other charges.
(d) The Fund shall be administered by the operator of the facility and a committee of residents, designated by the residents, for the exclusive benefit of the residents in a manner approved by the Commissioner.
(e) The Fund shall be subject to an annual independent audit. The independent audit may be filed and submitted in accordance with one of the following methods:
(1) an audited financial statement of the Fund shall be included as a separate schedule of supplementary information in the provider’s audited annual statement required under subsection 8002(g) of this title; or
(2) an audited financial statement of the Fund shall be submitted annually to the residents and the Commissioner. (Added 1987, No. 247 (Adj. Sess.), § 1; amended 2009, No. 137 (Adj. Sess.), § 13.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 154 - Long-Term Care Insurance › § 8081. Purpose

§ 8081. Purpose
The purpose of this chapter is to promote the public interest, to promote the availability of long-term care insurance policies, to protect applicants for long-term care insurance from unfair or deceptive sales or enrollment practices, to establish standards for long-term care insurance, to facilitate public understanding and comparison of long-term care insurance policies, and to facilitate flexibility and innovation in the development of long-term care insurance coverage. (Added 2003, No. 124 (Adj. Sess.), § 2.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 154 - Long-Term Care Insurance › § 8083. Extraterritorial jurisdiction

§ 8083. Extraterritorial jurisdiction
No group long-term care insurance coverage may be offered to a resident of this State under a group policy issued in another state to a group described in subdivision 8082(4)(D) of this title, unless this State or another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this State has made a determination that such requirements have been met. All other jurisdiction shall be pursuant to section 4062 of this title. (Added 2003, No. 124 (Adj. Sess.), § 2, eff. Jan. 1, 2005.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 154 - Long-Term Care Insurance › § 8084. Disclosure standards

§ 8084. Disclosure standards
(a) The Commissioner shall adopt rules establishing standards for full and fair disclosure of the terms of a long-term care insurance policy.
(b) The disclosure standards established under subsection (a) of this section shall include provisions setting forth the manner, content, and required disclosures for the sale of long-term care insurance policies, terms of renewability, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting conditions, termination of insurance, continuation, conversion, probationary periods, limitations, exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions, and definitions of terms. (Added 2003, No. 124 (Adj. Sess.), § 2, eff. Jan. 1, 2005.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 154 - Long-Term Care Insurance › § 8085. Minimum benefits and coverage; general

§ 8085. Minimum benefits and coverage; general
(a) The Commissioner shall adopt rules establishing standards for minimum benefits and coverage that must be provided by a long-term care insurance policy to carry out the purposes of subsection (b) of this section. Nothing in this section prohibits an insurer from underwriting in accordance with that insurer’s underwriting standards and the requirements of section 8086 of this title.
(b) No long-term care insurance policy may:
(1) be canceled, nonrenewed, or otherwise terminated on grounds other than by cancellation by the insured individual or certificate holder; nonpayment of premiums by the insured individual or certificate holder; all amounts potentially payable under the terms of the policy having been fully paid out; or except as provided for in section 8094 of this title;
(2) contain a provision establishing a new waiting period in the event existing coverage is converted to or replaced by a new or other form within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder;
(3) provide coverage for skilled nursing care only or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care;
(4) deny benefits or coverage on the basis that the need for services arises from a mental condition or Alzheimer’s disease and related disorders;
(5) be issued without including a provision covering home health care benefits that complies with the standards for minimum benefits and coverage established by rule under subsection (a) of this section;
(6) fail to offer adult day care benefits, either in the policy or as an optional rider, that comply with the standards for minimum benefits and coverage established by rule under subsection (a) of this section;
(7) be offered without including an option for inflation adjustment protection that complies with the standards for minimum benefits and coverage established by rule under subsection (a) of this section;
(8) include a deductible or elimination period in excess of 100 days, computed in a manner prescribed by the Commissioner by rule, for any covered benefit;
(9) require payment of premiums more frequently than monthly; or
(10) be represented as having a premium described as level, fixed, or by similar words, if the premium is not, in fact, fixed and may be increased. (Added 2003, No. 124 (Adj. Sess.), § 2, eff. Jan. 1, 2005; amended 2013, No. 96 (Adj. Sess.), § 23.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 154 - Long-Term Care Insurance › § 8086. Preexisting conditions

§ 8086. Preexisting conditions
(a) No long-term care insurance policy or certificate shall use a definition of “preexisting condition” that is more restrictive than the following: “preexisting condition” means a condition for which medical advice or treatment was recommended by or received from a provider of health care services within six months preceding the effective date of coverage of an insured person.
(b) No long-term care insurance policy or certificate may exclude coverage for a loss or confinement that is the result of a preexisting condition, unless such loss or confinement begins within six months following the effective date of coverage of an insured person.
(c) The Commissioner may by rule extend the limitation periods established in subsections (a) and (b) of this section as to specific age group categories in specific policy forms upon findings that the extension is in the best interests of the public.
(d) The definition of “preexisting condition” does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant and, on the basis of the answers on that application, from underwriting in accordance with that insurer’s established underwriting standards. Unless otherwise provided in the policy or certificate, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until the waiting period described in subsection (b) of this section expires. No long-term care insurance policy or certificate may exclude or use waivers or riders of any kind to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond the waiting period described in subsection (b) of this section. (Added 2003, No. 124 (Adj. Sess.), § 2, eff. Jan. 1, 2005; amended 2021, No. 105 (Adj. Sess.), § 266, eff. July 1, 2022.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 154 - Long-Term Care Insurance › § 8087. Prior institutionalization

§ 8087. Prior institutionalization
No long-term care insurance policy shall condition benefits upon a period of prior hospitalization or upon admission to a facility for the same or related condition that led to hospitalization or admission to the facility. (Added 2003, No. 124 (Adj. Sess.), § 2, eff. Jan. 1, 2005.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 154 - Long-Term Care Insurance › § 8088. Loss ratio standards

§ 8088. Loss ratio standards
The Commissioner may adopt rules establishing loss ratio standards for long-term care insurance policies, provided that a specific reference to long-term care insurance policies is contained in the rule. (Added 2003, No. 124 (Adj. Sess.), § 2, eff. Jan. 1, 2005.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 154 - Long-Term Care Insurance › § 8089. Right to return; free look

§ 8089. Right to return; free look
(a) Individual long-term care insurance policyholders shall have the right to return the policy within 30 days of its delivery and to have the premium refunded if, after examination of the policy, the policyholder is not satisfied for any reason. Individual long-term care insurance policies shall have a notice prominently printed on the first page of the policy stating in substance that the policyholder shall have the right to return the policy within 30 days of its delivery and to have the premium refunded if, after examination of the policy, the policyholder is not satisfied for any reason.
(b) A person insured under a long-term care insurance policy issued pursuant to a direct response solicitation shall have the right to return the policy within 30 days of its delivery and to have the premium refunded if, after examination, the insured person is not satisfied for any reason. Long-term care insurance policies issued pursuant to a direct response solicitation shall have a notice prominently printed on the first page stating in substance that the insured person shall have the right to return the policy within 30 days of its delivery and to have the premium refunded if, after examination, the insured person is not satisfied for any reason. (Added 2003, No. 124 (Adj. Sess.), § 2, eff. Jan. 1, 2005.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 154 - Long-Term Care Insurance › § 8090. Outline of coverage for applicant; certificate

§ 8090. Outline of coverage for applicant; certificate
(a) An outline of coverage shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means that prominently direct the attention of the recipient to the document and its purpose. The Commissioner shall prescribe a standard format, including style, arrangement, overall appearance, and the content of an outline of coverage.
(b) In the case of agent solicitations, an agent shall deliver the outline of coverage prior to the presentation of an application or enrollment form.
(c) In the case of direct response solicitations, the outline of coverage shall be presented in conjunction with any application or enrollment form.
(d) In the case of a policy issued to a group defined in subdivision 8082(4)(A) of this chapter, an outline of coverage shall not be required to be delivered, provided that the information described in subsection (e) of this section is contained in other materials relating to enrollment. Upon request, these other materials shall be made available to the Commissioner.
(e) The outline of coverage shall include all of the following:
(1) A description of the principal benefits and coverage provided in the policy.
(2) A statement of the principal exclusions, reductions, and limitations contained in the policy.
(3) A statement of the terms under which the policy or certificate, or both, may be continued in force or discontinued, including any reservation in the policy of a right to change premium. Continuation or conversion provisions of group coverage shall be specifically described.
(4) A statement that the outline of coverage is a summary only, not a contract of insurance, and that the policy or group master policy contains governing contractual provisions.
(5) A description of the terms under which the policy or certificate may be returned and the premium refunded.
(6) A brief description of the relationship of cost of care and benefits.
(7) A statement that discloses to the policyholder or certificate holder whether the policy is intended to be a federally tax-qualified long-term care insurance contract under Subsection 7702B(b) of the Internal Revenue Code of 1986, as amended.
(f) A certificate issued pursuant to a group long-term care insurance policy delivered or issued for delivery in this State shall include:
(1) a description of the principal benefits and coverage provided in the policy;
(2) a statement of the principal exclusions, reductions, and limitations contained in the policy; and
(3) a statement that the group master policy determines governing contractual provisions.
(g) If an application for a long-term care insurance contract or certificate is approved, the issuer shall deliver the contract or certificate of insurance to the applicant not later than 30 days after the date of approval. (Added 2003, No. 124 (Adj. Sess.), § 2, eff. Jan. 1, 2005; amended 2021, No. 105 (Adj. Sess.), § 267, eff. July 1, 2022; 2023, No. 6, § 75, eff. July 1, 2023.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 154 - Long-Term Care Insurance › § 8091. Policy summary for life insurance policy providing long-term care benefits

§ 8091. Policy summary for life insurance policy providing long-term care benefits
(a) If an individual life insurance policy provides long-term care benefits within the policy or by rider, a policy summary shall be delivered at the time of policy delivery. In the case of direct response solicitations, the insurer shall deliver the policy summary upon the applicant’s request, but regardless of request shall make delivery not later than at the time of policy delivery. In addition to complying with all applicable requirements, the summary shall also include:
(1) an explanation of how the long-term care benefit interacts with other components of the policy, including deductions from death benefits;
(2) an illustration of the amount of benefits, the length of benefits, and the guaranteed lifetime benefits if any, for each covered person;
(3) any exclusions, reductions, and limitations on benefits of long-term care;
(4) a statement that any long-term care inflation protection option required by subdivision 8085(b)(6) of this title is not available under this policy;
(5) if applicable to the policy type, the summary shall also include:
(A) a disclosure of the effects of exercising other rights under the policy;
(B) a disclosure of guarantees related to long-term care costs of insurance charges; and
(C) current and projected maximum lifetime benefits.
(b) The provisions of the policy summary listed in this section may be incorporated into a basic illustration required to be delivered or into the life insurance policy summary that is required to be delivered in accordance with the Department’s rules. (Added 2003, No. 124 (Adj. Sess.), § 2, eff. Jan. 1, 2005; amended 2021, No. 105 (Adj. Sess.), § 268, eff. July 1, 2022.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 154 - Long-Term Care Insurance › § 8092. Acceleration of life insurance death benefit; monthly report

§ 8092. Acceleration of life insurance death benefit; monthly report
Anytime a long-term care benefit, funded through a life insurance vehicle by the acceleration of the death benefit, is in benefit payment status, a monthly report shall be provided to the policyholder. The report shall include:
(1) any long-term care benefits paid out during the month;
(2) an explanation of any changes in the policy, such as death benefits or cash values, due to long-term care benefits being paid out; and
(3) the amount of long-term care benefits existing or remaining. (Added 2003, No. 124 (Adj. Sess.), § 2, eff. Jan. 1, 2005.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 154 - Long-Term Care Insurance › § 8093. Denial of claims; written explanation

§ 8093. Denial of claims; written explanation
(a) If a claim under a long-term care insurance contract is denied, the issuer shall, within 60 days of the date of a written request by the policyholder or certificate holder, or a representative thereof:
(1) provide a written explanation of the reasons for the denial; and
(2) make available all information directly related to the denial.
(b) After completion of all internal appeals, the policyholder or certificate holder may appeal the insurer’s benefit trigger determination to an independent review organization designated by the Commissioner, upon payment of a filing fee of no more than $15.00. The filing fee may be waived or reduced upon a finding by the Commissioner that the financial circumstances of the insured warrant a waiver or reduction. All other costs of the independent review shall be paid by the insurer. (Added 2003, No. 124 (Adj. Sess.), § 2, eff. Jan. 1, 2005; amended 2009, No. 137 (Adj. Sess.), § 28.)
2023 Vermont Statutes › Title 8 - Banking and Insurance › Chapter 154 - Long-Term Care Insurance › § 8094. Incontestability period

§ 8094. Incontestability period
(a) For a policy or certificate that has been in force for less than six months, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance for coverage.
(b) For a policy or certificate that has been in force for at least six months but less than two years, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance for coverage and that pertains to the condition for which benefits are sought.
(c) After a policy or certificate has been in force for two years, it is not contestable upon the grounds of misrepresentation alone, but may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured’s health.
(d) If an insurer has paid benefits under the long-term care insurance policy or certificate, the benefit payments may not be recovered by the insurer in the event that the policy or certificate is rescinded.
(e) In the event of the death of the insured, this section shall not apply to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care. In this situation, the remaining death benefits under these policies shall be governed by sections 3731 and 4065 of this title. In all other situations, this section shall apply to life insurance policies that accelerate benefits for long-term care. (Added 2003, No. 124 (Adj. Sess.), § 2, eff. Jan. 1, 2005.)