Vermont 2025-2026 Regular Session

Vermont Senate Bill S0030 Compare Versions

Version 1 (Old)

Version 2 (New)

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1		-	~~BILLASINTRODUCEDANDPASSEDBYSENATE~~ S.30
	1	+	BILL AS INTRODUCED S.30
2	2		2025 Page 1 of 181
3		-	S.30
4		-	IntroducedbySenatorsLyonsandCummings
5		-	ReferredtoCommitteeonFinance
6		-	Date:January29,2025
7		-	Subject:Health;healthinsurance;VermontStatutesAnnotated
8		-	Statementofpurposeofbillasintroduced:Thisbillproposestoupdateand
9		-	reorganizethehealthinsurancechapter,8V.S.A.chapter107,includingusing
10		-	consistentlanguageandterminologythroughoutthechapter.Thebillwould
11		-	alsoupdatecross-referencesinotherstatutesasneeded.
12		-	Anactrelatingtoupdatingandreorganizingthehealthinsurancestatutesin
13		-	8V.S.A.chapter107
14		-	ItisherebyenactedbytheGeneralAssemblyoftheStateofVermont:
15		-	*RepealofExisting8V.S.A.Chapter107*
16		-	Sec.1.REPEALOFEXISTING8V.S.A.CHAPTER107
17		-	8V.S.A.chapter107(healthinsurance)isrepealed.
18		-	*EnactmentofUpdatedandReorganized8V.S.A.Chapter107*
19		-	Sec.2.8V.S.A.chapter107isaddedtoread:
20		-	CHAPTER107.HEALTHINSURANCE
21		-	Subchapter1.GeneralProvisions
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40		-	19 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
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	4	+
	5	+	VT LEG #380165 v.1
	6	+	S.30 1
	7	+	Introduced by Senators Lyons and Cummings 2
	8	+	Referred to Committee on 3
	9	+	Date: 4
	10	+	Subject: Health; health insurance; Vermont Statutes Annotated 5
	11	+	Statement of purpose of bill as introduced: This bill proposes to update and 6
	12	+	reorganize the health insurance chapter, 8 V.S.A. chapter 107, including using 7
	13	+	consistent language and terminology throughout the chapter. The bill would 8
	14	+	also update cross-references in other statutes as needed. 9
	15	+	An act relating to updating and reorganizing the health insurance statutes in 10
	16	+	8 V.S.A. chapter 107 11
	17	+	It is hereby enacted by the General Assembly of the State of Vermont: 12
	18	+	* * * Repeal of Existing 8 V.S.A. Chapter 107 * * * 13
	19	+	Sec. 1. REPEAL OF EXISTING 8 V.S.A. CHAPTER 107 14
	20	+	8 V.S.A. chapter 107 (health insurance) is repealed. 15
	21	+	* * * Enactment of Updated and Reorganized 8 V.S.A. Chapter 107 * * * 16
	22	+	Sec. 2. 8 V.S.A. chapter 107 is added to read: 17
	23	+	CHAPTER 107. HEALTH INSURANCE 18
	24	+	Subchapter 1. General Provisions 19 BILL AS INTRODUCED S.30
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42		-	§ 4011.DEFINITIONS
43		-	Asusedinthischapter:
44		-	(1)“Coveredindividual”meansanindividualwhoiscoveredbya
45		-	healthinsuranceplan,whetherastheprimarysubscriberorpolicyholderoras
46		-	adependent,employee,oremployee’sdependentundertheplan.
47		-	(2)“Healthcareservices”meansservicesforthediagnosis,prevention,
48		-	treatment,cure,orreliefofahealthcondition,illness,injury,ordisease.
49		-	(3)“Healthinsuranceplan”meansapolicyorcontractissuedbya
50		-	healthinsurer,includingthehealthbenefitplanorplansofferedbytheStateof
51		-	Vermonttoitsemployeesandanyhealthbenefitplanofferedbyanyagencyor
52		-	instrumentalityoftheStatetoitsemployees.Unlessotherwisespecified,
53		-	“healthinsurance”doesnotincludeVermontMedicaid.
54		-	(4)“Healthinsurer”meansaninsurancecompanythatprovideshealth
55		-	insuranceasdefinedinsubdivision3301(a)(2)ofthistitle,anonprofithospital
56		-	ormedicalservicecorporation,amanagedcareorganization,ahealth
57		-	maintenanceorganization,and,totheextentpermittedunderfederallaw,any
58		-	administratorofaninsured,self-insured,orpubliclyfundedhealthcarebenefit
59		-	planofferedbyapublicorprivateentity.
60		-	(5)“Majormedicalinsurance”meansacomprehensivehealthinsurance
61		-	planthatisnotspecificdisease,accident,hospitalindemnity,dentalcare,
62		-	visioncare,disabilityincome,long-termcare,Medicaresupplementinsurance,
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	26	+
	27	+
	28	+	VT LEG #380165 v.1
	29	+	§ 4011. DEFINITIONS 1
	30	+	As used in this chapter: 2
	31	+	(1) “Covered individual” means an individual who is covered by a 3
	32	+	health insurance plan, whether as the primary subscriber or policyholder or as a 4
	33	+	dependent, employee, or employee’s dependent under the plan. 5
	34	+	(2) “Health care services” means services for the diagnosis, prevention, 6
	35	+	treatment, cure, or relief of a health condition, illness, injury, or disease. 7
	36	+	(3) “Health insurance plan” means a policy or contract issued by a 8
	37	+	health insurer, including the health benefit plan or plans offered by the State of 9
	38	+	Vermont to its employees and any health benefit plan offered by any agency or 10
	39	+	instrumentality of the State to its employees. Unless otherwise specified, 11
	40	+	“health insurance” does not include Vermont Medicaid. 12
	41	+	(4) “Health insurer” means an insurance company that provides health 13
	42	+	insurance as defined in subdivision 3301(a)(2) of this title, a nonprofit hospital 14
	43	+	or medical service corporation, a managed care organization, a health 15
	44	+	maintenance organization, and, to the extent permitted under federal law, any 16
	45	+	administrator of an insured, self-insured, or publicly funded health care benefit 17
	46	+	plan offered by a public or private entity. 18
	47	+	(5) “Major medical insurance” means a comprehensive health insurance 19
	48	+	plan that is not specific disease, accident, hospital indemnity, dental care, 20
	49	+	vision care, disability income, long-term care, Medicare supplement insurance, 21 BILL AS INTRODUCED S.30
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85		-	orotherlimited-benefitcoverage.Thetermdoesnotincludeshort-term,
86		-	limited-durationhealthinsurancecoverageoraplanunderwhichbenefitsare
87		-	paiddirectlytoacoveredindividualortheindividual’sassignsandforwhich
88		-	theamountofthebenefitisnotbasedonpotentialmedicalcostsoronactual
89		-	costsincurred.
90		-	§ 4012.COMPLIANCEWITHFEDERALLAW
91		-	(a)Exceptasotherwiseprovidedinthistitle,healthinsurers,hospitaland
92		-	medicalservicecorporations,andhealthmaintenanceorganizationsthatissue,
93		-	sell,renew,orofferhealthinsuranceplansinVermontshallcomplywiththe
94		-	requirementsoftheHealthInsurancePortabilityandAccountabilityActof
95		-	1996,asamendedfromtimetotime(42U.S.C.Chapter6A,Subchapter
96		-	XXV),andthePatientProtectionandAffordableCareActof2010,Pub.L.
97		-	No.111-148,asamendedbytheHealthCareandEducationReconciliationAct
98		-	of2010,Pub.L.No.111-152.TheCommissionershallenforcesuch
99		-	requirementspursuanttotheCommissioner’sauthorityunderthistitle.
100		-	(b)(1)Healthinsurers,hospitalandmedicalservicecorporations,health
101		-	maintenanceorganizations,andhealthcareproviders,asthattermisdefinedin
102		-	18V.S.A.§9432,shallcomplywiththerequirementsoftheNoSurprisesAct,
103		-	Pub.L.No.116-260,DivisionBB,TitleI,asamendedfromtimetotime.
104		-	(2)TheCommissionershallenforcetherequirementsoftheNo
105		-	SurprisesActastheyapplytohealthinsurers,hospitalandmedicalservice
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126		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	51	+
	52	+
	53	+	VT LEG #380165 v.1
	54	+	or other limited-benefit coverage. The term does not include short-term, 1
	55	+	limited-duration health insurance coverage or a plan under which benefits are 2
	56	+	paid directly to a covered individual or the individual’s assigns and for which 3
	57	+	the amount of the benefit is not based on potential medical costs or on actual 4
	58	+	costs incurred. 5
	59	+	§ 4012. COMPLIANCE WITH FEDERAL LAW 6
	60	+	(a) Except as otherwise provided in this title, health insurers, hospital and 7
	61	+	medical service corporations, and health maintenance organizations that issue, 8
	62	+	sell, renew, or offer health insurance plans in Vermont shall comply with the 9
	63	+	requirements of the Health Insurance Portability and Accountability Act of 10
	64	+	1996, as amended from time to time (42 U.S.C. Chapter 6A, Subchapter 11
	65	+	XXV), and the Patient Protection and Affordable Care Act of 2010, Pub. L. 12
	66	+	No. 111-148, as amended by the Health Care and Education Reconciliation Act 13
	67	+	of 2010, Pub. L. No. 111-152. The Commissioner shall enforce such 14
	68	+	requirements pursuant to the Commissioner’s authority under this title. 15
	69	+	(b)(1) Health insurers, hospital and medical service corporations, health 16
	70	+	maintenance organizations, and health care providers, as that term is defined in 17
	71	+	18 V.S.A. § 9432, shall comply with the requirements of the No Surprises Act, 18
	72	+	Pub. L. No. 116-260, Division BB, Title I, as amended from time to time. 19
	73	+	(2) The Commissioner shall enforce the requirements of the No 20
	74	+	Surprises Act as they apply to health insurers, hospital and medical service 21 BILL AS INTRODUCED S.30
127	75		2025 Page 4 of 181
128		-	corporations,healthmaintenanceorganizations,andhealthcareproviders,to
129		-	theextentpermittedunderfederallaw,pursuanttotheCommissioner’s
130		-	authorityunderthistitle.TheCommissionermayalsorefercasesof
131		-	noncompliancetotheU.S.DepartmentofHealthandHumanServicesunder
132		-	thetermsofacollaborativeenforcementagreement,ortotheOfficeofthe
133		-	VermontAttorneyGeneral.
134		-	§ 4013.DISCRIMINATIONPROHIBITED
135		-	Nohealthinsurershallmakeorpermitanyunfairdiscriminationbetween
136		-	individualsofsubstantiallythesamehazardintheamountofpremiumrates
137		-	chargedforanyhealthinsuranceplanorinthebenefitspayableundertheplan;
138		-	provided,however,thatthissectionshallnotbeconstruedtoprohibitdifferent
139		-	premiumrates,differentbenefits,ordifferentunderwritingprocedurefor
140		-	individualsinsuredundergroup,familyexpense,orblanketplansofinsurance.
141		-	§ 4014.ADVERTISINGPRACTICES
142		-	(a)NocompanydoingbusinessinthisState,andnoinsuranceagentor
143		-	broker,shalluseinconnectionwiththesolicitationofhealthinsuranceor
144		-	pharmacybenefitmanagementanyadvertisingcopyoradvertisingpracticeor
145		-	anyplanofsolicitationthatismateriallymisleadingordeceptive.An
146		-	advertisingcopyoradvertisingpracticeorplanofsolicitationshallbe
147		-	consideredtobemateriallymisleadingordeceptiveifbyimplicationor
148		-	otherwiseittransmitsinformationinsuchmannerorofsuchsubstancethata
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169		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	76	+
	77	+
	78	+	VT LEG #380165 v.1
	79	+	corporations, health maintenance organizations, and health care providers, to 1
	80	+	the extent permitted under federal law, pursuant to the Commissioner’s 2
	81	+	authority under this title. The Commissioner may also refer cases of 3
	82	+	noncompliance to the U.S. Department of Health and Human Services under 4
	83	+	the terms of a collaborative enforcement agreement, or to the Office of the 5
	84	+	Vermont Attorney General. 6
	85	+	§ 4013. DISCRIMINATION PROHIBITED 7
	86	+	No health insurer shall make or permit any unfair discrimination between 8
	87	+	individuals of substantially the same hazard in the amount of premium rates 9
	88	+	charged for any health insurance plan or in the benefits payable under the plan; 10
	89	+	provided, however, that this section shall not be construed to prohibit different 11
	90	+	premium rates, different benefits, or different underwriting procedure for 12
	91	+	individuals insured under group, family expense, or blanket plans of insurance. 13
	92	+	§ 4014. ADVERTISING PRACTICES 14
	93	+	(a) No company doing business in this State, and no insurance agent or 15
	94	+	broker, shall use in connection with the solicitation of health insurance or 16
	95	+	pharmacy benefit management any advertising copy or advertising practice or 17
	96	+	any plan of solicitation that is materially misleading or deceptive. An 18
	97	+	advertising copy or advertising practice or plan of solicitation shall be 19
	98	+	considered to be materially misleading or deceptive if by implication or 20
	99	+	otherwise it transmits information in such manner or of such substance that a 21 BILL AS INTRODUCED S.30
170	100		2025 Page 5 of 181
171		-	prospectiveapplicantforhealthinsurancemaybemisledbyittothe
172		-	applicant’smaterialdamage.
173		-	(b)(1)IftheCommissionerfindsthatanysuchadvertisingcopyor
174		-	advertisingpracticeorplanofsolicitationismateriallymisleadingor
175		-	deceptive,theCommissionershallorderthecompanyortheagentorbroker
176		-	usingsuchcopyorpracticeorplantoceaseanddesistfromsuchuse.
177		-	(2)Beforemakinganysuchfindingandorder,theCommissionershall
178		-	givenotice,notlessthan10daysinadvance,andahearingtothecompany,
179		-	agent,orbrokeraffected.
180		-	(3)IftheCommissionerfinds,afterduenoticeandhearing,thatany
181		-	authorizedinsurer,licensedpharmacybenefitmanager,licensedinsurance
182		-	agent,orlicensedinsurancebrokerhasintentionallyviolatedanysuchorderto
183		-	ceaseanddesist,theCommissionermaysuspendorrevokethelicenseofsuch
184		-	insurer,pharmacybenefitmanager,agent,orbroker.
185		-	§ 4015.PENALTIESFORVIOLATIONS
186		-	TheCommissionermayimposeanadministrativepenaltyofupto$750.00
187		-	onanypersonwhointentionallyviolatesanyprovisionofthischapterorany
188		-	orderoftheCommissionermadeinaccordancewiththischapter.The
189		-	Commissionermayalsosuspendorrevokethelicenseofahealthinsureror
190		-	agentforanysuchintentionalviolation.
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	101	+
	102	+
	103	+	VT LEG #380165 v.1
	104	+	prospective applicant for health insurance may be misled by it to the 1
	105	+	applicant’s material damage. 2
	106	+	(b)(1) If the Commissioner finds that any such advertising copy or 3
	107	+	advertising practice or plan of solicitation is materially misleading or 4
	108	+	deceptive, the Commissioner shall order the company or the agent or broker 5
	109	+	using such copy or practice or plan to cease and desist from such use. 6
	110	+	(2) Before making any such finding and order, the Commissioner shall 7
	111	+	give notice, not less than 10 days in advance, and a hearing to the company, 8
	112	+	agent, or broker affected. 9
	113	+	(3) If the Commissioner finds, after due notice and hearing, that any 10
	114	+	authorized insurer, licensed pharmacy benefit manager, licensed insurance 11
	115	+	agent, or licensed insurance broker has intentionally violated any such order to 12
	116	+	cease and desist, the Commissioner may suspend or revoke the license of such 13
	117	+	insurer, pharmacy benefit manager, agent, or broker. 14
	118	+	§ 4015. PENALTIES FOR VIOLATIONS 15
	119	+	The Commissioner may impose an administrative penalty of up to $750.00 16
	120	+	on any person who intentionally violates any provision of this chapter or any 17
	121	+	order of the Commissioner made in accordance with this chapter. The 18
	122	+	Commissioner may also suspend or revoke the license of a health insurer or 19
	123	+	agent for any such intentional violation. 20 BILL AS INTRODUCED S.30
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212		-	§ 4016.APPEAL
213		-	(a)AnypersonaggrievedbyanyactionoftheCommissionermayobtaina
214		-	reviewbyappealtotheSuperiorCourtofWashingtonCounty.Theappeal
215		-	shallbebasedontherecordoftheproceedingsbeforetheCommissionerand
216		-	shallnotbelimitedtoquestionsoflaw.Iftheappealisfromanorderofthe
217		-	Commissioner,theordershallnottakeeffectduringthependencyofthe
218		-	appealunlessthecourtdeterminesotherwise.
219		-	(b)Thecourtmayreviewallthefactsandindisposingofanyissuebefore
220		-	itmaymodify,affirm,orreverseanyorderoftheCommissionerinwholeorin
221		-	part.
222		-	(c)EitherpartymayappealfromthedecisionoftheSuperiorCourttothe
223		-	SupremeCourtinthemannerprovidedbylaw.
224		-	§ 4017.EXEMPTIONFROMATTACHMENTANDTRUSTEEPROCESS
225		-	Somuchofanybenefitsunderallpoliciesofhealthinsuranceasdoesnot
226		-	exceed$200.00foreachmonthduringanyperiodofdisabilitycoveredbythe
227		-	policyshallnotbeliabletoattachment,trusteeprocess,orotherprocess,orto
228		-	beseized,taken,appropriated,orappliedbyanylegalorequitableprocessor
229		-	byoperationoflaw,eitherbeforeorafterpaymentofsuchbenefits,topayany
230		-	debtorliabilitiesofthepersoninsuredunderthepolicy.However,this
231		-	exemptionshallnotapplywhereanactionisbroughttorecoverfornecessaries
232		-	contractedforduringtheperiodofdisabilityandthewritorbillofcomplaint
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	126	+
	127	+	VT LEG #380165 v.1
	128	+	§ 4016. APPEAL 1
	129	+	(a) Any person aggrieved by any action of the Commissioner may obtain a 2
	130	+	review by appeal to the Superior Court of Washington County. The appeal 3
	131	+	shall be based on the record of the proceedings before the Commissioner and 4
	132	+	shall not be limited to questions of law. If the appeal is from an order of the 5
	133	+	Commissioner, the order shall not take effect during the pendency of the 6
	134	+	appeal unless the court determines otherwise. 7
	135	+	(b) The court may review all the facts and in disposing of any issue before 8
	136	+	it may modify, affirm, or reverse any order of the Commissioner in whole or in 9
	137	+	part. 10
	138	+	(c) Either party may appeal from the decision of the Superior Court to the 11
	139	+	Supreme Court in the manner provided by law. 12
	140	+	§ 4017. EXEMPTION FROM ATTACHMENT AND TRUSTEE PROCESS 13
	141	+	So much of any benefits under all policies of health insurance as does not 14
	142	+	exceed $200.00 for each month during any period of disability covered by the 15
	143	+	policy shall not be liable to attachment, trustee process, or other process, or to 16
	144	+	be seized, taken, appropriated, or applied by any legal or equitable process or 17
	145	+	by operation of law, either before or after payment of such benefits, to pay any 18
	146	+	debt or liabilities of the person insured under the policy. However, this 19
	147	+	exemption shall not apply where an action is brought to recover for necessaries 20
	148	+	contracted for during the period of disability and the writ or bill of complaint 21 BILL AS INTRODUCED S.30
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255		-	containsastatementtothateffect.Whenapolicyprovidesforalumpsum
256		-	paymentbecauseofadismembermentorotherlossinsured,thepaymentshall
257		-	beexemptfromexecutionofthecoveredindividual’screditors.
258		-	§ 4018.THIRD-PARTYOWNERSHIP
259		-	Nothinginthischaptershallbeconstruedaspreventingapersonotherthan
260		-	thecoveredindividualwithproperinsurableinterestfrommakingapplication
261		-	forandowningapolicycoveringthecoveredindividualorfrombeingentitled
262		-	undersuchapolicytoanyindemnities,benefits,andrightsprovidedinthe
263		-	policy.
264		-	§ 4019.NOTICEASWAIVER
265		-	Ahealthinsurershallnotbedeemedtohavewaivedanyrightstodefenda
266		-	claimunderahealthinsuranceplanbasedsolelyonthehealthinsurer’s
267		-	acknowledgementofreceiptofnoticeundertheplan,furnishingoraccepting
268		-	formsforfilingproofoflossundertheplan,orinvestigatinganyclaimofloss
269		-	undertheplan.
270		-	§ 4020.AGELIMITS
271		-	(a)Ifahealthinsuranceplancontainsaprovisionestablishing,asanage
272		-	limitorotherwise,adateafterwhichthecoverageprovidedbytheplanwill
273		-	notbeeffective,andifthatdatefallswithinaperiodforwhichthehealth
274		-	insurerhasacceptedapremiumorifthehealthinsureracceptsapremiumafter
275		-	thatdate,thecoverageprovidedbytheplanshallcontinueinforcesubjectto
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	150	+
	151	+
	152	+	VT LEG #380165 v.1
	153	+	contains a statement to that effect. When a policy provides for a lump sum 1
	154	+	payment because of a dismemberment or other loss insured, the payment shall 2
	155	+	be exempt from execution of the covered individual’s creditors. 3
	156	+	§ 4018. THIRD-PARTY OWNERSHIP 4
	157	+	Nothing in this chapter shall be construed as preventing a person other than 5
	158	+	the covered individual with proper insurable interest from making application 6
	159	+	for and owning a policy covering the covered individual or from being entitled 7
	160	+	under such a policy to any indemnities, benefits, and rights provided in the 8
	161	+	policy. 9
	162	+	§ 4019. NOTICE AS WAIVER 10
	163	+	A health insurer shall not be deemed to have waived any rights to defend a 11
	164	+	claim under a health insurance plan based solely on the health insurer’s 12
	165	+	acknowledgement of receipt of notice under the plan, furnishing or accepting 13
	166	+	forms for filing proof of loss under the plan, or investigating any claim of loss 14
	167	+	under the plan. 15
	168	+	§ 4020. AGE LIMITS 16
	169	+	(a) If a health insurance plan contains a provision establishing, as an age 17
	170	+	limit or otherwise, a date after which the coverage provided by the plan will 18
	171	+	not be effective, and if that date falls within a period for which the health 19
	172	+	insurer has accepted a premium or if the health insurer accepts a premium after 20
	173	+	that date, the coverage provided by the plan shall continue in force subject to 21 BILL AS INTRODUCED S.30
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298		-	anyrightofcancellationuntiltheendoftheperiodforwhichapremiumhas
299		-	beenaccepted.
300		-	(b)Notwithstandinganyprovisionofsubsection(a)ofthissectiontothe
301		-	contrary,iftheageofthecoveredindividualhasbeenmisstatedandif,
302		-	accordingtothecorrectageofthecoveredindividual,thecoverageprovided
303		-	bythepolicywouldnothavebecomeeffectiveorwouldhaveceasedpriorto
304		-	thehealthinsurer’sacceptanceofthepremiumorpremiums,thenthehealth
305		-	insurer’sliabilityshallbelimitedtotherefund,uponrequest,ofallpremiums
306		-	paidfortheperiodnotcoveredbytheplan.
307		-	§ 4021.TERMINATIONOFCOVERAGE
308		-	(a)(1)Amajormedicalinsurancepolicyissuedbyahealthinsurerthat
309		-	insuresemployees,members,orsubscribersforhospitalandmedicalinsurance
310		-	onanexpense-incurred,service,orprepaidbasisshall:
311		-	(A)providenoticetothepolicyholderorotherresponsiblepartyof
312		-	anypremiumpaymentdueonapolicyatleast21daysbeforetheduedate;and
313		-	(B)provideagraceperiodofatleastonemonthforthepaymentof
314		-	eachpremiumfallingdueafterthefirstpremium,duringwhichgraceperiod
315		-	theplanshallcontinueinforceandtheissueroftheplanshallbeliablefor
316		-	validclaimsforcoveredlossesincurredpriortotheendofthegraceperiod.
317		-	(2)Iftheissuerofaplandescribedsubdivision(1)ofthissubsection
318		-	doesnotreceivepaymentbytheduedate,theissuershallsendatermination
319		-	1
320		-	2
321		-	3
322		-	4
323		-	5
324		-	6
325		-	7
326		-	8
327		-	9
328		-	10
329		-	11
330		-	12
331		-	13
332		-	14
333		-	15
334		-	16
335		-	17
336		-	18
337		-	19
338		-	20
339		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	175	+
	176	+
	177	+	VT LEG #380165 v.1
	178	+	any right of cancellation until the end of the period for which a premium has 1
	179	+	been accepted. 2
	180	+	(b) Notwithstanding any provision of subsection (a) of this section to the 3
	181	+	contrary, if the age of the covered individual has been misstated and if, 4
	182	+	according to the correct age of the covered individual, the coverage provided 5
	183	+	by the policy would not have become effective or would have ceased prior to 6
	184	+	the health insurer’s acceptance of the premium or premiums, then the health 7
	185	+	insurer’s liability shall be limited to the refund, upon request, of all premiums 8
	186	+	paid for the period not covered by the plan. 9
	187	+	§ 4021. TERMINATION OF COVERAGE 10
	188	+	(a)(1) A major medical insurance policy issued by a health insurer that 11
	189	+	insures employees, members, or subscribers for hospital and medical insurance 12
	190	+	on an expense-incurred, service, or prepaid basis shall: 13
	191	+	(A) provide notice to the policyholder or other responsible party of 14
	192	+	any premium payment due on a policy at least 21 days before the due date; and 15
	193	+	(B) provide a grace period of at least one month for the payment of 16
	194	+	each premium falling due after the first premium, during which grace period 17
	195	+	the plan shall continue in force and the issuer of the plan shall be liable for 18
	196	+	valid claims for covered losses incurred prior to the end of the grace period. 19
	197	+	(2) If the issuer of a plan described subdivision (1) of this subsection 20
	198	+	does not receive payment by the due date, the issuer shall send a termination 21 BILL AS INTRODUCED S.30
340	199		2025 Page 9 of 181
341		-	noticetothepolicyholderatleast21dayspriortoterminationnotifyingthe
342		-	policyholderthattheissuermayterminatetheplanifpaymentisnotreceived
343		-	bytheterminationdate.
344		-	(3)Theterminationdateofaplandescribedinsubdivision(1)ofthis
345		-	subsectionshallnotbeearlierthanthedayfollowingthelastdayofthegrace
346		-	periodsetforthinsubdivision(1)(A)ofthissubsection.
347		-	(b)Forallhealthinsurancepoliciesotherthanmajormedicalinsurance
348		-	policies,ahealthinsurershallnotifyapolicyholderofanypremiumpayment
349		-	dueonapolicyatleast21daysbeforetheduedate.Ifahealthinsurerdoes
350		-	notreceivepaymentbytheduedate,thehealthinsurershallsendatermination
351		-	noticetothepolicyholdernotifyingthepolicyholderthatthehealthinsurer
352		-	willterminatethepolicyeffectiveontheduedateifpaymentisnotreceived
353		-	within14daysfromthedateofmailingoftheterminationnotice.Ifahealth
354		-	insurerdoesnotreceivepaymentwithin14daysfromthedateofmailingof
355		-	theterminationnotice,thehealthinsurermaycancelcoverageeffectiveonthe
356		-	duedate.
357		-	§4022.REBATESANDCOMMISSIONSPROHIBITEDFORNONGROUP
358		-	ANDSMALLGROUPPOLICIESANDPLANSOFFERED
359		-	THROUGHTHEVERMONTHEALTHBENEFITEXCHANGE
360		-	(a)NohealthinsurerdoingbusinessinthisStateandnoinsuranceagentor
361		-	brokershall:
362		-	1
363		-	2
364		-	3
365		-	4
366		-	5
367		-	6
368		-	7
369		-	8
370		-	9
371		-	10
372		-	11
373		-	12
374		-	13
375		-	14
376		-	15
377		-	16
378		-	17
379		-	18
380		-	19
381		-	20
382		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	200	+
	201	+
	202	+	VT LEG #380165 v.1
	203	+	notice to the policyholder at least 21 days prior to termination notifying the 1
	204	+	policyholder that the issuer may terminate the plan if payment is not received 2
	205	+	by the termination date. 3
	206	+	(3) The termination date of a plan described in subdivision (1) of this 4
	207	+	subsection shall not be earlier than the day following the last day of the grace 5
	208	+	period set forth in subdivision (1)(A) of this subsection. 6
	209	+	(b) For all health insurance policies other than major medical insurance 7
	210	+	policies, a health insurer shall notify a policyholder of any premium payment 8
	211	+	due on a policy at least 21 days before the due date. If a health insurer does 9
	212	+	not receive payment by the due date, the health insurer shall send a termination 10
	213	+	notice to the policyholder notifying the policyholder that the health insurer will 11
	214	+	terminate the policy effective on the due date if payment is not received within 12
	215	+	14 days from the date of mailing of the termination notice. If a health insurer 13
	216	+	does not receive payment within 14 days from the date of mailing of the 14
	217	+	termination notice, the health insurer may cancel coverage effective on the due 15
	218	+	date. 16
	219	+	§ 4022. REBATES AND COMMISSIONS PROHIBITED FOR NONGROUP 17
	220	+	AND SMALL GROUP POLICIES AND PLANS OFFERED 18
	221	+	THROUGH THE VERMONT HEALTH BENEFIT EXCHANGE 19
	222	+	(a) No health insurer doing business in this State and no insurance agent or 20
	223	+	broker shall: 21 BILL AS INTRODUCED S.30
383	224		2025 Page 10 of 181
384		-	(1)offer,promise,allow,give,setoff,orpay,directlyorindirectly:
385		-	(A)anyrebateoforpartofthepremiumpayableonahealth
386		-	insuranceplanissuedpursuantto33V.S.A.§ 1811orearnings,profits,
387		-	dividends,orotherbenefitsfounded,arising,accruing,ortoaccrueonorfrom
388		-	thepremium;
389		-	(B)anyspecialadvantageindateofpolicyorageofissue;
390		-	(C)anypaidemploymentorcontractforservicesofanykind;
391		-	(D)anyothervaluableconsiderationorinducementtoorfor
392		-	insuranceonanyriskinthisState,orfororuponanyrenewalofanysuch
393		-	insurance,thatisnotspecifiedinthehealthinsuranceplan;or
394		-	(2)offer,promise,give,option,sell,orpurchaseanystocks,bonds,
395		-	securities,orproperty,oranydividendsorprofitsaccruingortoaccrueon
396		-	them,orotherthingofvalueasinducementtoinsuranceorinconnectionwith
397		-	insurance,oranyrenewalthereof,thatisnotspecifiedinthehealthinsurance
398		-	plan.
399		-	(b)Nopersoninsuredunderahealthinsuranceplanissuedpursuantto
400		-	33 V.S.A.§1811orpartyorapplicantforsuchplanshalldirectlyorindirectly
401		-	receiveoracceptoragreetoreceiveoracceptanyrebateofpremiumorofany
402		-	partofthepremium,oranyfavororadvantage,orshareinanybenefitto
403		-	accrueunderanyhealthinsuranceplanissuedpursuant33V.S.A.§1811,or
404		-	1
405		-	2
406		-	3
407		-	4
408		-	5
409		-	6
410		-	7
411		-	8
412		-	9
413		-	10
414		-	11
415		-	12
416		-	13
417		-	14
418		-	15
419		-	16
420		-	17
421		-	18
422		-	19
423		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	225	+
	226	+
	227	+	VT LEG #380165 v.1
	228	+	(1) offer, promise, allow, give, set off, or pay, directly or indirectly: 1
	229	+	(A) any rebate of or part of the premium payable on a health 2
	230	+	insurance plan issued pursuant to 33 V.S.A. § 1811 or earnings, profits, 3
	231	+	dividends, or other benefits founded, arising, accruing, or to accrue on or from 4
	232	+	the premium; 5
	233	+	(B) any special advantage in date of policy or age of issue; 6
	234	+	(C) any paid employment or contract for services of any kind; 7
	235	+	(D) any other valuable consideration or inducement to or for 8
	236	+	insurance on any risk in this State, or for or upon any renewal of any such 9
	237	+	insurance, that is not specified in the health insurance plan; or 10
	238	+	(2) offer, promise, give, option, sell, or purchase any stocks, bonds, 11
	239	+	securities, or property, or any dividends or profits accruing or to accrue on 12
	240	+	them, or other thing of value as inducement to insurance or in connection with 13
	241	+	insurance, or any renewal thereof, that is not specified in the health insurance 14
	242	+	plan. 15
	243	+	(b) No person insured under a health insurance plan issued pursuant to 16
	244	+	33 V.S.A. § 1811 or party or applicant for such plan shall directly or indirectly 17
	245	+	receive or accept or agree to receive or accept any rebate of premium or of any 18
	246	+	part of the premium, or any favor or advantage, or share in any benefit to 19
	247	+	accrue under any health insurance plan issued pursuant 33 V.S.A. § 1811, or 20 BILL AS INTRODUCED S.30
424	248		2025 Page 11 of 181
425		-	anyvaluableconsiderationorinducement,thatisnotspecifiedinthehealth
426		-	insuranceplan.
427		-	(c)Nothinginthissectionshallbeconstruedasprohibitinganyhealth
428		-	insurerfrom:
429		-	(1)allowingorreturningtoitsparticipatingpolicyholdersdividends,
430		-	savings,orunusedpremiumdeposits;
431		-	(2)returningorotherwiseabating,infullorinpart,thepremiumsofits
432		-	policyholdersoutofsurplusaccumulatedfromnonparticipatinginsurance;or
433		-	(3)takingabonafideobligation,withinterestnotexceedingsixpercent
434		-	perannum,inpaymentofanypremium.
435		-	(d)(1)Noinsurershallpayanycommission,fee,orothercompensation,
436		-	directlyorindirectly,toalicensedorunlicensedagent,broker,orother
437		-	individualinconnectionwiththesaleofahealthinsuranceplanissued
438		-	pursuantto33V.S.A.§1811,norshallahealthinsurerincludeinaninsurance
439		-	rateforahealthinsuranceplanissuedpursuantto33V.S.A.§1811anysums
440		-	relatedtoservicesprovidedbyanagent,broker,orotherindividual.Ahealth
441		-	insurermayprovidetoitsemployeeswages,salary,andotheremployment-
442		-	relatedcompensationinconnectionwiththesaleofhealthinsuranceplans,but
443		-	shallnotstructureanysuchcompensationinamannerthatpromotesthesale
444		-	ofparticularhealthinsuranceplansoverotherplansofferedbythatinsurer.
445		-	1
446		-	2
447		-	3
448		-	4
449		-	5
450		-	6
451		-	7
452		-	8
453		-	9
454		-	10
455		-	11
456		-	12
457		-	13
458		-	14
459		-	15
460		-	16
461		-	17
462		-	18
463		-	19
464		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	249	+
	250	+
	251	+	VT LEG #380165 v.1
	252	+	any valuable consideration or inducement, that is not specified in the health 1
	253	+	insurance plan. 2
	254	+	(c) Nothing in this section shall be construed as prohibiting any health 3
	255	+	insurer from: 4
	256	+	(1) allowing or returning to its participating policyholders dividends, 5
	257	+	savings, or unused premium deposits; 6
	258	+	(2) returning or otherwise abating, in full or in part, the premiums of its 7
	259	+	policyholders out of surplus accumulated from nonparticipating insurance; or 8
	260	+	(3) taking a bona fide obligation, with interest not exceeding six percent 9
	261	+	per annum, in payment of any premium. 10
	262	+	(d)(1) No insurer shall pay any commission, fee, or other compensation, 11
	263	+	directly or indirectly, to a licensed or unlicensed agent, broker, or other 12
	264	+	individual in connection with the sale of a health insurance plan issued 13
	265	+	pursuant to 33 V.S.A. § 1811, nor shall a health insurer include in an insurance 14
	266	+	rate for a health insurance plan issued pursuant to 33 V.S.A. § 1811 any sums 15
	267	+	related to services provided by an agent, broker, or other individual. A health 16
	268	+	insurer may provide to its employees wages, salary, and other employment-17
	269	+	related compensation in connection with the sale of health insurance plans, but 18
	270	+	shall not structure any such compensation in a manner that promotes the sale of 19
	271	+	particular health insurance plans over other plans offered by that insurer. 20 BILL AS INTRODUCED S.30
465	272		2025 Page 12 of 181
466		-	(2)NothinginthissubsectionshallbeconstruedtoprohibittheVermont
467		-	HealthBenefitExchangeestablishedin33V.S.A.chapter18,subchapter1
468		-	fromstructuringcompensationforagentsorbrokersintheformofan
469		-	additionalcommission,fee,orothercompensationoutsideinsuranceratesor
470		-	fromcompensatingagents,brokers,orotherindividualsthroughthe
471		-	proceduresandpaymentmechanismsestablishedpursuantto33V.S.A.
472		-	§ 1805(17).
473		-	§4022a.REBATESPROHIBITEDFORGROUPINSURANCEPOLICIES
474		-	(a)Asusedinthissection,“groupinsurance”meansanypolicydescribed
475		-	insection4041ofthistitle,exceptthatitshallnotincludeanysmallgroup
476		-	policyissuedpursuantto33V.S.A.§1811.
477		-	(b)NohealthinsurerdoingbusinessinthisStateandnoinsuranceagentor
478		-	brokershall:
479		-	(1)offer,promise,allow,give,setoff,orpay,directlyorindirectly:
480		-	(A)anyrebateoforpartofthepremiumpayableonagroup
481		-	insurancepolicy,oronanygroupinsurancepolicyoragent’scommissionon
482		-	thepremiumorearnings,profits,dividends,orotherbenefitsfounded,arising,
483		-	accruing,ortoaccrueonorfromthepremium;
484		-	(B)anyspecialadvantageindateofpolicyorageofissue;
485		-	(C)anypaidemploymentorcontractforservicesofanykind;or
486		-	1
487		-	2
488		-	3
489		-	4
490		-	5
491		-	6
492		-	7
493		-	8
494		-	9
495		-	10
496		-	11
497		-	12
498		-	13
499		-	14
500		-	15
501		-	16
502		-	17
503		-	18
504		-	19
505		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	273	+
	274	+
	275	+	VT LEG #380165 v.1
	276	+	(2) Nothing in this subsection shall be construed to prohibit the Vermont 1
	277	+	Health Benefit Exchange established in 33 V.S.A. chapter 18, subchapter 1 2
	278	+	from structuring compensation for agents or brokers in the form of an 3
	279	+	additional commission, fee, or other compensation outside insurance rates or 4
	280	+	from compensating agents, brokers, or other individuals through the 5
	281	+	procedures and payment mechanisms established pursuant to 33 V.S.A. 6
	282	+	§ 1805(17). 7
	283	+	§ 4022a. REBATES PROHIBITED FOR GROUP INSURANCE POLICIES 8
	284	+	(a) As used in this section, “group insurance” means any policy described 9
	285	+	in section 4041 of this title, except that it shall not include any small group 10
	286	+	policy issued pursuant to 33 V.S.A. § 1811. 11
	287	+	(b) No health insurer doing business in this State and no insurance agent or 12
	288	+	broker shall: 13
	289	+	(1) offer, promise, allow, give, set off, or pay, directly or indirectly: 14
	290	+	(A) any rebate of or part of the premium payable on a group 15
	291	+	insurance policy, or on any group insurance policy or agent’s commission on 16
	292	+	the premium or earnings, profits, dividends, or other benefits founded, arising, 17
	293	+	accruing, or to accrue on or from the premium; 18
	294	+	(B) any special advantage in date of policy or age of issue; 19
	295	+	(C) any paid employment or contract for services of any kind; or 20 BILL AS INTRODUCED S.30
506	296		2025 Page 13 of 181
507		-	(D)anyothervaluableconsiderationorinducementtoorfor
508		-	insuranceonanyriskinthisState,orfororuponanyrenewalofanysuch
509		-	insurance,thatisnotspecifiedinthehealthinsuranceplan;or
510		-	(2)offer,promise,give,option,sell,orpurchaseanystocks,bonds,
511		-	securities,orproperty,oranydividendsorprofitsaccruingortoaccrueon
512		-	them,orotherthingofvalueasinducementtoinsuranceorinconnectionwith
513		-	insurance,oranyrenewalthereof,thatisnotspecifiedinthehealthinsurance
514		-	plan.
515		-	(c)Nopersoninsuredunderagroupinsurancepolicyorpartyorapplicant
516		-	forgroupinsuranceshalldirectlyorindirectlyreceiveoracceptoragreeto
517		-	receiveoracceptanyrebateofpremiumorofanypartofthepremium,orall
518		-	oranypartofanyagent’sorbroker’scommissiononthepremium,orany
519		-	favororadvantage,orshareinanybenefittoaccrueunderanyhealth
520		-	insuranceplan,oranyvaluableconsiderationorinducement,thatisnot
521		-	specifiedinthehealthinsuranceplan.
522		-	(d)Nothinginthissectionshallbeconstruedasprohibiting:
523		-	(1)thepaymentofcommissionorothercompensationtoanyduly
524		-	licensedagentorbroker;
525		-	(2)anyhealthinsurerfromallowingorreturningtoitsparticipating
526		-	policyholdersdividends,savings,orunusedpremiumdeposits;
527		-	1
528		-	2
529		-	3
530		-	4
531		-	5
532		-	6
533		-	7
534		-	8
535		-	9
536		-	10
537		-	11
538		-	12
539		-	13
540		-	14
541		-	15
542		-	16
543		-	17
544		-	18
545		-	19
546		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	297	+
	298	+
	299	+	VT LEG #380165 v.1
	300	+	(D) any other valuable consideration or inducement to or for 1
	301	+	insurance on any risk in this State, or for or upon any renewal of any such 2
	302	+	insurance, that is not specified in the health insurance plan; or 3
	303	+	(2) offer, promise, give, option, sell, or purchase any stocks, bonds, 4
	304	+	securities, or property, or any dividends or profits accruing or to accrue on 5
	305	+	them, or other thing of value as inducement to insurance or in connection with 6
	306	+	insurance, or any renewal thereof, that is not specified in the health insurance 7
	307	+	plan. 8
	308	+	(c) No person insured under a group insurance policy or party or applicant 9
	309	+	for group insurance shall directly or indirectly receive or accept or agree to 10
	310	+	receive or accept any rebate of premium or of any part of the premium, or all 11
	311	+	or any part of any agent’s or broker’s commission on the premium, or any 12
	312	+	favor or advantage, or share in any benefit to accrue under any health 13
	313	+	insurance plan, or any valuable consideration or inducement, that is not 14
	314	+	specified in the health insurance plan. 15
	315	+	(d) Nothing in this section shall be construed as prohibiting: 16
	316	+	(1) the payment of commission or other compensation to any duly 17
	317	+	licensed agent or broker; 18
	318	+	(2) any health insurer from allowing or returning to its participating 19
	319	+	policyholders dividends, savings, or unused premium deposits; 20 BILL AS INTRODUCED S.30
547	320		2025 Page 14 of 181
548		-	(3)anyhealthinsurerfromreturningorotherwiseabating,infullorin
549		-	part,thepremiumsofitspolicyholdersoutofsurplusaccumulatedfrom
550		-	nonparticipatinginsurance;or
551		-	(4)thehealthinsurerfromtakingabonafideobligation,withinterest
552		-	notexceedingsixpercentperannum,inpaymentofanypremium.
553		-	(e)Ahealthinsurerthatpaysacommission,fee,orothercompensation,
554		-	directlyorindirectly,toalicensedorunlicensedagent,broker,orother
555		-	individualotherthanabonafideemployeeofthehealthinsurerinconnection
556		-	withthesaleofagroupinsurancepolicyshallclearlydisclosetothepurchaser
557		-	ofthepolicytheamountofanysuchcommission,fee,orcompensationpaidor
558		-	tobepaid.
559		-	§ 4023.PROVISIONSAPPLYINGTOPOLICIESDELIVEREDIN
560		-	ANOTHERSTATE
561		-	IfanypolicyisissuedbyahealthinsurerdomiciledinthisStatefor
562		-	deliverytoapersonresidinginanotherstate,andiftheofficialhaving
563		-	responsibilityfortheadministrationoftheinsurancelawsoftheotherstate
564		-	informstheCommissionerthatthepolicyisnotsubjecttoapprovalor
565		-	disapprovalbytheofficial,theCommissionermayissueanorderrequiring
566		-	thatthepolicymeetthestandardssetforthinsections4029,4030,and4031of
567		-	thistitle.
568		-	1
569		-	2
570		-	3
571		-	4
572		-	5
573		-	6
574		-	7
575		-	8
576		-	9
577		-	10
578		-	11
579		-	12
580		-	13
581		-	14
582		-	15
583		-	16
584		-	17
585		-	18
586		-	19
587		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	321	+
	322	+
	323	+	VT LEG #380165 v.1
	324	+	(3) any health insurer from returning or otherwise abating, in full or in 1
	325	+	part, the premiums of its policyholders out of surplus accumulated from 2
	326	+	nonparticipating insurance; or 3
	327	+	(4) the health insurer from taking a bona fide obligation, with interest 4
	328	+	not exceeding six percent per annum, in payment of any premium. 5
	329	+	(e) A health insurer that pays a commission, fee, or other compensation, 6
	330	+	directly or indirectly, to a licensed or unlicensed agent, broker, or other 7
	331	+	individual other than a bona fide employee of the health insurer in connection 8
	332	+	with the sale of a group insurance policy shall clearly disclose to the purchaser 9
	333	+	of the policy the amount of any such commission, fee, or compensation paid or 10
	334	+	to be paid. 11
	335	+	§ 4023. PROVISIONS APPLYING TO POLICIES DELIVERED IN 12
	336	+	ANOTHER STATE 13
	337	+	If any policy is issued by a health insurer domiciled in this State for 14
	338	+	delivery to a person residing in another state, and if the official having 15
	339	+	responsibility for the administration of the insurance laws of the other state 16
	340	+	informs the Commissioner that the policy is not subject to approval or 17
	341	+	disapproval by the official, the Commissioner may issue an order requiring that 18
	342	+	the policy meet the standards set forth in sections 4029, 4030, and 4031 of this 19
	343	+	title. 20 BILL AS INTRODUCED S.30
588	344		2025 Page 15 of 181
589		-	§ 4024.COORDINATIONOFINSURANCECOVERAGEWITH
590		-	MEDICAIDANDCOMPLIANCEWITHMEDICAIDRECOVERY
591		-	PROVISIONS
592		-	(a)Nohealthinsurershallconsidertheavailabilityoforeligibilityfor
593		-	medicalassistanceinthisoranyotherstateunderTitleXIXoftheSocial
594		-	SecurityAct(Medicaid)whenconsideringeligibilityforcoverageormaking
595		-	paymentsunderitsplanforeligibleenrollees,subscribers,policyholders,or
596		-	certificateholders.
597		-	(b)Ahealthinsurerthatissues,sells,renews,oroffershealthinsurance
598		-	coverageinVermontorwhoisrequiredtobelicensedorregisteredwiththe
599		-	Departmentshallcomplywiththerequirementsof33V.S.A.§§1907,1908,
600		-	1909,and1910.TheCommissionershallenforcesuchrequirementspursuant
601		-	totheCommissioner’sauthorityunderthistitle.
602		-	§ 4025.HEALTHINSURANCEANDTHEBLUEPRINTFORHEALTH
603		-	(a)Allmajormedicalinsuranceplansshallbeoffered,issued,and
604		-	administeredconsistentwiththeBlueprintforHealthestablishedin18V.S.A.
605		-	chapter13.
606		-	(b)Healthinsurersofferingmajormedicalinsuranceplansshallparticipate
607		-	intheBlueprintforHealthasspecifiedin18V.S.A.§706.
608		-	1
609		-	2
610		-	3
611		-	4
612		-	5
613		-	6
614		-	7
615		-	8
616		-	9
617		-	10
618		-	11
619		-	12
620		-	13
621		-	14
622		-	15
623		-	16
624		-	17
625		-	18
626		-	19 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	345	+
	346	+
	347	+	VT LEG #380165 v.1
	348	+	§ 4024. COORDINATION OF INSURANCE COVERAGE WITH 1
	349	+	MEDICAID AND COMPLIANCE WITH MEDICAID RECOVERY 2
	350	+	PROVISIONS 3
	351	+	(a) No health insurer shall consider the availability of or eligibility for 4
	352	+	medical assistance in this or any other state under Title XIX of the Social 5
	353	+	Security Act (Medicaid) when considering eligibility for coverage or making 6
	354	+	payments under its plan for eligible enrollees, subscribers, policyholders, or 7
	355	+	certificate holders. 8
	356	+	(b) A health insurer that issues, sells, renews, or offers health insurance 9
	357	+	coverage in Vermont or who is required to be licensed or registered with the 10
	358	+	Department shall comply with the requirements of 33 V.S.A. §§ 1907, 1908, 11
	359	+	1909, and 1910. The Commissioner shall enforce such requirements pursuant 12
	360	+	to the Commissioner’s authority under this title. 13
	361	+	§ 4025. HEALTH INSURANCE AND THE BLUEPRINT FOR HEALTH 14
	362	+	(a) All major medical insurance plans shall be offered, issued, and 15
	363	+	administered consistent with the Blueprint for Health established in 18 V.S.A. 16
	364	+	chapter 13. 17
	365	+	(b) Health insurers offering major medical insurance plans shall participate 18
	366	+	in the Blueprint for Health as specified in 18 V.S.A. § 706. 19 BILL AS INTRODUCED S.30
627	367		2025 Page 16 of 181
628		-	Subchapter2.PolicyFormsandFilingRequirements
629		-	§ 4026.FILINGANDAPPROVALOFPOLICYFORMSANDPREMIUMS
630		-	(a)(1)Nopolicyofhealthinsuranceorcertificateunderapolicyfiledbya
631		-	healthinsurerandnotexemptedbysubdivision3368(a)(4)ofthistitleshallbe
632		-	deliveredorissuedfordeliveryinthisState,norshallanyendorsement,rider,
633		-	orapplicationthatbecomesapartofanysuchpolicybeused,untilacopyof
634		-	theformandoftherulesfortheclassificationofriskshasbeenfiledwiththe
635		-	DepartmentofFinancialRegulationandacopyofthepremiumrateshasbeen
636		-	filedwiththeGreenMountainCareBoard,andtheGreenMountainCare
637		-	Boardhasissuedadecisionapproving,modifying,ordisapprovingthe
638		-	proposedrate.
639		-	(2)(A)TheGreenMountainCareBoardshallreviewraterequestsand
640		-	shallapprove,modify,ordisapprovearaterequestwithin90calendardays
641		-	afterreceiptofaninitialratefilingfromahealthinsurer.Ifahealthinsurer
642		-	failstoprovidenecessarymaterialsorotherinformationtotheBoardina
643		-	timelymanner,theBoardmayextenditsreviewforareasonableadditional
644		-	periodoftime,nottoexceed30calendardays.
645		-	(B)PriortotheBoard’sdecisiononaraterequest,theDepartmentof
646		-	FinancialRegulationshallprovidetheBoardwithananalysisandopinionon
647		-	theimpactoftheproposedrateontheinsurer’ssolvencyandreserves.
648		-	1
649		-	2
650		-	3
651		-	4
652		-	5
653		-	6
654		-	7
655		-	8
656		-	9
657		-	10
658		-	11
659		-	12
660		-	13
661		-	14
662		-	15
663		-	16
664		-	17
665		-	18
666		-	19
667		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	368	+
	369	+
	370	+	VT LEG #380165 v.1
	371	+	Subchapter 2. Policy Forms and Filing Requirements 1
	372	+	§ 4026. FILING AND APPROVAL OF POLICY FORMS AND PREMIUMS 2
	373	+	(a)(1) No policy of health insurance or certificate under a policy filed by a 3
	374	+	health insurer and not exempted by subdivision 3368(a)(4) of this title shall be 4
	375	+	delivered or issued for delivery in this State, nor shall any endorsement, rider, 5
	376	+	or application that becomes a part of any such policy be used, until a copy of 6
	377	+	the form and of the rules for the classification of risks has been filed with the 7
	378	+	Department of Financial Regulation and a copy of the premium rates has been 8
	379	+	filed with the Green Mountain Care Board, and the Green Mountain Care 9
	380	+	Board has issued a decision approving, modifying, or disapproving the 10
	381	+	proposed rate. 11
	382	+	(2)(A) The Green Mountain Care Board shall review rate requests and 12
	383	+	shall approve, modify, or disapprove a rate request within 90 calendar days 13
	384	+	after receipt of an initial rate filing from a health insurer. If a health insurer 14
	385	+	fails to provide necessary materials or other information to the Board in a 15
	386	+	timely manner, the Board may extend its review for a reasonable additional 16
	387	+	period of time, not to exceed 30 calendar days. 17
	388	+	(B) Prior to the Board’s decision on a rate request, the Department of 18
	389	+	Financial Regulation shall provide the Board with an analysis and opinion on 19
	390	+	the impact of the proposed rate on the insurer’s solvency and reserves. 20 BILL AS INTRODUCED S.30
668	391		2025 Page 17 of 181
669		-	(3)TheBoardshalldeterminewhetherarateisaffordable;promotes
670		-	qualitycare;promotesaccesstohealthcare;protectsinsurersolvency;andis
671		-	notunjust,unfair,inequitable,misleading,orcontrarytothelawsofthisState.
672		-	Inmakingthisdetermination,theBoardshallconsidertheanalysisandopinion
673		-	providedbytheDepartmentofFinancialRegulationpursuanttosubdivision
674		-	(2)(B)ofthissubsection.
675		-	(b)(1)Inconjunctionwitharatefilingrequiredbysubsection(a)ofthis
676		-	section,ahealthinsurershallfileaplainlanguagesummaryoftheproposed
677		-	rate.Allsummariesshallincludeabriefjustificationofanyrateincrease
678		-	requested,theinformationthattheSecretaryoftheU.S.DepartmentofHealth
679		-	andHumanServices(HHS)requiresforrateincreasesover10percent,and
680		-	anyotherinformationrequiredbytheBoard.Theplainlanguagesummary
681		-	shallbeintheformatrequiredbytheSecretaryofHHSpursuanttothePatient
682		-	ProtectionandAffordableCareActof2010,Pub.L.No.111-148,asamended
683		-	bytheHealthCareandEducationReconciliationActof2010,Pub.L.No.
684		-	111-152,andshallincludenotificationofthepubliccommentperiod
685		-	establishedinsubsection(c)ofthissection.Inaddition,theinsurershallpost
686		-	thesummariesonitswebsite.
687		-	(2)(A)Inconjunctionwitharatefilingrequiredbysubsection(a)ofthis
688		-	section,ahealthinsurershalldisclosetotheBoard:
689		-	1
690		-	2
691		-	3
692		-	4
693		-	5
694		-	6
695		-	7
696		-	8
697		-	9
698		-	10
699		-	11
700		-	12
701		-	13
702		-	14
703		-	15
704		-	16
705		-	17
706		-	18
707		-	19
708		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	392	+
	393	+
	394	+	VT LEG #380165 v.1
	395	+	(3) The Board shall determine whether a rate is affordable; promotes 1
	396	+	quality care; promotes access to health care; protects insurer solvency; and is 2
	397	+	not unjust, unfair, inequitable, misleading, or contrary to the laws of this State. 3
	398	+	In making this determination, the Board shall consider the analysis and opinion 4
	399	+	provided by the Department of Financial Regulation pursuant to subdivision 5
	400	+	(2)(B) of this subsection. 6
	401	+	(b)(1) In conjunction with a rate filing required by subsection (a) of this 7
	402	+	section, a health insurer shall file a plain language summary of the proposed 8
	403	+	rate. All summaries shall include a brief justification of any rate increase 9
	404	+	requested, the information that the Secretary of the U.S. Department of Health 10
	405	+	and Human Services (HHS) requires for rate increases over 10 percent, and 11
	406	+	any other information required by the Board. The plain language summary 12
	407	+	shall be in the format required by the Secretary of HHS pursuant to the Patient 13
	408	+	Protection and Affordable Care Act of 2010, Pub. L. No. 111-148, as amended 14
	409	+	by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 15
	410	+	111-152, and shall include notification of the public comment period 16
	411	+	established in subsection (c) of this section. In addition, the insurer shall post 17
	412	+	the summaries on its website. 18
	413	+	(2)(A) In conjunction with a rate filing required by subsection (a) of this 19
	414	+	section, a health insurer shall disclose to the Board: 20 BILL AS INTRODUCED S.30
709	415		2025 Page 18 of 181
710		-	(i)forallcoveredprescriptiondrugs,includinggenericdrugs,
711		-	brand-namedrugsexcludingspecialtydrugs,andspecialtydrugsdispensedata
712		-	pharmacy,networkpharmacy,ormail-orderpharmacyforoutpatientuse:
713		-	(I)thepercentageofthepremiumrateattributableto
714		-	prescriptiondrugcostsfortheprioryearforeachcategoryofprescription
715		-	drugs;
716		-	(II)theyear-over-yearincreaseordecrease,expressedasa
717		-	percentage,inper-member,per-monthtotalhealthplanspendingoneach
718		-	categoryofprescriptiondrugs;and
719		-	(III)theyear-over-yearincreaseordecreaseinper-member,
720		-	per-monthcostsforprescriptiondrugscomparedtoothercomponentsofthe
721		-	premiumrate;and
722		-	(ii)thespecialtytierformularylist.
723		-	(B)Theinsurershallprovide,ifavailable,thepercentageofthe
724		-	premiumrateattributabletoprescriptiondrugsadministeredbyahealthcare
725		-	providerinanoutpatientsettingthatarepartofthemedicalbenefitasseparate
726		-	fromthepharmacybenefit.
727		-	(C)Theinsurershallincludeinformationonitsuseofapharmacy
728		-	benefitmanager,ifany,includingwhichcomponentsoftheprescriptiondrug
729		-	coveragedescribedinsubdivisions(A)and(B)ofthissubdivision(2)are
730		-	1
731		-	2
732		-	3
733		-	4
734		-	5
735		-	6
736		-	7
737		-	8
738		-	9
739		-	10
740		-	11
741		-	12
742		-	13
743		-	14
744		-	15
745		-	16
746		-	17
747		-	18
748		-	19
749		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	416	+
	417	+
	418	+	VT LEG #380165 v.1
	419	+	(i) for all covered prescription drugs, including generic drugs, 1
	420	+	brand-name drugs excluding specialty drugs, and specialty drugs dispensed at a 2
	421	+	pharmacy, network pharmacy, or mail-order pharmacy for outpatient use: 3
	422	+	(I) the percentage of the premium rate attributable to 4
	423	+	prescription drug costs for the prior year for each category of prescription 5
	424	+	drugs; 6
	425	+	(II) the year-over-year increase or decrease, expressed as a 7
	426	+	percentage, in per-member, per-month total health plan spending on each 8
	427	+	category of prescription drugs; and 9
	428	+	(III) the year-over-year increase or decrease in per-member, 10
	429	+	per-month costs for prescription drugs compared to other components of the 11
	430	+	premium rate; and 12
	431	+	(ii) the specialty tier formulary list. 13
	432	+	(B) The insurer shall provide, if available, the percentage of the 14
	433	+	premium rate attributable to prescription drugs administered by a health care 15
	434	+	provider in an outpatient setting that are part of the medical benefit as separate 16
	435	+	from the pharmacy benefit. 17
	436	+	(C) The insurer shall include information on its use of a pharmacy 18
	437	+	benefit manager, if any, including which components of the prescription drug 19
	438	+	coverage described in subdivisions (A) and (B) of this subdivision (2) are 20 BILL AS INTRODUCED S.30
750	439		2025 Page 19 of 181
751		-	managedbythepharmacybenefitmanager,aswellasthenameofthe
752		-	pharmacybenefitmanagerormanagersused.
753		-	(3)(A)Uponrequest,inconjunctionwitharatefilingrequiredby
754		-	subsection(a)ofthissection,ahealthinsurershallprovidetotheBoard
755		-	detailedinformationabouttheinsurer’spaymentstospecificproviders,which
756		-	mayincludefeeschedules,paymentmethodologies,andotherpayment
757		-	informationspecifiedbytheBoard.
758		-	(B)Confidentialbusinessinformationandtradesecretsreceived
759		-	fromahealthinsurerpursuanttosubdivision(A)ofthissubdivision(3)shall
760		-	beexemptfrompublicinspectionandcopyingunder1V.S.A.§317(c)(9)and
761		-	shallbekeptconfidential,exceptthattheBoardmaydiscloseorrelease
762		-	informationpubliclyinsummaryoraggregateformifdoingsowouldnot
763		-	discloseconfidentialbusinessinformationortradesecrets.
764		-	(C)Notwithstanding1V.S.A.chapter5,subchapter2(Vermont
765		-	OpenMeetingLaw),theBoardmayexamineanddiscussconfidential
766		-	informationoutsideapublichearingormeeting.
767		-	(c)(1)TheBoardshallprovideinformationtothepublicontheBoard’s
768		-	websiteaboutthepublicavailabilityofthefilingsandsummariesrequired
769		-	underthissection.
770		-	(2)(A)TheBoardshallposttheratefilingspursuanttosubsection(a)of
771		-	thissectionandsummariespursuanttosubsection(b)ofthissectiononthe
772		-	1
773		-	2
774		-	3
775		-	4
776		-	5
777		-	6
778		-	7
779		-	8
780		-	9
781		-	10
782		-	11
783		-	12
784		-	13
785		-	14
786		-	15
787		-	16
788		-	17
789		-	18
790		-	19
791		-	20
792		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	440	+
	441	+
	442	+	VT LEG #380165 v.1
	443	+	managed by the pharmacy benefit manager, as well as the name of the 1
	444	+	pharmacy benefit manager or managers used. 2
	445	+	(3)(A) Upon request, in conjunction with a rate filing required by 3
	446	+	subsection (a) of this section, a health insurer shall provide to the Board 4
	447	+	detailed information about the insurer’s payments to specific providers, which 5
	448	+	may include fee schedules, payment methodologies, and other payment 6
	449	+	information specified by the Board. 7
	450	+	(B) Confidential business information and trade secrets received from 8
	451	+	a health insurer pursuant to subdivision (A) of this subdivision (3) shall be 9
	452	+	exempt from public inspection and copying under 1 V.S.A. § 317(c)(9) and 10
	453	+	shall be kept confidential, except that the Board may disclose or release 11
	454	+	information publicly in summary or aggregate form if doing so would not 12
	455	+	disclose confidential business information or trade secrets. 13
	456	+	(C) Notwithstanding 1 V.S.A. chapter 5, subchapter 2 (Vermont 14
	457	+	Open Meeting Law), the Board may examine and discuss confidential 15
	458	+	information outside a public hearing or meeting. 16
	459	+	(c)(1) The Board shall provide information to the public on the Board’s 17
	460	+	website about the public availability of the filings and summaries required 18
	461	+	under this section. 19
	462	+	(2)(A) The Board shall post the rate filings pursuant to subsection (a) of 20
	463	+	this section and summaries pursuant to subsection (b) of this section on the 21 BILL AS INTRODUCED S.30
793	464		2025 Page 20 of 181
794		-	Board’swebsitewithinfivecalendardaysfollowingfiling.TheBoardshall
795		-	alsoestablishamechanismbywhichmembersofthepublicmayrequesttobe
796		-	notifiedautomaticallyeachtimeaproposedrateisfiledwiththeBoard.
797		-	(B)TheBoardshallprovideanelectronicmechanismforthepublic
798		-	tocommentonallratefilings.TheBoardshallacceptpubliccommenton
799		-	eachratefilingfromthedateonwhichtheBoardpoststheratefilingonits
800		-	websitepursuanttosubdivision(A)ofthissubdivision(2)until15calendar
801		-	daysaftertheBoardpostsonitswebsitetheanalysesandopinionsofthe
802		-	DepartmentofFinancialRegulationandoftheBoard’sconsultingactuary,if
803		-	any,asrequiredbysubsection(d)ofthissection.TheBoardshallreviewand
804		-	considerthepubliccommentspriortoissuingitsdecision.
805		-	(3)(A)Inadditiontothepubliccommentprovisionssetforthinthis
806		-	subsection,theOfficeoftheHealthCareAdvocateestablishedin18V.S.A.
807		-	chapter229,actingonbehalfofhealthinsuranceconsumersinthisState,may,
808		-	within30calendardaysaftertheBoardreceivesahealthinsurer’sraterequest
809		-	pursuanttothissection,submittotheBoard,inwriting,suggestedquestions
810		-	regardingthefilingfortheBoardtoprovidetoitscontractingactuary,ifany.
811		-	(B)TheOfficeoftheHealthCareAdvocatemayalsosubmittothe
812		-	Boardwrittencommentsonahealthinsurer’sraterequest.TheBoardshall
813		-	postthecommentsonitswebsiteandshallconsiderthecommentspriorto
814		-	issuingitsdecision.
815		-	1
816		-	2
817		-	3
818		-	4
819		-	5
820		-	6
821		-	7
822		-	8
823		-	9
824		-	10
825		-	11
826		-	12
827		-	13
828		-	14
829		-	15
830		-	16
831		-	17
832		-	18
833		-	19
834		-	20
835		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	465	+
	466	+
	467	+	VT LEG #380165 v.1
	468	+	Board’s website within five calendar days following filing. The Board shall 1
	469	+	also establish a mechanism by which members of the public may request to be 2
	470	+	notified automatically each time a proposed rate is filed with the Board. 3
	471	+	(B) The Board shall provide an electronic mechanism for the public 4
	472	+	to comment on all rate filings. The Board shall accept public comment on each 5
	473	+	rate filing from the date on which the Board posts the rate filing on its website 6
	474	+	pursuant to subdivision (A) of this subdivision (2) until 15 calendar days after 7
	475	+	the Board posts on its website the analyses and opinions of the Department of 8
	476	+	Financial Regulation and of the Board’s consulting actuary, if any, as required 9
	477	+	by subsection (d) of this section. The Board shall review and consider the 10
	478	+	public comments prior to issuing its decision. 11
	479	+	(3)(A) In addition to the public comment provisions set forth in this 12
	480	+	subsection, the Office of the Health Care Advocate established in 18 V.S.A. 13
	481	+	chapter 229, acting on behalf of health insurance consumers in this State, may, 14
	482	+	within 30 calendar days after the Board receives a health insurer’s rate request 15
	483	+	pursuant to this section, submit to the Board, in writing, suggested questions 16
	484	+	regarding the filing for the Board to provide to its contracting actuary, if any. 17
	485	+	(B) The Office of the Health Care Advocate may also submit to the 18
	486	+	Board written comments on a health insurer’s rate request. The Board shall 19
	487	+	post the comments on its website and shall consider the comments prior to 20
	488	+	issuing its decision. 21 BILL AS INTRODUCED S.30
836	489		2025 Page 21 of 181
837		-	(d)(1)Notlaterthan60calendardaysafterreceivingahealthinsurer’srate
838		-	requestpursuanttothissection,theGreenMountainCareBoardshallmake
839		-	availabletothepublictheinsurer’sratefiling,theDepartment’sanalysisand
840		-	opinionoftheeffectoftheproposedrateontheinsurer’ssolvency,andthe
841		-	analysisandopinionoftheratefilingbytheBoard’scontractingactuary,if
842		-	any.
843		-	(2)TheBoardshallpostonitswebsite,afterredactinganyconfidential
844		-	orproprietaryinformationrelatingtotheinsurerortotheinsurer’sratefiling:
845		-	(A)allquestionstheBoardposestoitscontractingactuary,ifany,
846		-	andtheactuary’sresponsestotheBoard’squestions;and
847		-	(B)allquestionstheBoard;theBoard’scontractingactuary,ifany;
848		-	ortheDepartmentposestotheinsurerandtheinsurer’sresponsestothose
849		-	questions.
850		-	(e)Withinthetimeperiodsetforthinsubdivision(a)(2)(A)ofthissection,
851		-	theBoardshall:
852		-	(1)conductapublichearing,atwhichtheBoardshall:
853		-	(A)callaswitnessestheCommissionerofFinancialRegulationor
854		-	designeeandtheBoard’scontractingactuary,ifany,unlessallpartiesagreeto
855		-	waivesuchtestimony;and
856		-	(B)provideanopportunityfortestimonyfromtheinsurer,theOffice
857		-	oftheHealthCareAdvocate,andmembersofthepublic;
858		-	1
859		-	2
860		-	3
861		-	4
862		-	5
863		-	6
864		-	7
865		-	8
866		-	9
867		-	10
868		-	11
869		-	12
870		-	13
871		-	14
872		-	15
873		-	16
874		-	17
875		-	18
876		-	19
877		-	20
878		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	490	+
	491	+
	492	+	VT LEG #380165 v.1
	493	+	(d)(1) Not later than 60 calendar days after receiving a health insurer’s rate 1
	494	+	request pursuant to this section, the Green Mountain Care Board shall make 2
	495	+	available to the public the insurer’s rate filing, the Department’s analysis and 3
	496	+	opinion of the effect of the proposed rate on the insurer’s solvency, and the 4
	497	+	analysis and opinion of the rate filing by the Board’s contracting actuary, if 5
	498	+	any. 6
	499	+	(2) The Board shall post on its website, after redacting any confidential 7
	500	+	or proprietary information relating to the insurer or to the insurer’s rate filing: 8
	501	+	(A) all questions the Board poses to its contracting actuary, if any, 9
	502	+	and the actuary’s responses to the Board’s questions; and 10
	503	+	(B) all questions the Board; the Board’s contracting actuary, if any; 11
	504	+	or the Department poses to the insurer and the insurer’s responses to those 12
	505	+	questions. 13
	506	+	(e) Within the time period set forth in subdivision (a)(2)(A) of this section, 14
	507	+	the Board shall: 15
	508	+	(1) conduct a public hearing, at which the Board shall: 16
	509	+	(A) call as witnesses the Commissioner of Financial Regulation or 17
	510	+	designee and the Board’s contracting actuary, if any, unless all parties agree to 18
	511	+	waive such testimony; and 19
	512	+	(B) provide an opportunity for testimony from the insurer, the Office 20
	513	+	of the Health Care Advocate, and members of the public; 21 BILL AS INTRODUCED S.30
879	514		2025 Page 22 of 181
880		-	(2)atapublichearing,announcetheBoard’sdecisionofwhetherto
881		-	approve,modify,ordisapprovetheproposedrate;and
882		-	(3)issueitsdecisioninwriting.
883		-	(f)(1)TheinsurershallnotifyitspolicyholdersoftheBoard’sdecisionina
884		-	timelymanner,asdefinedbytheBoardbyrule.
885		-	(2)Ratesshalltakeeffectonthedatespecifiedintheinsurer’srate
886		-	filing.
887		-	(3)IftheBoardhasnotissueditsdecisionbytheeffectivedate
888		-	specifiedintheinsurer’sratefiling,theinsurershallnotifyitspolicyholdersof
889		-	itspendingraterequestandoftheeffectivedateproposedbytheinsurerinits
890		-	ratefiling.
891		-	(g)Ahealthinsurer,theOfficeoftheHealthCareAdvocate,andany
892		-	memberofthepublicwithpartystatus,asdefinedbytheBoardbyrule,may
893		-	appealadecisionoftheBoardapproving,modifying,ordisapprovingthe
894		-	insurer’sproposedratetotheVermontSupremeCourt.
895		-	(h)(1)TheauthorityoftheBoardunderthissectionshallapplyonlytothe
896		-	ratereviewprocessforpoliciesformajormedicalinsurancecoverageandshall
897		-	notapplytothepolicyformsformajormedicalinsurancecoverageortothe
898		-	rateandpolicyformreviewprocessforpoliciesforspecificdisease,accident,
899		-	injury,hospitalindemnity,dentalcare,visioncare,disabilityincome,long-
900		-	termcare,studenthealthinsurancecoverage,Medicaresupplementinsurance
901		-	1
902		-	2
903		-	3
904		-	4
905		-	5
906		-	6
907		-	7
908		-	8
909		-	9
910		-	10
911		-	11
912		-	12
913		-	13
914		-	14
915		-	15
916		-	16
917		-	17
918		-	18
919		-	19
920		-	20
921		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	515	+
	516	+
	517	+	VT LEG #380165 v.1
	518	+	(2) at a public hearing, announce the Board’s decision of whether to 1
	519	+	approve, modify, or disapprove the proposed rate; and 2
	520	+	(3) issue its decision in writing. 3
	521	+	(f)(1) The insurer shall notify its policyholders of the Board’s decision in a 4
	522	+	timely manner, as defined by the Board by rule. 5
	523	+	(2) Rates shall take effect on the date specified in the insurer’s rate 6
	524	+	filing. 7
	525	+	(3) If the Board has not issued its decision by the effective date specified 8
	526	+	in the insurer’s rate filing, the insurer shall notify its policyholders of its 9
	527	+	pending rate request and of the effective date proposed by the insurer in its rate 10
	528	+	filing. 11
	529	+	(g) A health insurer, the Office of the Health Care Advocate, and any 12
	530	+	member of the public with party status, as defined by the Board by rule, may 13
	531	+	appeal a decision of the Board approving, modifying, or disapproving the 14
	532	+	insurer’s proposed rate to the Vermont Supreme Court. 15
	533	+	(h)(1) The authority of the Board under this section shall apply only to the 16
	534	+	rate review process for policies for major medical insurance coverage and shall 17
	535	+	not apply to the policy forms for major medical insurance coverage or to the 18
	536	+	rate and policy form review process for policies for specific disease, accident, 19
	537	+	injury, hospital indemnity, dental care, vision care, disability income, long-20
	538	+	term care, student health insurance coverage, Medicare supplement insurance 21 BILL AS INTRODUCED S.30
922	539		2025 Page 23 of 181
923		-	coverage,orotherlimitedbenefitcoverage;toshort-term,limited-duration
924		-	healthinsurancecoverage;ortobenefitplansthatarepaiddirectlytoan
925		-	individualinsuredortotheindividual’sassignsandforwhichtheamountof
926		-	thebenefitisnotbasedonpotentialmedicalcostsoractualcostsincurred.
927		-	PremiumratesandrulesfortheclassificationofriskforMedicaresupplement
928		-	insurancepoliciesshallbegovernedbysection4051ofthistitle.
929		-	(2)Thepolicyformsformajormedicalinsurancecoverage,aswellas
930		-	thepolicyforms,premiumrates,andrulesfortheclassificationofriskforthe
931		-	otherlinesofinsurancedescribedinsubdivision(1)ofthissubsectionshallbe
932		-	reviewedandapprovedordisapprovedbytheCommissioner.Inmakinga
933		-	determination,theCommissionershallconsiderwhetherapolicyform,
934		-	premiumrate,orruleisaffordableandisnotunjust,unfair,inequitable,
935		-	misleading,orcontrarytothelawsofthisState;and,forapolicyformfor
936		-	majormedicalinsurancecoverage,whetheritensuresequalaccessto
937		-	appropriatementalhealthcareinamannerequivalenttootheraspectsof
938		-	healthcareaspartofanintegrated,holisticsystemofcare.TheCommissioner
939		-	shallmakeadeterminationwithin30daysafterthedatetheinsurerfiledthe
940		-	policyform,premiumrate,orrulewiththeDepartment.Attheexpirationof
941		-	the30-dayperiod,theform,premiumrate,orruleshallbedeemedapproved
942		-	unlesspriortothenithasbeenaffirmativelyapprovedordisapprovedbythe
943		-	Commissionerorfoundtobeincomplete.TheCommissionershallnotifya
944		-	1
945		-	2
946		-	3
947		-	4
948		-	5
949		-	6
950		-	7
951		-	8
952		-	9
953		-	10
954		-	11
955		-	12
956		-	13
957		-	14
958		-	15
959		-	16
960		-	17
961		-	18
962		-	19
963		-	20
964		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	540	+
	541	+
	542	+	VT LEG #380165 v.1
	543	+	coverage, or other limited benefit coverage; to short-term, limited-duration 1
	544	+	health insurance coverage; or to benefit plans that are paid directly to an 2
	545	+	individual insured or to the individual’s assigns and for which the amount of 3
	546	+	the benefit is not based on potential medical costs or actual costs incurred. 4
	547	+	Premium rates and rules for the classification of risk for Medicare supplement 5
	548	+	insurance policies shall be governed by section 4051 of this title. 6
	549	+	(2) The policy forms for major medical insurance coverage, as well as 7
	550	+	the policy forms, premium rates, and rules for the classification of risk for the 8
	551	+	other lines of insurance described in subdivision (1) of this subsection shall be 9
	552	+	reviewed and approved or disapproved by the Commissioner. In making a 10
	553	+	determination, the Commissioner shall consider whether a policy form, 11
	554	+	premium rate, or rule is affordable and is not unjust, unfair, inequitable, 12
	555	+	misleading, or contrary to the laws of this State; and, for a policy form for 13
	556	+	major medical insurance coverage, whether it ensures equal access to 14
	557	+	appropriate mental health care in a manner equivalent to other aspects of health 15
	558	+	care as part of an integrated, holistic system of care. The Commissioner shall 16
	559	+	make a determination within 30 days after the date the insurer filed the policy 17
	560	+	form, premium rate, or rule with the Department. At the expiration of the 30-18
	561	+	day period, the form, premium rate, or rule shall be deemed approved unless 19
	562	+	prior to then it has been affirmatively approved or disapproved by the 20
	563	+	Commissioner or found to be incomplete. The Commissioner shall notify a 21 BILL AS INTRODUCED S.30
965	564		2025 Page 24 of 181
966		-	healthinsurerinwritingiftheinsurerfilesanyform,premiumrate,orrule
967		-	containingaprovisionthatdoesnotmeetthestandardsexpressedinthis
968		-	subsection.Insuchnotice,theCommissionershallstatethatahearingwillbe
969		-	grantedwithin20daysupontheinsurer’swrittenrequest.
970		-	(i)Notwithstandingtheproceduresandtimelinessetforthinsubsections
971		-	(a)through(e)ofthissection,theBoardmayestablish,byrule,astreamlined
972		-	ratereviewprocessforcertainratedecisions,includingproposedrates
973		-	affectingfewerthanaminimumnumberofcoveredlivesandproposedrates
974		-	forwhichademinimisincrease,asdefinedbytheBoardbyrule,issought.
975		-	§ 4027.FILINGFEES
976		-	Eachfilingofapolicy,contract,ordocumentformorpremiumratesor
977		-	rules,submittedpursuanttosection4026ofthistitle,shallbeaccompaniedby
978		-	paymenttotheCommissionerortheGreenMountainCareBoard,as
979		-	appropriate,ofanonrefundablefeeof$150.00.
980		-	§ 4028.FORMANDCONTENTSOFPOLICY
981		-	Nopolicyofindividualhealthinsuranceshallbedeliveredorissuedfor
982		-	deliverytoanypersoninthisStateunlessallofthefollowingconditionsare
983		-	met:
984		-	(1)Thepolicysetsforthallofthemonetaryandotherconsiderationsfor
985		-	thepolicy.
986		-	1
987		-	2
988		-	3
989		-	4
990		-	5
991		-	6
992		-	7
993		-	8
994		-	9
995		-	10
996		-	11
997		-	12
998		-	13
999		-	14
1000		-	15
1001		-	16
1002		-	17
1003		-	18
1004		-	19
1005		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	565	+
	566	+
	567	+	VT LEG #380165 v.1
	568	+	health insurer in writing if the insurer files any form, premium rate, or rule 1
	569	+	containing a provision that does not meet the standards expressed in this 2
	570	+	subsection. In such notice, the Commissioner shall state that a hearing will be 3
	571	+	granted within 20 days upon the insurer’s written request. 4
	572	+	(i) Notwithstanding the procedures and timelines set forth in subsections 5
	573	+	(a) through (e) of this section, the Board may establish, by rule, a streamlined 6
	574	+	rate review process for certain rate decisions, including proposed rates 7
	575	+	affecting fewer than a minimum number of covered lives and proposed rates 8
	576	+	for which a de minimis increase, as defined by the Board by rule, is sought. 9
	577	+	§ 4027. FILING FEES 10
	578	+	Each filing of a policy, contract, or document form or premium rates or 11
	579	+	rules, submitted pursuant to section 4026 of this title, shall be accompanied by 12
	580	+	payment to the Commissioner or the Green Mountain Care Board, as 13
	581	+	appropriate, of a nonrefundable fee of $150.00. 14
	582	+	§ 4028. FORM AND CONTENTS OF POLICY 15
	583	+	No policy of individual health insurance shall be delivered or issued for 16
	584	+	delivery to any person in this State unless all of the following conditions are 17
	585	+	met: 18
	586	+	(1) The policy sets forth all of the monetary and other considerations for 19
	587	+	the policy. 20 BILL AS INTRODUCED S.30
1006	588		2025 Page 25 of 181
1007		-	(2)Thepolicysetsforththetimeatwhichtheinsurancetakeseffectand
1008		-	terminates.
1009		-	(3)Thepolicypurportstoinsureonlyoneperson,exceptthatapolicy
1010		-	mayinsure,originallyorbysubsequentamendment,upontheapplicationofan
1011		-	adultmemberofafamilywhoshallbedeemedthepolicyholder,anytwoor
1012		-	moreeligiblemembersofthatfamily,includingaspouseorcivilunion
1013		-	partner,dependentchildrenoranychildrenunderaspecifiedagethatshallnot
1014		-	exceed26yearsofage,andanyotherpersondependentuponthepolicyholder.
1015		-	(4)Thestyle,arrangement,andoverallappearanceofthepolicygiveno
1016		-	undueprominencetoanyportionofthetext,andeveryprintedportionofthe
1017		-	textofthepolicyandofanyendorsementsorattachedpapersisplainlyprinted
1018		-	inlight-facedtypeofastyleingeneraluse,thesizeofwhichshallbeuniform
1019		-	andnotlessthan10-pointwithalowercaseunspacedalphabetlengthnotless
1020		-	than120-point.Asusedinthissubdivision,the“text”includesallprinted
1021		-	matterexceptthenameandaddressoftheinsurer;thenameortitleofthe
1022		-	policy;thebriefdescription,ifany;andthecaptionsandsubcaptions.
1023		-	(5)Theexceptionsandreductionsofindemnityaresetforthinthe
1024		-	policyand,exceptthosethataresetforthinsections4029and4030ofthis
1025		-	title,areprinted,attheinsurer’soption,eitherwiththebenefitprovisionto
1026		-	whichtheyapplyorunderanappropriatecaptionsuchas“EXCEPTIONS”or
1027		-	“EXCEPTIONSANDREDUCTIONS”;provided,however,thatifan
1028		-	1
1029		-	2
1030		-	3
1031		-	4
1032		-	5
1033		-	6
1034		-	7
1035		-	8
1036		-	9
1037		-	10
1038		-	11
1039		-	12
1040		-	13
1041		-	14
1042		-	15
1043		-	16
1044		-	17
1045		-	18
1046		-	19
1047		-	20
1048		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	589	+
	590	+
	591	+	VT LEG #380165 v.1
	592	+	(2) The policy sets forth the time at which the insurance takes effect and 1
	593	+	terminates. 2
	594	+	(3) The policy purports to insure only one person, except that a policy 3
	595	+	may insure, originally or by subsequent amendment, upon the application of an 4
	596	+	adult member of a family who shall be deemed the policyholder, any two or 5
	597	+	more eligible members of that family, including a spouse or civil union 6
	598	+	partner, dependent children or any children under a specified age that shall not 7
	599	+	exceed 26 years of age, and any other person dependent upon the policyholder. 8
	600	+	(4) The style, arrangement, and overall appearance of the policy give no 9
	601	+	undue prominence to any portion of the text, and every printed portion of the 10
	602	+	text of the policy and of any endorsements or attached papers is plainly printed 11
	603	+	in light-faced type of a style in general use, the size of which shall be uniform 12
	604	+	and not less than 10-point with a lowercase unspaced alphabet length not less 13
	605	+	than 120-point. As used in this subdivision, the “text” includes all printed 14
	606	+	matter except the name and address of the insurer; the name or title of the 15
	607	+	policy; the brief description, if any; and the captions and subcaptions. 16
	608	+	(5) The exceptions and reductions of indemnity are set forth in the 17
	609	+	policy and, except those that are set forth in sections 4029 and 4030 of this 18
	610	+	title, are printed, at the insurer’s option, either with the benefit provision to 19
	611	+	which they apply or under an appropriate caption such as “EXCEPTIONS” or 20
	612	+	“EXCEPTIONS AND REDUCTIONS”; provided, however, that if an 21 BILL AS INTRODUCED S.30
1049	613		2025 Page 26 of 181
1050		-	exceptionorreductionspecificallyappliesonlytoaparticularbenefitofthe
1051		-	policy,thestatementoftheexceptionorreductionshallbeincludedwiththe
1052		-	benefitprovisiontowhichitapplies.
1053		-	(6)Eachpolicyform,includingridersandendorsements,isidentified
1054		-	byaformnumberinthelowerleft-handcornerofthefirstpageoftheform.
1055		-	(7)Thepolicydoesnotcontainanyprovisionpurportingtomakeany
1056		-	portionofthecharter,rules,constitution,orbylawsofthehealthinsurerapart
1057		-	ofthepolicyunlessthatportionissetforthinfullinthepolicy,exceptinthe
1058		-	caseoftheincorporationof,orreferenceto,astatementofratesor
1059		-	classificationofrisksorashort-ratetablefiledwiththeCommissioner.
1060		-	(8)Eitherprominentlyprintedonorattachedtothefirstpageofthe
1061		-	policyisanoticetotheeffectthatduringaperiodof30daysfollowingthe
1062		-	datethepolicyisdeliveredtopersonseligibleforMedicarebyreasonofage,
1063		-	and10daysfollowingthedateofdeliverytoallotherpersons,thepolicymay
1064		-	besurrenderedtotheinsurertogetherwithawrittenrequestforcancellationof
1065		-	thepolicy,andthatinsuchevent,theinsurerwillrefundanypremiumpaid,
1066		-	includinganypolicyfeesorothercharges;provided,however,thatthis
1067		-	subdivisionshallnotapplytosinglepremiumnonrenewablepoliciesinsuring
1068		-	againstaccidentonlyormedicalcostsoraccidentalbodilyinjuryonly.
1069		-	1
1070		-	2
1071		-	3
1072		-	4
1073		-	5
1074		-	6
1075		-	7
1076		-	8
1077		-	9
1078		-	10
1079		-	11
1080		-	12
1081		-	13
1082		-	14
1083		-	15
1084		-	16
1085		-	17
1086		-	18
1087		-	19 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	614	+
	615	+
	616	+	VT LEG #380165 v.1
	617	+	exception or reduction specifically applies only to a particular benefit of the 1
	618	+	policy, the statement of the exception or reduction shall be included with the 2
	619	+	benefit provision to which it applies. 3
	620	+	(6) Each policy form, including riders and endorsements, is identified by 4
	621	+	a form number in the lower left-hand corner of the first page of the form. 5
	622	+	(7) The policy does not contain any provision purporting to make any 6
	623	+	portion of the charter, rules, constitution, or bylaws of the health insurer a part 7
	624	+	of the policy unless that portion is set forth in full in the policy, except in the 8
	625	+	case of the incorporation of, or reference to, a statement of rates or 9
	626	+	classification of risks or a short-rate table filed with the Commissioner. 10
	627	+	(8) Either prominently printed on or attached to the first page of the 11
	628	+	policy is a notice to the effect that during a period of 30 days following the 12
	629	+	date the policy is delivered to persons eligible for Medicare by reason of age, 13
	630	+	and 10 days following the date of delivery to all other persons, the policy may 14
	631	+	be surrendered to the insurer together with a written request for cancellation of 15
	632	+	the policy, and that in such event, the insurer will refund any premium paid, 16
	633	+	including any policy fees or other charges; provided, however, that this 17
	634	+	subdivision shall not apply to single premium nonrenewable policies insuring 18
	635	+	against accident only or medical costs or accidental bodily injury only. 19 BILL AS INTRODUCED S.30
1088	636		2025 Page 27 of 181
1089		-	§ 4029.REQUIREDSTANDARDPOLICYPROVISIONS
1090		-	Exceptasprovidedinsection4031ofthistitle,eachhealthinsurancepolicy
1091		-	deliveredorissuedfordeliverytoanypersoninthisStateshallcontainthe
1092		-	provisionsspecifiedinthissectionusingthelanguagesetforthinthissection;
1093		-	provided,however,thatahealthinsurermay,atitsoption,substitutedifferent
1094		-	languageapprovedbytheCommissionerforoneormoreprovisions,provided
1095		-	thesubstitutedlanguageisnotlessfavorableinanyrespecttotheinsuredor
1096		-	coveredindividualthanthelanguageusedinthissection.Theprovisions
1097		-	specifiedinthissectionshallbeprecededindividuallybythecaption
1098		-	appearinginthissectionor,attheoptionofthehealthinsurer,bysuch
1099		-	appropriatecaptionsorsubcaptionsastheCommissionermayapprove:
1100		-	(1)ENTIRECONTRACT;CHANGES:Thispolicy,includingthe
1101		-	endorsementsandtheattachedpapers,ifany,constitutestheentirecontractof
1102		-	insurance.Nochangeinthispolicyshallbevaliduntilapprovedbyan
1103		-	executiveofficeroftheinsurerandunlesssuchapprovalbeendorsedhereonor
1104		-	attachedhereto.Noagenthasauthoritytochangethispolicyortowaiveany
1105		-	ofitsprovisions.
1106		-	(2)TIMELIMITONCERTAINDEFENSES:(a)Afterthreeyears
1107		-	fromthedateofissueofthispolicynomisstatements,exceptfraudulent
1108		-	misstatements,madebytheapplicantintheapplicationforsuchpolicy,shall
1109		-	beusedtovoidthepolicyortodenyaclaimforlossincurredordisability(as
1110		-	1
1111		-	2
1112		-	3
1113		-	4
1114		-	5
1115		-	6
1116		-	7
1117		-	8
1118		-	9
1119		-	10
1120		-	11
1121		-	12
1122		-	13
1123		-	14
1124		-	15
1125		-	16
1126		-	17
1127		-	18
1128		-	19
1129		-	20
1130		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	637	+
	638	+
	639	+	VT LEG #380165 v.1
	640	+	§ 4029. REQUIRED STANDARD POLICY PROVISIONS 1
	641	+	Except as provided in section 4031 of this title, each health insurance policy 2
	642	+	delivered or issued for delivery to any person in this State shall contain the 3
	643	+	provisions specified in this section using the language set forth in this section; 4
	644	+	provided, however, that a health insurer may, at its option, substitute different 5
	645	+	language approved by the Commissioner for one or more provisions, provided 6
	646	+	the substituted language is not less favorable in any respect to the insured or 7
	647	+	covered individual than the language used in this section. The provisions 8
	648	+	specified in this section shall be preceded individually by the caption appearing 9
	649	+	in this section or, at the option of the health insurer, by such appropriate 10
	650	+	captions or subcaptions as the Commissioner may approve: 11
	651	+	(1) ENTIRE CONTRACT; CHANGES: This policy, including the 12
	652	+	endorsements and the attached papers, if any, constitutes the entire contract of 13
	653	+	insurance. No change in this policy shall be valid until approved by an 14
	654	+	executive officer of the insurer and unless such approval be endorsed hereon or 15
	655	+	attached hereto. No agent has authority to change this policy or to waive any 16
	656	+	of its provisions. 17
	657	+	(2) TIME LIMIT ON CERTAIN DEFENSES: (a) After three years 18
	658	+	from the date of issue of this policy no misstatements, except fraudulent 19
	659	+	misstatements, made by the applicant in the application for such policy, shall 20
	660	+	be used to void the policy or to deny a claim for loss incurred or disability (as 21 BILL AS INTRODUCED S.30
1131	661		2025 Page 28 of 181
1132		-	definedinthepolicy)commencingaftertheexpirationofsuchthreeyear
1133		-	period.
1134		-	Afterthispolicyhasbeeninforceforaperiodofthreeyearsduringthe
1135		-	lifetimeoftheinsured(excludinganyperiodduringwhichtheinsuredis
1136		-	disabled),itshallbecomeincontestableastothestatementscontainedinthe
1137		-	application.)
1138		-	(b)Noclaimforlossincurredordisability(asdefinedinthepolicy)
1139		-	commencingafterthreeyearsfromthedateofissueofthispolicyshallbe
1140		-	reducedordeniedonthegroundthatadiseaseorphysicalconditionnot
1141		-	excludedfromcoveragebynameorspecificdescriptioneffectiveonthedate
1142		-	oflosshadexistedpriortotheeffectivedateofcoverageofthispolicy.
1143		-	(3)GRACEPERIOD:Agraceperiodof....(insertanumbernotless
1144		-	than“7”forweeklypremiumpolicies,“10”formonthlypremiumpoliciesand
1145		-	“31”forallotherpolicies)dayswillbegrantedforthepaymentofeach
1146		-	premiumfallingdueafterthefirstpremium,duringwhichgraceperiodthe
1147		-	policyshallcontinueinforce.
1148		-	(Apolicywhichcontainsacancellationprovisionmayadd,attheendof
1149		-	theaboveprovision,
1150		-	subjecttotherightoftheinsurertocancelinaccordancewiththe
1151		-	cancellationprovisionhereof,
1152		-	1
1153		-	2
1154		-	3
1155		-	4
1156		-	5
1157		-	6
1158		-	7
1159		-	8
1160		-	9
1161		-	10
1162		-	11
1163		-	12
1164		-	13
1165		-	14
1166		-	15
1167		-	16
1168		-	17
1169		-	18
1170		-	19
1171		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	662	+
	663	+
	664	+	VT LEG #380165 v.1
	665	+	defined in the policy) commencing after the expiration of such three year 1
	666	+	period. 2
	667	+	After this policy has been in force for a period of three years during the 3
	668	+	lifetime of the insured (excluding any period during which the insured is 4
	669	+	disabled), it shall become incontestable as to the statements contained in the 5
	670	+	application.) 6
	671	+	(b) No claim for loss incurred or disability (as defined in the policy) 7
	672	+	commencing after three years from the date of issue of this policy shall be 8
	673	+	reduced or denied on the ground that a disease or physical condition not 9
	674	+	excluded from coverage by name or specific description effective on the date 10
	675	+	of loss had existed prior to the effective date of coverage of this policy. 11
	676	+	(3) GRACE PERIOD: A grace period of . . . . (insert a number not less 12
	677	+	than “7” for weekly premium policies, “10” for monthly premium policies and 13
	678	+	“31” for all other policies) days will be granted for the payment of each 14
	679	+	premium falling due after the first premium, during which grace period the 15
	680	+	policy shall continue in force. 16
	681	+	(A policy which contains a cancellation provision may add, at the end of 17
	682	+	the above provision, 18
	683	+	subject to the right of the insurer to cancel in accordance with the 19
	684	+	cancellation provision hereof, 20 BILL AS INTRODUCED S.30
1172	685		2025 Page 29 of 181
1173		-	Apolicyinwhichtheinsurerreservestherighttorefuseanyrenewal
1174		-	shallhave,atthebeginningoftheaboveprovision,
1175		-	Unlessnotlessthanfivedayspriortothepremiumduedatetheinsurerhas
1176		-	deliveredtotheinsuredorhasmailedtohisorherlastaddressasshownbythe
1177		-	recordsoftheinsurerwrittennoticeofitsintentionnottorenewthispolicy
1178		-	beyondtheperiodforwhichthepremiumhasbeenaccepted.)
1179		-	(4)REINSTATEMENT:Ifanyrenewalpremiumbenotpaidwithinthe
1180		-	timegrantedtheinsuredforpayment,asubsequentacceptanceofpremiumby
1181		-	theinsurerorbyanyagentdulyauthorizedbytheinsurertoacceptsuch
1182		-	premium,withoutrequiringinconnectiontherewithanapplicationfor
1183		-	reinstatement,shallreinstatethepolicy;provided,however,thatiftheinsurer
1184		-	orsuchagentrequiresanapplicationforreinstatementandissuesaconditional
1185		-	receiptforthepremiumtendered,thepolicywillbereinstateduponapproval
1186		-	ofsuchapplicationbytheinsureror,lackingsuchapproval,uponthe45thday
1187		-	followingthedateofsuchconditionalreceiptunlesstheinsurerhaspreviously
1188		-	notifiedtheinsuredinwritingofitsdisapprovalofsuchapplication.The
1189		-	reinstatedpolicyshallcoveronlylossresultingfromsuchaccidentalinjuryas
1190		-	maybesustainedafterthedateofreinstatementandlossduetosuchsickness
1191		-	asmaybeginmorethantendaysaftersuchdate.Inallotherrespectsthe
1192		-	insuredandinsurershallhavethesamerightsthereunderastheyhadunderthe
1193		-	policyimmediatelybeforetheduedateofthedefaultedpremium,subjectto
1194		-	1
1195		-	2
1196		-	3
1197		-	4
1198		-	5
1199		-	6
1200		-	7
1201		-	8
1202		-	9
1203		-	10
1204		-	11
1205		-	12
1206		-	13
1207		-	14
1208		-	15
1209		-	16
1210		-	17
1211		-	18
1212		-	19
1213		-	20
1214		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	686	+
	687	+
	688	+	VT LEG #380165 v.1
	689	+	A policy in which the insurer reserves the right to refuse any renewal 1
	690	+	shall have, at the beginning of the above provision, 2
	691	+	Unless not less than five days prior to the premium due date the insurer has 3
	692	+	delivered to the insured or has mailed to his or her last address as shown by the 4
	693	+	records of the insurer written notice of its intention not to renew this policy 5
	694	+	beyond the period for which the premium has been accepted.) 6
	695	+	(4) REINSTATEMENT: If any renewal premium be not paid within the 7
	696	+	time granted the insured for payment, a subsequent acceptance of premium by 8
	697	+	the insurer or by any agent duly authorized by the insurer to accept such 9
	698	+	premium, without requiring in connection therewith an application for 10
	699	+	reinstatement, shall reinstate the policy; provided, however, that if the insurer 11
	700	+	or such agent requires an application for reinstatement and issues a conditional 12
	701	+	receipt for the premium tendered, the policy will be reinstated upon approval 13
	702	+	of such application by the insurer or, lacking such approval, upon the 45th day 14
	703	+	following the date of such conditional receipt unless the insurer has previously 15
	704	+	notified the insured in writing of its disapproval of such application. The 16
	705	+	reinstated policy shall cover only loss resulting from such accidental injury as 17
	706	+	may be sustained after the date of reinstatement and loss due to such sickness 18
	707	+	as may begin more than ten days after such date. In all other respects the 19
	708	+	insured and insurer shall have the same rights thereunder as they had under the 20
	709	+	policy immediately before the due date of the defaulted premium, subject to 21 BILL AS INTRODUCED S.30
1215	710		2025 Page 30 of 181
1216		-	anyprovisionsendorsedhereonorattachedheretoinconnectionwiththe
1217		-	reinstatement.Anypremiumacceptedinconnectionwithareinstatementshall
1218		-	beappliedtoaperiodforwhichpremiumhasnotbeenpreviouslypaid,butnot
1219		-	toanyperiodmorethansixtydayspriortothedateofreinstatement.
1220		-	(Thelastsentenceoftheaboveprovisionmaybeomittedfromany
1221		-	policywhichtheinsuredhastherighttocontinueinforcesubjecttoitsterms
1222		-	bythetimelypaymentofpremiums(1)untilatleastage50,or(2)inthecase
1223		-	ofapolicyissuedafterage44,foratleastfiveyearsfromitsdateofissue.)
1224		-	(5)NOTICEOFCLAIM:Writtennoticeofclaimmustbegiventothe
1225		-	insurerwithin20daysaftertheoccurrenceorcommencementofanyloss
1226		-	coveredbythepolicy,orassoonthereafterasisreasonablypossible.Notice
1227		-	givenbyoronbehalfoftheinsuredorthebeneficiarytotheinsurerat....
1228		-	(insertthelocationofsuchofficeastheinsurermaydesignateforthe
1229		-	purpose),ortoanyauthorizedagentoftheinsurer,withinformationsufficient
1230		-	toidentifytheinsured,shallbedeemednoticetotheinsurer.
1231		-	(Inapolicyprovidingaloss-of-timebenefitwhichmaybepayableforat
1232		-	leasttwoyears,aninsurermayatitsoptioninsertthefollowingbetweenthe
1233		-	firstandsecondsentencesoftheaboveprovision:
1234		-	Subjecttothequalificationssetforthbelow,iftheinsuredsufferslossof
1235		-	timeonaccountofdisabilityforwhichindemnitymaybepayableforatleast
1236		-	twoyears,heorsheshall,atleastonceineverysixmonthsafterhavinggiven
1237		-	1
1238		-	2
1239		-	3
1240		-	4
1241		-	5
1242		-	6
1243		-	7
1244		-	8
1245		-	9
1246		-	10
1247		-	11
1248		-	12
1249		-	13
1250		-	14
1251		-	15
1252		-	16
1253		-	17
1254		-	18
1255		-	19
1256		-	20
1257		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	711	+
	712	+
	713	+	VT LEG #380165 v.1
	714	+	any provisions endorsed hereon or attached hereto in connection with the 1
	715	+	reinstatement. Any premium accepted in connection with a reinstatement shall 2
	716	+	be applied to a period for which premium has not been previously paid, but not 3
	717	+	to any period more than sixty days prior to the date of reinstatement. 4
	718	+	(The last sentence of the above provision may be omitted from any 5
	719	+	policy which the insured has the right to continue in force subject to its terms 6
	720	+	by the timely payment of premiums (1) until at least age 50, or (2) in the case 7
	721	+	of a policy issued after age 44, for at least five years from its date of issue.) 8
	722	+	(5) NOTICE OF CLAIM: Written notice of claim must be given to the 9
	723	+	insurer within 20 days after the occurrence or commencement of any loss 10
	724	+	covered by the policy, or as soon thereafter as is reasonably possible. Notice 11
	725	+	given by or on behalf of the insured or the beneficiary to the insurer at . . . . 12
	726	+	(insert the location of such office as the insurer may designate for the purpose), 13
	727	+	or to any authorized agent of the insurer, with information sufficient to identify 14
	728	+	the insured, shall be deemed notice to the insurer. 15
	729	+	(In a policy providing a loss-of-time benefit which may be payable for at 16
	730	+	least two years, an insurer may at its option insert the following between the 17
	731	+	first and second sentences of the above provision: 18
	732	+	Subject to the qualifications set forth below, if the insured suffers loss of 19
	733	+	time on account of disability for which indemnity may be payable for at least 20
	734	+	two years, he or she shall, at least once in every six months after having given 21 BILL AS INTRODUCED S.30
1258	735		2025 Page 31 of 181
1259		-	noticeofclaim,givetotheinsurernoticeofcontinuanceofsaiddisability,
1260		-	exceptintheeventoflegalincapacity.Theperiodofsixmonthsfollowing
1261		-	anyfilingofproofbytheinsuredoranypaymentbytheinsureronaccountof
1262		-	suchclaimoranydenialofliabilityinwholeorinpartbytheinsurershallbe
1263		-	excludedinapplyingthisprovision.Delayinthegivingofsuchnoticeshall
1264		-	notimpairtheinsured’srighttoanyindemnitywhichwouldotherwisehave
1265		-	accruedduringtheperiodofsixmonthsprecedingthedateonwhichsuch
1266		-	noticeisactuallygiven.)
1267		-	(6)CLAIMFORMS:Theinsurer,uponreceiptofanoticeofclaim,will
1268		-	furnishtotheclaimantsuchformsasareusuallyfurnishedbyitforfiling
1269		-	proofsofloss.Ifsuchformsarenotfurnishedwithin15daysafterthegiving
1270		-	ofsuchnoticetheclaimantshallbedeemedtohavecompliedwiththe
1271		-	requirementsofthispolicyastoproofoflossuponsubmitting,withinthetime
1272		-	fixedinthepolicyforfilingproofsofloss,writtenproofcoveringthe
1273		-	occurrence,thecharacterandtheextentofthelossforwhichclaimismade.
1274		-	(7)PROOFSOFLOSS:Writtenproofoflossmustbefurnishedtothe
1275		-	insureratitssaidofficeincaseofclaimforlossforwhichthispolicyprovides
1276		-	anyperiodicpaymentcontingentuponcontinuinglosswithin90daysafterthe
1277		-	terminationoftheperiodforwhichtheinsurerisliableandincaseofclaimfor
1278		-	anyotherlosswithin90daysafterthedateofsuchloss.Failuretofurnish
1279		-	suchproofwithinthetimerequiredshallnotinvalidatenorreduceanyclaimif
1280		-	1
1281		-	2
1282		-	3
1283		-	4
1284		-	5
1285		-	6
1286		-	7
1287		-	8
1288		-	9
1289		-	10
1290		-	11
1291		-	12
1292		-	13
1293		-	14
1294		-	15
1295		-	16
1296		-	17
1297		-	18
1298		-	19
1299		-	20
1300		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	736	+
	737	+
	738	+	VT LEG #380165 v.1
	739	+	notice of claim, give to the insurer notice of continuance of said disability, 1
	740	+	except in the event of legal incapacity. The period of six months following any 2
	741	+	filing of proof by the insured or any payment by the insurer on account of such 3
	742	+	claim or any denial of liability in whole or in part by the insurer shall be 4
	743	+	excluded in applying this provision. Delay in the giving of such notice shall 5
	744	+	not impair the insured’s right to any indemnity which would otherwise have 6
	745	+	accrued during the period of six months preceding the date on which such 7
	746	+	notice is actually given.) 8
	747	+	(6) CLAIM FORMS: The insurer, upon receipt of a notice of claim, will 9
	748	+	furnish to the claimant such forms as are usually furnished by it for filing 10
	749	+	proofs of loss. If such forms are not furnished within 15 days after the giving 11
	750	+	of such notice the claimant shall be deemed to have complied with the 12
	751	+	requirements of this policy as to proof of loss upon submitting, within the time 13
	752	+	fixed in the policy for filing proofs of loss, written proof covering the 14
	753	+	occurrence, the character and the extent of the loss for which claim is made. 15
	754	+	(7) PROOFS OF LOSS: Written proof of loss must be furnished to the 16
	755	+	insurer at its said office in case of claim for loss for which this policy provides 17
	756	+	any periodic payment contingent upon continuing loss within 90 days after the 18
	757	+	termination of the period for which the insurer is liable and in case of claim for 19
	758	+	any other loss within 90 days after the date of such loss. Failure to furnish 20
	759	+	such proof within the time required shall not invalidate nor reduce any claim if 21 BILL AS INTRODUCED S.30
1301	760		2025 Page 32 of 181
1302		-	itwasnotreasonablypossibletogiveproofwithinsuchtime,providedsuch
1303		-	proofisfurnishedassoonasreasonablypossibleandinnoevent,exceptinthe
1304		-	absenceoflegalcapacity,laterthanoneyearfromthetimeproofisotherwise
1305		-	required.
1306		-	(8)TIMEOFPAYMENTOFCLAIMS:Indemnitiespayableunderthis
1307		-	policyforanylossotherthanlossforwhichthispolicyprovidesanyperiodic
1308		-	paymentwillbepaidimmediatelyuponreceiptofduewrittenproofofsuch
1309		-	loss.Subjecttoduewrittenproofofloss,allaccruedindemnitiesforlossfor
1310		-	whichthispolicyprovidesperiodicpaymentwillbepaid....(insertperiod
1311		-	forpaymentwhichmustnotbelessfrequentlythanmonthly)andanybalance
1312		-	remainingunpaidupontheterminationofliabilitywillbepaidimmediately
1313		-	uponreceiptofduewrittenproof.
1314		-	(9)PAYMENTOFCLAIMS:Indemnityforlossoflifewillbepayablein
1315		-	accordancewiththebeneficiarydesignationandtheprovisionsrespectingsuch
1316		-	paymentwhichmaybeprescribedhereinandeffectiveatthetimeofpayment.
1317		-	Ifnosuchdesignationorprovisionistheneffective,suchindemnityshallbe
1318		-	payabletotheestateoftheinsured.Anyotheraccruedindemnitiesunpaidat
1319		-	theinsured’sdeathmay,attheoptionoftheinsurer,bepaideithertosuch
1320		-	beneficiaryortosuchestate.Allotherindemnitieswillbepayabletothe
1321		-	insured.
1322		-	1
1323		-	2
1324		-	3
1325		-	4
1326		-	5
1327		-	6
1328		-	7
1329		-	8
1330		-	9
1331		-	10
1332		-	11
1333		-	12
1334		-	13
1335		-	14
1336		-	15
1337		-	16
1338		-	17
1339		-	18
1340		-	19
1341		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	761	+
	762	+
	763	+	VT LEG #380165 v.1
	764	+	it was not reasonably possible to give proof within such time, provided such 1
	765	+	proof is furnished as soon as reasonably possible and in no event, except in the 2
	766	+	absence of legal capacity, later than one year from the time proof is otherwise 3
	767	+	required. 4
	768	+	(8) TIME OF PAYMENT OF CLAIMS: Indemnities payable under this 5
	769	+	policy for any loss other than loss for which this policy provides any periodic 6
	770	+	payment will be paid immediately upon receipt of due written proof of such 7
	771	+	loss. Subject to due written proof of loss, all accrued indemnities for loss for 8
	772	+	which this policy provides periodic payment will be paid . . . . (insert period for 9
	773	+	payment which must not be less frequently than monthly) and any balance 10
	774	+	remaining unpaid upon the termination of liability will be paid immediately 11
	775	+	upon receipt of due written proof. 12
	776	+	(9) PAYMENT OF CLAIMS: Indemnity for loss of life will be payable in 13
	777	+	accordance with the beneficiary designation and the provisions respecting such 14
	778	+	payment which may be prescribed herein and effective at the time of payment. 15
	779	+	If no such designation or provision is then effective, such indemnity shall be 16
	780	+	payable to the estate of the insured. Any other accrued indemnities unpaid at 17
	781	+	the insured’s death may, at the option of the insurer, be paid either to such 18
	782	+	beneficiary or to such estate. All other indemnities will be payable to the 19
	783	+	insured. 20 BILL AS INTRODUCED S.30
1342	784		2025 Page 33 of 181
1343		-	(Thefollowingprovisions,oreitherofthem,maybeincludedwiththe
1344		-	foregoingprovisionattheoptionoftheinsurer:
1345		-	Ifanyindemnityofthispolicyshallbepayabletotheestateoftheinsured,
1346		-	ortoaninsuredorbeneficiarywhoisaminororotherwisenotcompetentto
1347		-	giveavalidrelease,theinsurermaypaysuchindemnity,uptoanamountnot
1348		-	exceeding$......(insertanamountwhichshallnotexceed$1,000.00),to
1349		-	anyrelativebybloodorconnectionbycivilmarriageoftheinsuredor
1350		-	beneficiarywhoisdeemedbytheinsurertobeequitablyentitledthereto.Any
1351		-	paymentmadebytheinsureringoodfaithpursuanttothisprovisionshall
1352		-	fullydischargetheinsurertotheextentofsuchpayment.
1353		-	Subjecttoanywrittendirectionoftheinsuredintheapplicationor
1354		-	otherwisealloraportionofanyindemnitiesprovidedbythispolicyon
1355		-	accountofhospital,nursing,medical,orsurgicalservicesmay,attheinsurer’s
1356		-	optionandunlesstheinsuredrequestsotherwiseinwritingnotlaterthanthe
1357		-	timeoffilingproofsofsuchloss,bepaiddirectlytothehospitalorperson
1358		-	renderingsuchservices;butitisnotrequiredthattheserviceberenderedbya
1359		-	particularhospitalorperson.)
1360		-	(10)PHYSICALEXAMINATIONSANDAUTOPSY:Theinsureratits
1361		-	ownexpenseshallhavetherightandtheopportunitytoexaminethepersonof
1362		-	theinsuredwhenandasoftenasitmayreasonablyrequireduringthe
1363		-	1
1364		-	2
1365		-	3
1366		-	4
1367		-	5
1368		-	6
1369		-	7
1370		-	8
1371		-	9
1372		-	10
1373		-	11
1374		-	12
1375		-	13
1376		-	14
1377		-	15
1378		-	16
1379		-	17
1380		-	18
1381		-	19
1382		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	785	+
	786	+
	787	+	VT LEG #380165 v.1
	788	+	(The following provisions, or either of them, may be included with the 1
	789	+	foregoing provision at the option of the insurer: 2
	790	+	If any indemnity of this policy shall be payable to the estate of the insured, 3
	791	+	or to an insured or beneficiary who is a minor or otherwise not competent to 4
	792	+	give a valid release, the insurer may pay such indemnity, up to an amount not 5
	793	+	exceeding $. . . . . . (insert an amount which shall not exceed $1,000.00), to any 6
	794	+	relative by blood or connection by civil marriage of the insured or beneficiary 7
	795	+	who is deemed by the insurer to be equitably entitled thereto. Any payment 8
	796	+	made by the insurer in good faith pursuant to this provision shall fully 9
	797	+	discharge the insurer to the extent of such payment. 10
	798	+	Subject to any written direction of the insured in the application or 11
	799	+	otherwise all or a portion of any indemnities provided by this policy on 12
	800	+	account of hospital, nursing, medical, or surgical services may, at the insurer’s 13
	801	+	option and unless the insured requests otherwise in writing not later than the 14
	802	+	time of filing proofs of such loss, be paid directly to the hospital or person 15
	803	+	rendering such services; but it is not required that the service be rendered by a 16
	804	+	particular hospital or person.) 17
	805	+	(10) PHYSICAL EXAMINATIONS AND AUTOPSY: The insurer at its 18
	806	+	own expense shall have the right and the opportunity to examine the person of 19
	807	+	the insured when and as often as it may reasonably require during the 20 BILL AS INTRODUCED S.30
1383	808		2025 Page 34 of 181
1384		-	pendencyofaclaimhereunderandtomakeanautopsyincaseofdeathwhere
1385		-	itisnotforbiddenbylaw.
1386		-	(11)LEGALACTIONS:Noactionatlaworinequityshallbebroughtto
1387		-	recoveronthispolicypriortotheexpirationof60daysafterwrittenproofof
1388		-	losshasbeenfurnishedinaccordancewiththerequirementsofthispolicy.No
1389		-	suchactionshallbebroughtaftertheexpirationofthreeyearsafterthetime
1390		-	writtenproofoflossisrequiredtobefurnished.
1391		-	(12)CHANGEOFBENEFICIARY:Unlesstheinsuredmakesan
1392		-	irrevocabledesignationofbeneficiary,therighttochangeofbeneficiaryis
1393		-	reservedtotheinsuredandtheconsentofthebeneficiaryorbeneficiariesshall
1394		-	notberequisitetosurrenderorassignmentofthispolicyortoanychangeof
1395		-	beneficiaryorbeneficiaries,ortoanyotherchangesinthispolicy.
1396		-	(Thefirstclauseofthisprovision,relativetotheirrevocabledesignation
1397		-	ofbeneficiary,maybeomittedattheinsurer’soption.)
1398		-	§ 4030.OPTIONALSTANDARDPOLICYPROVISIONS
1399		-	Exceptasprovidedinsection4031ofthistitle,nohealthinsurancepolicy
1400		-	deliveredorissuedfordeliverytoanypersoninthisStateshallcontain
1401		-	provisionsrespectingthematterssetforthinthissectionunlesstheprovisions
1402		-	usethelanguagesetforthinthissection;provided,however,thatahealth
1403		-	insurermay,atitsoption,substitutedifferentlanguageapprovedbythe
1404		-	Commissionerforoneormoreprovisions,providedthesubstitutedlanguageis
1405		-	1
1406		-	2
1407		-	3
1408		-	4
1409		-	5
1410		-	6
1411		-	7
1412		-	8
1413		-	9
1414		-	10
1415		-	11
1416		-	12
1417		-	13
1418		-	14
1419		-	15
1420		-	16
1421		-	17
1422		-	18
1423		-	19
1424		-	20
1425		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	809	+
	810	+
	811	+	VT LEG #380165 v.1
	812	+	pendency of a claim hereunder and to make an autopsy in case of death where 1
	813	+	it is not forbidden by law. 2
	814	+	(11) LEGAL ACTIONS: No action at law or in equity shall be brought to 3
	815	+	recover on this policy prior to the expiration of 60 days after written proof of 4
	816	+	loss has been furnished in accordance with the requirements of this policy. No 5
	817	+	such action shall be brought after the expiration of three years after the time 6
	818	+	written proof of loss is required to be furnished. 7
	819	+	(12) CHANGE OF BENEFICIARY: Unless the insured makes an 8
	820	+	irrevocable designation of beneficiary, the right to change of beneficiary is 9
	821	+	reserved to the insured and the consent of the beneficiary or beneficiaries shall 10
	822	+	not be requisite to surrender or assignment of this policy or to any change of 11
	823	+	beneficiary or beneficiaries, or to any other changes in this policy. 12
	824	+	(The first clause of this provision, relative to the irrevocable designation 13
	825	+	of beneficiary, may be omitted at the insurer’s option.) 14
	826	+	§ 4030. OPTIONAL STANDARD POLICY PROVISIONS 15
	827	+	Except as provided in section 4031 of this title, no health insurance policy 16
	828	+	delivered or issued for delivery to any person in this State shall contain 17
	829	+	provisions respecting the matters set forth in this section unless the provisions 18
	830	+	use the language set forth in this section; provided, however, that a health 19
	831	+	insurer may, at its option, substitute different language approved by the 20
	832	+	Commissioner for one or more provisions, provided the substituted language is 21 BILL AS INTRODUCED S.30
1426	833		2025 Page 35 of 181
1427		-	notlessfavorableinanyrespecttotheinsuredorcoveredindividualthanthe
1428		-	languageusedinthissection.Anyprovisionsetforthinthissectionthatis
1429		-	containedinthepolicyshallbeprecededindividuallybytheappropriate
1430		-	captionappearinginthissectionor,attheoptionofthehealthinsurer,bysuch
1431		-	appropriatecaptionsorsubcaptionsastheCommissionermayapprove:
1432		-	(1)CHANGEOFOCCUPATION:Iftheinsuredbeinjuredorcontract
1433		-	sicknessafterhavingchangedhisorheroccupationtooneclassifiedbythe
1434		-	insurerasmorehazardousthanthatstatedinthispolicyorwhiledoingfor
1435		-	compensationanythingpertainingtoanoccupationsoclassified,theinsurer
1436		-	willpayonlysuchportionoftheindemnitiesprovidedinthispolicyasthe
1437		-	premiumpaidwouldhavepurchasedattheratesandwithinthelimitsfixedby
1438		-	theinsurerforsuchmorehazardousoccupation.Iftheinsuredchangeshisor
1439		-	heroccupationtooneclassifiedbytheinsureraslesshazardousthanthat
1440		-	statedinthispolicy,theinsurer,uponreceiptofproofofsuchchangeof
1441		-	occupation,willreducethepremiumrateaccordingly,andwillreturnthe
1442		-	excessprorataunearnedpremiumfromthedateofchangeofoccupationor
1443		-	fromthepolicyanniversarydateimmediatelyprecedingreceiptofsuchproof,
1444		-	whicheveristhemorerecent.Inapplyingthisprovision,theclassificationof
1445		-	occupationalriskandthepremiumratesshallbesuchashavebeenlastfiled
1446		-	bytheinsurerpriortotheoccurrenceofthelossforwhichtheinsurerisliable
1447		-	orpriortodateofproofofchangeinoccupationwiththestateofficialhaving
1448		-	1
1449		-	2
1450		-	3
1451		-	4
1452		-	5
1453		-	6
1454		-	7
1455		-	8
1456		-	9
1457		-	10
1458		-	11
1459		-	12
1460		-	13
1461		-	14
1462		-	15
1463		-	16
1464		-	17
1465		-	18
1466		-	19
1467		-	20
1468		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	834	+
	835	+
	836	+	VT LEG #380165 v.1
	837	+	not less favorable in any respect to the insured or covered individual than the 1
	838	+	language used in this section. Any provision set forth in this section that is 2
	839	+	contained in the policy shall be preceded individually by the appropriate 3
	840	+	caption appearing in this section or, at the option of the health insurer, by such 4
	841	+	appropriate captions or subcaptions as the Commissioner may approve: 5
	842	+	(1) CHANGE OF OCCUPATION: If the insured be injured or contract 6
	843	+	sickness after having changed his or her occupation to one classified by the 7
	844	+	insurer as more hazardous than that stated in this policy or while doing for 8
	845	+	compensation anything pertaining to an occupation so classified, the insurer 9
	846	+	will pay only such portion of the indemnities provided in this policy as the 10
	847	+	premium paid would have purchased at the rates and within the limits fixed by 11
	848	+	the insurer for such more hazardous occupation. If the insured changes his or 12
	849	+	her occupation to one classified by the insurer as less hazardous than that 13
	850	+	stated in this policy, the insurer, upon receipt of proof of such change of 14
	851	+	occupation, will reduce the premium rate accordingly, and will return the 15
	852	+	excess pro rata unearned premium from the date of change of occupation or 16
	853	+	from the policy anniversary date immediately preceding receipt of such proof, 17
	854	+	whichever is the more recent. In applying this provision, the classification of 18
	855	+	occupational risk and the premium rates shall be such as have been last filed by 19
	856	+	the insurer prior to the occurrence of the loss for which the insurer is liable or 20
	857	+	prior to date of proof of change in occupation with the state official having 21 BILL AS INTRODUCED S.30
1469	858		2025 Page 36 of 181
1470		-	supervisionofinsuranceinthestatewheretheinsuredresidedatthetimethis
1471		-	policywasissued;butifsuchfilingwasnotrequired,thentheclassificationof
1472		-	occupationalriskandthepremiumratesshallbethoselastmadeeffectiveby
1473		-	theinsurerinsuchstatepriortotheoccurrenceofthelossorpriortothedate
1474		-	ofproofofchangeinoccupation.
1475		-	(2)MISSTATEMENTOFAGE:Iftheageoftheinsuredhasbeen
1476		-	misstated,allamountspayableunderthispolicyshallbesuchasthepremium
1477		-	paidwouldhavepurchasedatthecorrectage.
1478		-	(3)OTHERINSURANCEINTHISINSURER:Ifanaccidentor
1479		-	sicknessoraccidentandsicknesspolicyorpoliciespreviouslyissuedbythe
1480		-	insurertotheinsuredbeinforceconcurrentlyherewith,makingtheaggregate
1481		-	indemnityfor....(inserttypeofcoverageorcoverages)inexcessof$
1482		-	....................(insertmaximumlimitofindemnityorindemnities)theexcess
1483		-	insuranceshallbevoidandallpremiumspaidforsuchexcessshallbereturned
1484		-	totheinsuredortohisorherestate.
1485		-	Insuranceeffectiveatanyonetimeontheinsuredunderalikepolicyor
1486		-	policiesinthisinsurerislimitedtotheonesuchpolicyelectedbytheinsured,
1487		-	hisorherbeneficiaryorhisorherestate,asthecasemaybe,andtheinsurer
1488		-	willreturnallpremiumspaidforallothersuchpolicies.
1489		-	(4)INSURANCEWITHOTHERINSURERS:Iftherebeothervalid
1490		-	coverage,notwiththisinsurer,providingbenefitsforthesamelossona
1491		-	1
1492		-	2
1493		-	3
1494		-	4
1495		-	5
1496		-	6
1497		-	7
1498		-	8
1499		-	9
1500		-	10
1501		-	11
1502		-	12
1503		-	13
1504		-	14
1505		-	15
1506		-	16
1507		-	17
1508		-	18
1509		-	19
1510		-	20
1511		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	859	+
	860	+
	861	+	VT LEG #380165 v.1
	862	+	supervision of insurance in the state where the insured resided at the time this 1
	863	+	policy was issued; but if such filing was not required, then the classification of 2
	864	+	occupational risk and the premium rates shall be those last made effective by 3
	865	+	the insurer in such state prior to the occurrence of the loss or prior to the date 4
	866	+	of proof of change in occupation. 5
	867	+	(2) MISSTATEMENT OF AGE: If the age of the insured has been 6
	868	+	misstated, all amounts payable under this policy shall be such as the premium 7
	869	+	paid would have purchased at the correct age. 8
	870	+	(3) OTHER INSURANCE IN THIS INSURER: If an accident or 9
	871	+	sickness or accident and sickness policy or policies previously issued by the 10
	872	+	insurer to the insured be in force concurrently herewith, making the aggregate 11
	873	+	indemnity for .... (insert type of coverage or coverages) in excess of $ 12
	874	+	.................... (insert maximum limit of indemnity or indemnities) the excess 13
	875	+	insurance shall be void and all premiums paid for such excess shall be returned 14
	876	+	to the insured or to his or her estate. 15
	877	+	Insurance effective at any one time on the insured under a like policy or 16
	878	+	policies in this insurer is limited to the one such policy elected by the insured, 17
	879	+	his or her beneficiary or his or her estate, as the case may be, and the insurer 18
	880	+	will return all premiums paid for all other such policies. 19
	881	+	(4) INSURANCE WITH OTHER INSURERS: If there be other valid 20
	882	+	coverage, not with this insurer, providing benefits for the same loss on a 21 BILL AS INTRODUCED S.30
1512	883		2025 Page 37 of 181
1513		-	provisionofservicebasisoronanexpenseincurredbasisandofwhichthis
1514		-	insurerhasnotbeengivenwrittennoticepriortotheoccurrenceor
1515		-	commencementofloss,theonlyliabilityunderanyexpenseincurredcoverage
1516		-	ofthispolicyshallbeforsuchproportionofthelossastheamountwhich
1517		-	wouldotherwisehavebeenpayablehereunderplusthetotalofthelike
1518		-	amountsunderallsuchothervalidcoveragesforthesamelossofwhichthis
1519		-	insurerhadnoticebearstothetotallikeamountsunderallvalidcoveragesfor
1520		-	suchloss,andforthereturnofsuchportionofthepremiumspaidasshall
1521		-	exceedtheprorataportionfortheamountsodetermined.Forthepurposeof
1522		-	applyingthisprovisionwhenothercoverageisonaprovisionofservicebasis,
1523		-	the“likeamount”ofsuchothercoverageshallbetakenastheamountwhich
1524		-	theservicesrenderedwouldhavecostintheabsenceofsuchcoverage.
1525		-	(Iftheforegoingpolicyprovisionisincludedinapolicywhichalso
1526		-	containsthenextfollowingpolicyprovisionthereshallbeaddedtothecaption
1527		-	oftheforegoingprovisionthephrase“—EXPENSEINCURRED
1528		-	BENEFITS.”Theinsurermay,atitsoption,includeinthisprovisiona
1529		-	definitionof“othervalidcoverage,”approvedastoformbythe
1530		-	Commissioner,whichdefinitionshallbelimitedinsubjectmattertocoverage
1531		-	providedbyorganizationssubjecttoregulationbyinsurancelaworby
1532		-	insuranceauthoritiesofthisoranyotherstateoftheUnitedStatesorany
1533		-	provinceofCanada,andbyhospitalormedicalserviceorganizations,andto
1534		-	1
1535		-	2
1536		-	3
1537		-	4
1538		-	5
1539		-	6
1540		-	7
1541		-	8
1542		-	9
1543		-	10
1544		-	11
1545		-	12
1546		-	13
1547		-	14
1548		-	15
1549		-	16
1550		-	17
1551		-	18
1552		-	19
1553		-	20
1554		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	884	+
	885	+
	886	+	VT LEG #380165 v.1
	887	+	provision of service basis or on an expense incurred basis and of which this 1
	888	+	insurer has not been given written notice prior to the occurrence or 2
	889	+	commencement of loss, the only liability under any expense incurred coverage 3
	890	+	of this policy shall be for such proportion of the loss as the amount which 4
	891	+	would otherwise have been payable hereunder plus the total of the like 5
	892	+	amounts under all such other valid coverages for the same loss of which this 6
	893	+	insurer had notice bears to the total like amounts under all valid coverages for 7
	894	+	such loss, and for the return of such portion of the premiums paid as shall 8
	895	+	exceed the pro rata portion for the amount so determined. For the purpose of 9
	896	+	applying this provision when other coverage is on a provision of service basis, 10
	897	+	the “like amount” of such other coverage shall be taken as the amount which 11
	898	+	the services rendered would have cost in the absence of such coverage. 12
	899	+	(If the foregoing policy provision is included in a policy which also 13
	900	+	contains the next following policy provision there shall be added to the caption 14
	901	+	of the foregoing provision the phrase “—EXPENSE INCURRED 15
	902	+	BENEFITS.” The insurer may, at its option, include in this provision a 16
	903	+	definition of “other valid coverage,” approved as to form by the 17
	904	+	Commissioner, which definition shall be limited in subject matter to coverage 18
	905	+	provided by organizations subject to regulation by insurance law or by 19
	906	+	insurance authorities of this or any other state of the United States or any 20
	907	+	province of Canada, and by hospital or medical service organizations, and to 21 BILL AS INTRODUCED S.30
1555	908		2025 Page 38 of 181
1556		-	anyothercoveragetheinclusionofwhichmaybeapprovedbythe
1557		-	Commissioner.Intheabsenceofsuchdefinitionsuchtermshallnotinclude
1558		-	groupinsurance,automobilemedicalpaymentsinsurance,orcoverage
1559		-	providedbyhospitalormedicalserviceorganizationsorbyunionwelfare
1560		-	plansoremployeroremployeebenefitorganizations.Forthepurposeof
1561		-	applyingtheforegoingpolicyprovisionwithrespecttoanyinsured,any
1562		-	amountofbenefitprovidedforsuchinsuredpursuanttoanycompulsory
1563		-	benefitstatute(includinganyworkers’compensationoremployer’sliability
1564		-	statute)whetherprovidedbyagovernmentalagencyorotherwiseshallinall
1565		-	casesbedeemedtobe“othervalidcoverage”ofwhichtheinsurerhashad
1566		-	notice.Inapplyingtheforegoingpolicyprovisionnothirdpartyliability
1567		-	coverageshallbeincludedas“othervalidcoverage.”)
1568		-	(5)INSURANCEWITHOTHERINSURERS:Iftherebeothervalid
1569		-	coverage,notwiththisinsurer,providingbenefitsforthesamelossonother
1570		-	thananexpenseincurredbasisandofwhichthisinsurerhasnotbeengiven
1571		-	writtennoticepriortotheoccurrenceorcommencementofloss,theonly
1572		-	liabilityforsuchbenefitsunderthispolicyshallbeforsuchproportionofthe
1573		-	indemnitiesotherwiseprovidedhereunderforsuchlossasthelikeindemnities
1574		-	ofwhichtheinsurerhadnotice(includingtheindemnitiesunderthispolicy)
1575		-	beartothetotalamountofalllikeindemnitiesforsuchloss,andforthereturn
1576		-	1
1577		-	2
1578		-	3
1579		-	4
1580		-	5
1581		-	6
1582		-	7
1583		-	8
1584		-	9
1585		-	10
1586		-	11
1587		-	12
1588		-	13
1589		-	14
1590		-	15
1591		-	16
1592		-	17
1593		-	18
1594		-	19
1595		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	909	+
	910	+
	911	+	VT LEG #380165 v.1
	912	+	any other coverage the inclusion of which may be approved by the 1
	913	+	Commissioner. In the absence of such definition such term shall not include 2
	914	+	group insurance, automobile medical payments insurance, or coverage 3
	915	+	provided by hospital or medical service organizations or by union welfare 4
	916	+	plans or employer or employee benefit organizations. For the purpose of 5
	917	+	applying the foregoing policy provision with respect to any insured, any 6
	918	+	amount of benefit provided for such insured pursuant to any compulsory 7
	919	+	benefit statute (including any workers’ compensation or employer’s liability 8
	920	+	statute) whether provided by a governmental agency or otherwise shall in all 9
	921	+	cases be deemed to be “other valid coverage” of which the insurer has had 10
	922	+	notice. In applying the foregoing policy provision no third party liability 11
	923	+	coverage shall be included as “other valid coverage.”) 12
	924	+	(5) INSURANCE WITH OTHER INSURERS: If there be other valid 13
	925	+	coverage, not with this insurer, providing benefits for the same loss on other 14
	926	+	than an expense incurred basis and of which this insurer has not been given 15
	927	+	written notice prior to the occurrence or commencement of loss, the only 16
	928	+	liability for such benefits under this policy shall be for such proportion of the 17
	929	+	indemnities otherwise provided hereunder for such loss as the like indemnities 18
	930	+	of which the insurer had notice (including the indemnities under this policy) 19
	931	+	bear to the total amount of all like indemnities for such loss, and for the return 20 BILL AS INTRODUCED S.30
1596	932		2025 Page 39 of 181
1597		-	ofsuchportionofthepremiumpaidasshallexceedtheprorataportionforthe
1598		-	indemnitiesthusdetermined.
1599		-	(Iftheforegoingpolicyprovisionisincludedinapolicywhichalso
1600		-	containsthenextprecedingpolicyprovisionthereshallbeaddedtothecaption
1601		-	oftheforegoingprovisionthephrase“—OTHERBENEFITS.”Theinsurer
1602		-	may,atitsoption,includeinthisprovisionadefinitionof“othervalid
1603		-	coverage,”approvedastoformbytheCommissioner,whichdefinitionshall
1604		-	belimitedinsubjectmattertocoverageprovidedbyorganizationssubjectto
1605		-	regulationbyinsurancelaworbyinsuranceauthoritiesofthisoranyother
1606		-	stateoftheUnitedStatesoranyprovinceofCanada,andtoanyothercoverage
1607		-	theinclusionofwhichmaybeapprovedbytheCommissioner.Intheabsence
1608		-	ofsuchdefinitionsuchtermshallnotincludegroupinsurance,orbenefits
1609		-	providedbyunionwelfareplansorbyemployeroremployeebenefit
1610		-	organizations.Forthepurposeofapplyingtheforegoingpolicyprovisionwith
1611		-	respecttoanyinsured,anyamountofbenefitprovidedforsuchinsured
1612		-	pursuanttoanycompulsorybenefitstatute(includinganyworkers’
1613		-	compensationoremployer’sliabilitystatute)whetherprovidedbya
1614		-	governmentalagencyorotherwiseshallinallcasesbedeemedtobe“other
1615		-	validcoverage”ofwhichtheinsurerhashadnotice.Inapplyingtheforegoing
1616		-	policyprovisionnothirdpartyliabilitycoverageshallbeincludedas“other
1617		-	validcoverage.”)
1618		-	1
1619		-	2
1620		-	3
1621		-	4
1622		-	5
1623		-	6
1624		-	7
1625		-	8
1626		-	9
1627		-	10
1628		-	11
1629		-	12
1630		-	13
1631		-	14
1632		-	15
1633		-	16
1634		-	17
1635		-	18
1636		-	19
1637		-	20
1638		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	933	+
	934	+
	935	+	VT LEG #380165 v.1
	936	+	of such portion of the premium paid as shall exceed the pro rata portion for the 1
	937	+	indemnities thus determined. 2
	938	+	(If the foregoing policy provision is included in a policy which also 3
	939	+	contains the next preceding policy provision there shall be added to the caption 4
	940	+	of the foregoing provision the phrase “—OTHER BENEFITS.” The insurer 5
	941	+	may, at its option, include in this provision a definition of “other valid 6
	942	+	coverage,” approved as to form by the Commissioner, which definition shall be 7
	943	+	limited in subject matter to coverage provided by organizations subject to 8
	944	+	regulation by insurance law or by insurance authorities of this or any other 9
	945	+	state of the United States or any province of Canada, and to any other coverage 10
	946	+	the inclusion of which may be approved by the Commissioner. In the absence 11
	947	+	of such definition such term shall not include group insurance, or benefits 12
	948	+	provided by union welfare plans or by employer or employee benefit 13
	949	+	organizations. For the purpose of applying the foregoing policy provision with 14
	950	+	respect to any insured, any amount of benefit provided for such insured 15
	951	+	pursuant to any compulsory benefit statute (including any workers’ 16
	952	+	compensation or employer’s liability statute) whether provided by a 17
	953	+	governmental agency or otherwise shall in all cases be deemed to be “other 18
	954	+	valid coverage” of which the insurer has had notice. In applying the foregoing 19
	955	+	policy provision no third party liability coverage shall be included as “other 20
	956	+	valid coverage.”) 21 BILL AS INTRODUCED S.30
1639	957		2025 Page 40 of 181
1640		-	(6)RELATIONOFEARNINGSTOINSURANCE:Ifthetotalmonthly
1641		-	amountoflossoftimebenefitspromisedforthesamelossunderallvalidloss
1642		-	oftimecoverageupontheinsured,whetherpayableonaweeklyormonthly
1643		-	basis,shallexceedthemonthlyearningsoftheinsuredatthetimedisability
1644		-	commencedorhisorheraveragemonthlyearningsfortheperiodoftwoyears
1645		-	immediatelyprecedingadisabilityforwhichclaimismade,whicheveristhe
1646		-	greater,theinsurerwillbeliableonlyforsuchproportionateamountofsuch
1647		-	benefitsunderthispolicyastheamountofsuchmonthlyearningsorsuch
1648		-	averagemonthlyearningsoftheinsuredbearstothetotalamountofmonthly
1649		-	benefitsforthesamelossunderallsuchcoverageupontheinsuredatthetime
1650		-	suchdisabilitycommencesandforthereturnofsuchpartofthepremiums
1651		-	paidduringsuchtwoyearsasshallexceedtheprorataamountofthe
1652		-	premiumsforthebenefitsactuallypaidhereunder;butthisshallnotoperateto
1653		-	reducethetotalmonthlyamountofbenefitspayableunderallsuchcoverage
1654		-	upontheinsuredbelowthesumof$200.00orthesumofthemonthlybenefits
1655		-	specifiedinsuchcoverages,whicheveristhelesser,norshallitoperateto
1656		-	reducebenefitsotherthanthosepayableforlossoftime.
1657		-	(Theforegoingpolicyprovisionmaybeinsertedonlyinapolicywhich
1658		-	theinsuredhastherighttocontinueinforcesubjecttoitstermsbythetimely
1659		-	paymentofpremiums(1)untilatleastage50;or(2)inthecaseofapolicy
1660		-	issuedafterage44,foratleastfiveyearsfromitsdateofissue.Theinsurer
1661		-	1
1662		-	2
1663		-	3
1664		-	4
1665		-	5
1666		-	6
1667		-	7
1668		-	8
1669		-	9
1670		-	10
1671		-	11
1672		-	12
1673		-	13
1674		-	14
1675		-	15
1676		-	16
1677		-	17
1678		-	18
1679		-	19
1680		-	20
1681		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	958	+
	959	+
	960	+	VT LEG #380165 v.1
	961	+	(6) RELATION OF EARNINGS TO INSURANCE: If the total monthly 1
	962	+	amount of loss of time benefits promised for the same loss under all valid loss 2
	963	+	of time coverage upon the insured, whether payable on a weekly or monthly 3
	964	+	basis, shall exceed the monthly earnings of the insured at the time disability 4
	965	+	commenced or his or her average monthly earnings for the period of two years 5
	966	+	immediately preceding a disability for which claim is made, whichever is the 6
	967	+	greater, the insurer will be liable only for such proportionate amount of such 7
	968	+	benefits under this policy as the amount of such monthly earnings or such 8
	969	+	average monthly earnings of the insured bears to the total amount of monthly 9
	970	+	benefits for the same loss under all such coverage upon the insured at the time 10
	971	+	such disability commences and for the return of such part of the premiums paid 11
	972	+	during such two years as shall exceed the pro rata amount of the premiums for 12
	973	+	the benefits actually paid hereunder; but this shall not operate to reduce the 13
	974	+	total monthly amount of benefits payable under all such coverage upon the 14
	975	+	insured below the sum of $200.00 or the sum of the monthly benefits specified 15
	976	+	in such coverages, whichever is the lesser, nor shall it operate to reduce 16
	977	+	benefits other than those payable for loss of time. 17
	978	+	(The foregoing policy provision may be inserted only in a policy which 18
	979	+	the insured has the right to continue in force subject to its terms by the timely 19
	980	+	payment of premiums (1) until at least age 50; or (2) in the case of a policy 20
	981	+	issued after age 44, for at least five years from its date of issue. The insurer 21 BILL AS INTRODUCED S.30
1682	982		2025 Page 41 of 181
1683		-	may,atitsoption,includeinthisprovisionadefinitionof“validlossoftime
1684		-	coverage,”approvedastoformbytheCommissioner,whichdefinitionshall
1685		-	belimitedinsubjectmattertocoverageprovidedbygovernmentalagenciesor
1686		-	byorganizationssubjecttoregulationbyinsurancelaworbyinsurance
1687		-	authoritiesofthisoranyotherstateoftheUnitedStatesoranyprovinceof
1688		-	Canada,ortoanyothercoveragetheinclusionofwhichmaybeapprovedby
1689		-	theCommissioneroranycombinationofsuchcoverages.Intheabsenceof
1690		-	suchdefinitionsuchtermshallnotincludeanycoverageprovidedforsuch
1691		-	insuredpursuanttoanycompulsorybenefitstatute(includinganyworkers’
1692		-	compensationoremployer’sliabilitystatute),orbenefitsprovidedbyunion
1693		-	welfareplansorbyemployeroremployeebenefitorganizations.)
1694		-	(7)UNPAIDPREMIUM:Uponthepaymentofaclaimunderthispolicy,
1695		-	anypremiumthendueandunpaidorcoveredbyanynoteorwrittenordermay
1696		-	bedeductedtherefrom.
1697		-	(8)CANCELLATION:Theinsurermaycancelthispolicyatanytimeby
1698		-	writtennoticedeliveredtotheinsured,ormailedtohisorherlastaddressas
1699		-	shownbytherecordsoftheinsurer,statingwhen,notlessthanfivedays
1700		-	thereafter,suchcancellationshallbeeffective;andafterthepolicyhasbeen
1701		-	continuedbeyonditsoriginaltermtheinsuredmaycancelthispolicyatany
1702		-	timebywrittennoticedeliveredormailedtotheinsurer,effectiveuponreceipt
1703		-	oronsuchlaterdateasmaybespecifiedinsuchnotice.Intheeventof
1704		-	1
1705		-	2
1706		-	3
1707		-	4
1708		-	5
1709		-	6
1710		-	7
1711		-	8
1712		-	9
1713		-	10
1714		-	11
1715		-	12
1716		-	13
1717		-	14
1718		-	15
1719		-	16
1720		-	17
1721		-	18
1722		-	19
1723		-	20
1724		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	983	+
	984	+
	985	+	VT LEG #380165 v.1
	986	+	may, at its option, include in this provision a definition of “valid loss of time 1
	987	+	coverage,” approved as to form by the Commissioner, which definition shall be 2
	988	+	limited in subject matter to coverage provided by governmental agencies or by 3
	989	+	organizations subject to regulation by insurance law or by insurance authorities 4
	990	+	of this or any other state of the United States or any province of Canada, or to 5
	991	+	any other coverage the inclusion of which may be approved by the 6
	992	+	Commissioner or any combination of such coverages. In the absence of such 7
	993	+	definition such term shall not include any coverage provided for such insured 8
	994	+	pursuant to any compulsory benefit statute (including any workers’ 9
	995	+	compensation or employer’s liability statute), or benefits provided by union 10
	996	+	welfare plans or by employer or employee benefit organizations.) 11
	997	+	(7) UNPAID PREMIUM: Upon the payment of a claim under this policy, 12
	998	+	any premium then due and unpaid or covered by any note or written order may 13
	999	+	be deducted therefrom. 14
	1000	+	(8) CANCELLATION: The insurer may cancel this policy at any time by 15
	1001	+	written notice delivered to the insured, or mailed to his or her last address as 16
	1002	+	shown by the records of the insurer, stating when, not less than five days 17
	1003	+	thereafter, such cancellation shall be effective; and after the policy has been 18
	1004	+	continued beyond its original term the insured may cancel this policy at any 19
	1005	+	time by written notice delivered or mailed to the insurer, effective upon receipt 20
	1006	+	or on such later date as may be specified in such notice. In the event of 21 BILL AS INTRODUCED S.30
1725	1007		2025 Page 42 of 181
1726		-	cancellation,theinsurerwillreturnpromptlytheunearnedportionofany
1727		-	premiumpaid.Iftheinsuredcancels,theearnedpremiumshallbecomputed
1728		-	bytheuseoftheshort-ratetablelastfiledwiththestateofficialhaving
1729		-	supervisionofinsuranceinthestatewheretheinsuredresidedwhenthepolicy
1730		-	wasissued.Iftheinsurercancels,theearnedpremiumshallbecomputedpro
1731		-	rata.Cancellationshallbewithoutprejudicetoanyclaimoriginatingpriorto
1732		-	theeffectivedateofcancellation.
1733		-	(9)CONFORMITYWITHSTATESTATUTES:Anyprovisionofthis
1734		-	policywhich,onitseffectivedate,isinconflictwiththestatutesofthestatein
1735		-	whichtheinsuredresidesonsuchdateisherebyamendedtoconformtothe
1736		-	minimumrequirementsofsuchstatutes.
1737		-	(10)ILLEGALOCCUPATION:Theinsurershallnotbeliableforanyloss
1738		-	towhichacontributingcausewastheinsured’scommissionoforattemptto
1739		-	commitafelonyortowhichacontributingcausewastheinsured’sbeing
1740		-	engagedinanillegaloccupation.
1741		-	§ 4031.OMISSIONOFINAPPLICABLEORINCONSISTENT
1742		-	STANDARDPROVISIONS
1743		-	Ifanyprovisionofsections4029and4030ofthistitleisinwholeorinpart
1744		-	inapplicabletoorinconsistentwiththecoverageprovidedbyaparticularform
1745		-	ofpolicy,thehealthinsurer,withtheapprovaloftheCommissioner,shallomit
1746		-	fromsuchpolicyanyinapplicableprovisionorpartofaprovision,andshall
1747		-	1
1748		-	2
1749		-	3
1750		-	4
1751		-	5
1752		-	6
1753		-	7
1754		-	8
1755		-	9
1756		-	10
1757		-	11
1758		-	12
1759		-	13
1760		-	14
1761		-	15
1762		-	16
1763		-	17
1764		-	18
1765		-	19
1766		-	20
1767		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1008	+
	1009	+
	1010	+	VT LEG #380165 v.1
	1011	+	cancellation, the insurer will return promptly the unearned portion of any 1
	1012	+	premium paid. If the insured cancels, the earned premium shall be computed 2
	1013	+	by the use of the short-rate table last filed with the state official having 3
	1014	+	supervision of insurance in the state where the insured resided when the policy 4
	1015	+	was issued. If the insurer cancels, the earned premium shall be computed pro 5
	1016	+	rata. Cancellation shall be without prejudice to any claim originating prior to 6
	1017	+	the effective date of cancellation. 7
	1018	+	(9) CONFORMITY WITH STATE STATUTES: Any provision of this 8
	1019	+	policy which, on its effective date, is in conflict with the statutes of the state in 9
	1020	+	which the insured resides on such date is hereby amended to conform to the 10
	1021	+	minimum requirements of such statutes. 11
	1022	+	(10) ILLEGAL OCCUPATION: The insurer shall not be liable for any 12
	1023	+	loss to which a contributing cause was the insured’s commission of or attempt 13
	1024	+	to commit a felony or to which a contributing cause was the insured’s being 14
	1025	+	engaged in an illegal occupation. 15
	1026	+	§ 4031. OMISSION OF INAPPLICABLE OR INCONSISTENT 16
	1027	+	STANDARD PROVISIONS 17
	1028	+	If any provision of sections 4029 and 4030 of this title is in whole or in part 18
	1029	+	inapplicable to or inconsistent with the coverage provided by a particular form 19
	1030	+	of policy, the health insurer, with the approval of the Commissioner, shall omit 20
	1031	+	from such policy any inapplicable provision or part of a provision, and shall 21 BILL AS INTRODUCED S.30
1768	1032		2025 Page 43 of 181
1769		-	modifyanyinconsistentprovisionorpartoftheprovisioninsuchmannerasto
1770		-	maketheprovisionascontainedinthepolicyconsistentwiththecoverage
1771		-	providedbythepolicy.
1772		-	§ 4032.ORDEROFSTANDARDPOLICYPROVISIONS
1773		-	Theprovisionsspecifiedinsections4029and4030ofthistitle,orany
1774		-	correspondingprovisionsusedinlieuofthoseprovisionsaspermittedbythose
1775		-	sections,shalleitherbeprintedinthesameorderastheprovisionsaresetforth
1776		-	inthosesectionsor,attheoptionofthehealthinsurer,anysuchprovisionmay
1777		-	appearasaunitinanypartofthepolicy,withotherprovisionstowhichitmay
1778		-	belogicallyrelated,providedtheresultingpolicyshallnotbeinwholeorin
1779		-	partunintelligible,uncertain,ambiguous,abstruse,orlikelytomisleada
1780		-	persontowhomthepolicyisoffered,delivered,orissued.
1781		-	§ 4033.DISCRETIONARYCLAUSESPROHIBITED
1782		-	(a)Thepurposeofthissectionistoensurethathealthinsurancebenefits,
1783		-	disabilityincomeprotectioncoverage,andlifeinsurancebenefitsare
1784		-	contractuallyguaranteedandtoavoidtheconflictofinterestthatmayoccur
1785		-	whenthecarrierresponsibleforprovidingbenefitshasdiscretionaryauthority
1786		-	todecidewhatbenefitsaredue.Nothinginthissectionshallbeconstruedto
1787		-	imposeanyrequirementordutyonanypersonotherthanahealthinsurerora
1788		-	healthinsurerofferingdisabilityincomeprotectioncoverageorlifeinsurance.
1789		-	(b)Asusedinthissection:
1790		-	1
1791		-	2
1792		-	3
1793		-	4
1794		-	5
1795		-	6
1796		-	7
1797		-	8
1798		-	9
1799		-	10
1800		-	11
1801		-	12
1802		-	13
1803		-	14
1804		-	15
1805		-	16
1806		-	17
1807		-	18
1808		-	19
1809		-	20
1810		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1033	+
	1034	+
	1035	+	VT LEG #380165 v.1
	1036	+	modify any inconsistent provision or part of the provision in such manner as to 1
	1037	+	make the provision as contained in the policy consistent with the coverage 2
	1038	+	provided by the policy. 3
	1039	+	§ 4032. ORDER OF STANDARD POLICY PROVISIONS 4
	1040	+	The provisions specified in sections 4029 and 4030 of this title, or any 5
	1041	+	corresponding provisions used in lieu of those provisions as permitted by those 6
	1042	+	sections, shall either be printed in the same order as the provisions are set forth 7
	1043	+	in those sections or, at the option of the health insurer, any such provision may 8
	1044	+	appear as a unit in any part of the policy, with other provisions to which it may 9
	1045	+	be logically related, provided the resulting policy shall not be in whole or in 10
	1046	+	part unintelligible, uncertain, ambiguous, abstruse, or likely to mislead a 11
	1047	+	person to whom the policy is offered, delivered, or issued. 12
	1048	+	§ 4033. DISCRETIONARY CLAUSES PROHIBITED 13
	1049	+	(a) The purpose of this section is to ensure that health insurance benefits, 14
	1050	+	disability income protection coverage, and life insurance benefits are 15
	1051	+	contractually guaranteed and to avoid the conflict of interest that may occur 16
	1052	+	when the carrier responsible for providing benefits has discretionary authority 17
	1053	+	to decide what benefits are due. Nothing in this section shall be construed to 18
	1054	+	impose any requirement or duty on any person other than a health insurer or a 19
	1055	+	health insurer offering disability income protection coverage or life insurance. 20
	1056	+	(b) As used in this section: 21 BILL AS INTRODUCED S.30
1811	1057		2025 Page 44 of 181
1812		-	(1)“Disabilityincomeprotectioncoverage”meansapolicy,contract,
1813		-	certificate,oragreementthatprovidesforweekly,monthly,orotherperiodic
1814		-	paymentsforaspecifiedperiodduringthecontinuanceofdisabilityresulting
1815		-	fromillness,injury,oracombinationofillnessandinjury.
1816		-	(2)“Healthinsurer”hasthesamemeaningasinsection4021ofthis
1817		-	chapterand,asusedinthissection,alsoincludesentitiesofferingpoliciesfor
1818		-	specificdisease,accident,injury,hospitalindemnity,dentalcare,disability
1819		-	income,long-termcare,andotherlimitedbenefitcoverage.
1820		-	(3)“Lifeinsurance”meansapolicy,contract,certificate,oragreement
1821		-	thatprovideslifeinsuranceasdefinedinsubdivision3301(a)(1)ofthistitle.
1822		-	(c)Nopolicy,contract,certificate,oragreementofferedorissuedinthis
1823		-	Statebyahealthinsurertoprovide,deliver,arrangefor,payfor,orreimburse
1824		-	anyofthecostsofhealthcareservicesmaycontainaprovisionpurportingto
1825		-	reservediscretiontothehealthinsurertointerpretthetermsofthecontractor
1826		-	toprovidestandardsofinterpretationorreviewthatareinconsistentwiththe
1827		-	lawsofthisState,andanysuchprovisioninapolicy,contract,certificate,or
1828		-	agreementshallbenullandvoid.
1829		-	(d)Nopolicy,contract,certificate,oragreementofferedorissuedinthis
1830		-	Stateprovidingfordisabilityincomeprotectioncoveragemaycontaina
1831		-	provisionpurportingtoreservediscretiontotheinsurertointerprettheterms
1832		-	ofthecontractortoprovidestandardsofinterpretationorreviewthatare
1833		-	1
1834		-	2
1835		-	3
1836		-	4
1837		-	5
1838		-	6
1839		-	7
1840		-	8
1841		-	9
1842		-	10
1843		-	11
1844		-	12
1845		-	13
1846		-	14
1847		-	15
1848		-	16
1849		-	17
1850		-	18
1851		-	19
1852		-	20
1853		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1058	+
	1059	+
	1060	+	VT LEG #380165 v.1
	1061	+	(1) “Disability income protection coverage” means a policy, contract, 1
	1062	+	certificate, or agreement that provides for weekly, monthly, or other periodic 2
	1063	+	payments for a specified period during the continuance of disability resulting 3
	1064	+	from illness, injury, or a combination of illness and injury. 4
	1065	+	(2) “Health insurer” has the same meaning as in section 4021 of this 5
	1066	+	chapter and, as used in this section, also includes entities offering policies for 6
	1067	+	specific disease, accident, injury, hospital indemnity, dental care, disability 7
	1068	+	income, long-term care, and other limited benefit coverage. 8
	1069	+	(3) “Life insurance” means a policy, contract, certificate, or agreement 9
	1070	+	that provides life insurance as defined in subdivision 3301(a)(1) of this title. 10
	1071	+	(c) No policy, contract, certificate, or agreement offered or issued in this 11
	1072	+	State by a health insurer to provide, deliver, arrange for, pay for, or reimburse 12
	1073	+	any of the costs of health care services may contain a provision purporting to 13
	1074	+	reserve discretion to the health insurer to interpret the terms of the contract or 14
	1075	+	to provide standards of interpretation or review that are inconsistent with the 15
	1076	+	laws of this State, and any such provision in a policy, contract, certificate, or 16
	1077	+	agreement shall be null and void. 17
	1078	+	(d) No policy, contract, certificate, or agreement offered or issued in this 18
	1079	+	State providing for disability income protection coverage may contain a 19
	1080	+	provision purporting to reserve discretion to the insurer to interpret the terms 20
	1081	+	of the contract or to provide standards of interpretation or review that are 21 BILL AS INTRODUCED S.30
1854	1082		2025 Page 45 of 181
1855		-	inconsistentwiththelawsofthisState,andanysuchprovisioninapolicy,
1856		-	contract,certificate,oragreementshallbenullandvoid.
1857		-	(e)Nopolicy,contract,certificate,oragreementoflifeinsuranceoffered
1858		-	orissuedinthisStateshallcontainaprovisionpurportingtoreservediscretion
1859		-	totheinsurertointerpretthetermsofthecontractortoprovidestandardsof
1860		-	interpretationorreviewthatareinconsistentwiththelawsofthisState,and
1861		-	anysuchprovisioninapolicy,contract,certificate,oragreementshallbenull
1862		-	andvoid.
1863		-	§ 4034.REQUIREMENTS OFOTHERJURISDICTIONS
1864		-	(a)Anypolicyofaforeignoralieninsurer,whendeliveredorissuedfor
1865		-	deliverytoanypersoninthisState,maycontainanyprovisionthatisnotless
1866		-	favorabletothecoveredindividualthantheprovisionsofthischapterandthat
1867		-	isprescribedorrequiredbythelawofthestateunderwhichtheinsureris
1868		-	organized.
1869		-	(b)Anypolicyofadomestichealthinsurer,whenissuedfordeliveryin
1870		-	anyotherstateorcountry,maycontainanyprovisionpermittedorrequiredby
1871		-	thelawsofsuchotherstateorcountry.
1872		-	§ 4035.POLICIESNOTAFFECTED
1873		-	Nothinginsections4018–4020,4023,4028–4032,4034,4036,and4037of
1874		-	thistitleshallapplytooraffect:
1875		-	1
1876		-	2
1877		-	3
1878		-	4
1879		-	5
1880		-	6
1881		-	7
1882		-	8
1883		-	9
1884		-	10
1885		-	11
1886		-	12
1887		-	13
1888		-	14
1889		-	15
1890		-	16
1891		-	17
1892		-	18
1893		-	19
1894		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1083	+
	1084	+
	1085	+	VT LEG #380165 v.1
	1086	+	inconsistent with the laws of this State, and any such provision in a policy, 1
	1087	+	contract, certificate, or agreement shall be null and void. 2
	1088	+	(e) No policy, contract, certificate, or agreement of life insurance offered or 3
	1089	+	issued in this State shall contain a provision purporting to reserve discretion to 4
	1090	+	the insurer to interpret the terms of the contract or to provide standards of 5
	1091	+	interpretation or review that are inconsistent with the laws of this State, and 6
	1092	+	any such provision in a policy, contract, certificate, or agreement shall be null 7
	1093	+	and void. 8
	1094	+	§ 4034. REQUIREMENTS OF OTHER JURISDICTIONS 9
	1095	+	(a) Any policy of a foreign or alien insurer, when delivered or issued for 10
	1096	+	delivery to any person in this State, may contain any provision that is not less 11
	1097	+	favorable to the covered individual than the provisions of this chapter and that 12
	1098	+	is prescribed or required by the law of the state under which the insurer is 13
	1099	+	organized. 14
	1100	+	(b) Any policy of a domestic health insurer, when issued for delivery in any 15
	1101	+	other state or country, may contain any provision permitted or required by the 16
	1102	+	laws of such other state or country. 17
	1103	+	§ 4035. POLICIES NOT AFFECTED 18
	1104	+	Nothing in sections 4018–4020, 4023, 4028–4032, 4034, 4036, and 4037 of 19
	1105	+	this title shall apply to or affect: 20 BILL AS INTRODUCED S.30
1895	1106		2025 Page 46 of 181
1896		-	(1)anypolicyofworkers’compensationinsuranceoranypolicyof
1897		-	liabilityinsurance,withorwithoutsupplementarycoverage;
1898		-	(2)anypolicyorcontractofreinsurance;
1899		-	(3)anyblanketorgrouppolicyofinsuranceenumeratedinsections
1900		-	4041–4043and4052ofthistitle,exceptasotherwiseprovidedinthose
1901		-	sections;or
1902		-	(4)lifeinsurance,endowment,orannuitycontracts,orcontracts
1903		-	supplementaltothosecontracts,thatcontainonlysuchprovisionsrelatingto
1904		-	accidentandsicknessinsuranceas:
1905		-	(A)provideadditionalbenefitsincaseofdeathordismembermentor
1906		-	lossofsightbyaccident;or
1907		-	(B)operatetosafeguardthecontractsagainstlapseortogivea
1908		-	specialsurrendervalueorspecialbenefitoranannuityintheeventthatthe
1909		-	insuredorannuitantbecomestotallyandpermanentlydisabled,asdefinedby
1910		-	thecontractorsupplementalcontract.
1911		-	§ 4036.NONCONFORMING POLICIES
1912		-	(a)Ahealthinsurancepolicyshallnotcontainanyprovisionthatmakesthe
1913		-	policyoranyportionofthepolicylessfavorableinanyrespecttothecovered
1914		-	individualthantheprovisionsofthepolicythatareregulatedbysections4029
1915		-	and4030ofthistitle.
1916		-	1
1917		-	2
1918		-	3
1919		-	4
1920		-	5
1921		-	6
1922		-	7
1923		-	8
1924		-	9
1925		-	10
1926		-	11
1927		-	12
1928		-	13
1929		-	14
1930		-	15
1931		-	16
1932		-	17
1933		-	18
1934		-	19
1935		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1107	+
	1108	+
	1109	+	VT LEG #380165 v.1
	1110	+	(1) any policy of workers’ compensation insurance or any policy of 1
	1111	+	liability insurance, with or without supplementary coverage; 2
	1112	+	(2) any policy or contract of reinsurance; 3
	1113	+	(3) any blanket or group policy of insurance enumerated in sections 4
	1114	+	4041–4043 and 4052 of this title, except as otherwise provided in those 5
	1115	+	sections; or 6
	1116	+	(4) life insurance, endowment, or annuity contracts, or contracts 7
	1117	+	supplemental to those contracts, that contain only such provisions relating to 8
	1118	+	accident and sickness insurance as: 9
	1119	+	(A) provide additional benefits in case of death or dismemberment or 10
	1120	+	loss of sight by accident; or 11
	1121	+	(B) operate to safeguard the contracts against lapse or to give a 12
	1122	+	special surrender value or special benefit or an annuity in the event that the 13
	1123	+	insured or annuitant becomes totally and permanently disabled, as defined by 14
	1124	+	the contract or supplemental contract. 15
	1125	+	§ 4036. NONCONFORMING POLICIES 16
	1126	+	(a) A health insurance policy shall not contain any provision that makes the 17
	1127	+	policy or any portion of the policy less favorable in any respect to the covered 18
	1128	+	individual than the provisions of the policy that are regulated by sections 4029 19
	1129	+	and 4030 of this title. 20 BILL AS INTRODUCED S.30
1936	1130		2025 Page 47 of 181
1937		-	(b)ApolicydeliveredorissuedfordeliverytoanypersoninthisStatein
1938		-	violationofsections4029and4030ofthistitleshallbeheldvalidbutshallbe
1939		-	construedasprovidedinthischapter.Whenanyprovisioninapolicy
1940		-	regulatedbysections4029and4030isinconflictwithanyprovisionofthose
1941		-	sections,therights,duties,andobligationsofthehealthinsurerandthe
1942		-	coveredindividualshallbegovernedbytheprovisionsofthosesections.
1943		-	§ 4037.APPLICATIONSFORINSURANCE
1944		-	(a)(1)Acoveredindividualshallnotbeboundbyanystatementmadein
1945		-	anapplicationforapolicyunlessacopyoftheapplicationisattachedtoor
1946		-	endorsedonthepolicyasapartofthepolicywhenissued.
1947		-	(2)IfapolicydeliveredorissuedfordeliverytoanypersoninthisState
1948		-	isreinstatedorrenewedandthecoveredindividualorassigneeofthepolicy
1949		-	makesawrittenrequesttothehealthinsurerforacopyoftheapplication,if
1950		-	any,forsuchreinstatementorrenewal,thehealthinsurershalldeliverormail
1951		-	acopyoftheapplicationtotheindividualmakingtherequestwithin15days
1952		-	afterthereceiptoftherequest.Ifthehealthinsurerdoesnotdeliverormail
1953		-	thecopywithin15days,thehealthinsurershallbeprecludedfromintroducing
1954		-	theapplicationasevidenceinanyactionorproceedingbasedonorinvolving
1955		-	thepolicyoritsreinstatementorrenewal.
1956		-	(b)Noalterationofawrittenapplicationforapolicyshallbemadebyany
1957		-	personotherthantheapplicantwithouttheapplicant’swrittenconsent,except
1958		-	1
1959		-	2
1960		-	3
1961		-	4
1962		-	5
1963		-	6
1964		-	7
1965		-	8
1966		-	9
1967		-	10
1968		-	11
1969		-	12
1970		-	13
1971		-	14
1972		-	15
1973		-	16
1974		-	17
1975		-	18
1976		-	19
1977		-	20
1978		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1131	+
	1132	+
	1133	+	VT LEG #380165 v.1
	1134	+	(b) A policy delivered or issued for delivery to any person in this State in 1
	1135	+	violation of sections 4029 and 4030 of this title shall be held valid but shall be 2
	1136	+	construed as provided in this chapter. When any provision in a policy 3
	1137	+	regulated by sections 4029 and 4030 is in conflict with any provision of those 4
	1138	+	sections, the rights, duties, and obligations of the health insurer and the 5
	1139	+	covered individual shall be governed by the provisions of those sections. 6
	1140	+	§ 4037. APPLICATIONS FOR INSURANCE 7
	1141	+	(a)(1) A covered individual shall not be bound by any statement made in an 8
	1142	+	application for a policy unless a copy of the application is attached to or 9
	1143	+	endorsed on the policy as a part of the policy when issued. 10
	1144	+	(2) If a policy delivered or issued for delivery to any person in this State 11
	1145	+	is reinstated or renewed and the covered individual or assignee of the policy 12
	1146	+	makes a written request to the health insurer for a copy of the application, if 13
	1147	+	any, for such reinstatement or renewal, the health insurer shall deliver or mail a 14
	1148	+	copy of the application to the individual making the request within 15 days 15
	1149	+	after the receipt of the request. If the health insurer does not deliver or mail the 16
	1150	+	copy within 15 days, the health insurer shall be precluded from introducing the 17
	1151	+	application as evidence in any action or proceeding based on or involving the 18
	1152	+	policy or its reinstatement or renewal. 19
	1153	+	(b) No alteration of a written application for a policy shall be made by any 20
	1154	+	person other than the applicant without the applicant’s written consent, except 21 BILL AS INTRODUCED S.30
1979	1155		2025 Page 48 of 181
1980		-	thatinsertionsmaybemadebythehealthinsurer,foradministrativepurposes
1981		-	only,inamannerthatindicatesclearlythattheinsertionsarenottobeascribed
1982		-	totheapplicant.
1983		-	(c)Thefalsityofanystatementinanapplicationforapolicyshallnotbar
1984		-	therighttorecoveryunderthepolicyunlessthefalsestatementmaterially
1985		-	affectedeithertheacceptanceoftheriskorthehazardassumedbythehealth
1986		-	insurer.
1987		-	§ 4038.RULEMAKINGONPOLICYFILINGS
1988		-	TheCommissionermayadoptsuchreasonablerulesconcerningthe
1989		-	procedureforthefilingorsubmissionofpoliciessubjecttosections4023and
1990		-	4028–4030ofthistitleasarenecessary,proper,oradvisableforthe
1991		-	administrationofthesesections.Thisprovisionshallnotabridgeanyother
1992		-	authoritygrantedtotheCommissionerbylaw.
1993		-	Subchapter3.GroupCoverage
1994		-	§ 4041.GROUPHEALTHINSURANCEPOLICIES;DEFINITIONS
1995		-	(a)Asusedinthissection:
1996		-	(1)“Employees”includestheofficers,managers,andemployeesofthe
1997		-	employer;thepartners,iftheemployerisapartnership;theofficers,managers,
1998		-	andemployeesofsubsidiaryoraffiliatedcorporationsofacorporation
1999		-	employer;andtheindividualproprietors,partners,andemployeesof
2000		-	1
2001		-	2
2002		-	3
2003		-	4
2004		-	5
2005		-	6
2006		-	7
2007		-	8
2008		-	9
2009		-	10
2010		-	11
2011		-	12
2012		-	13
2013		-	14
2014		-	15
2015		-	16
2016		-	17
2017		-	18
2018		-	19
2019		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1156	+
	1157	+
	1158	+	VT LEG #380165 v.1
	1159	+	that insertions may be made by the health insurer, for administrative purposes 1
	1160	+	only, in a manner that indicates clearly that the insertions are not to be ascribed 2
	1161	+	to the applicant. 3
	1162	+	(c) The falsity of any statement in an application for a policy shall not bar 4
	1163	+	the right to recovery under the policy unless the false statement materially 5
	1164	+	affected either the acceptance of the risk or the hazard assumed by the health 6
	1165	+	insurer. 7
	1166	+	§ 4038. RULEMAKING ON POLICY FILINGS 8
	1167	+	The Commissioner may adopt such reasonable rules concerning the 9
	1168	+	procedure for the filing or submission of policies subject to sections 4023 and 10
	1169	+	4028–4030 of this title as are necessary, proper, or advisable for the 11
	1170	+	administration of these sections. This provision shall not abridge any other 12
	1171	+	authority granted to the Commissioner by law. 13
	1172	+	Subchapter 3. Group Coverage 14
	1173	+	§ 4041. GROUP HEALTH INSURANCE POLICIES; DEFINITIONS 15
	1174	+	(a) As used in this section: 16
	1175	+	(1) “Employees” includes the officers, managers, and employees of the 17
	1176	+	employer; the partners, if the employer is a partnership; the officers, managers, 18
	1177	+	and employees of subsidiary or affiliated corporations of a corporation 19
	1178	+	employer; and the individual proprietors, partners, and employees of 20 BILL AS INTRODUCED S.30
2020	1179		2025 Page 49 of 181
2021		-	individualsandfirms,thebusinessofwhichiscontrolledbytheinsured
2022		-	employerthroughstockownership,contract,orotherwise.
2023		-	(2)“Employer”maybedeemedtoincludeanymunicipalor
2024		-	governmentalentityorofficer,ortheappropriateofficerforanunincorporated
2025		-	townorgoreorfortheUnifiedTownsandGoresofEssexCounty,aswellas
2026		-	privateindividuals,partnerships,andcorporations.
2027		-	(b)Grouphealthinsuranceisaformofhealthinsurancethatcoversoneor
2028		-	morepersons,withorwithouttheirdependents,thatisissueduponthe
2029		-	followingbasis:
2030		-	(1)(A)Underapolicyissuedtoanemployer,whoisdeemedthe
2031		-	policyholder,insuringatleastoneemployeeoftheemployer,forthebenefitof
2032		-	personsotherthantheemployer.
2033		-	(B)Inaccordancewithsection3368ofthistitle,anemployer
2034		-	domiciledinajurisdictionotherthanVermontthathasmorethan25
2035		-	certificate-holderemployeeswhoseprincipalworksiteanddomicileisin
2036		-	Vermontandthatisdefinedasalargegroupinitsownjurisdictionandunder
2037		-	thePatientProtectionandAffordableCareAct,Pub.L.No.111-148,§1304,
2038		-	asamendedbytheHealthCareandEducationReconciliationActof2010,
2039		-	Pub.L.No.111-152,maypurchaseinsuranceinthelargegrouphealth
2040		-	insurancemarketforitsVermont-domiciledcertificate-holderemployees.
2041		-	(2)(A)Underapolicyissued:
2042		-	1
2043		-	2
2044		-	3
2045		-	4
2046		-	5
2047		-	6
2048		-	7
2049		-	8
2050		-	9
2051		-	10
2052		-	11
2053		-	12
2054		-	13
2055		-	14
2056		-	15
2057		-	16
2058		-	17
2059		-	18
2060		-	19
2061		-	20
2062		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1180	+
	1181	+
	1182	+	VT LEG #380165 v.1
	1183	+	individuals and firms, the business of which is controlled by the insured 1
	1184	+	employer through stock ownership, contract, or otherwise. 2
	1185	+	(2) “Employer” may be deemed to include any municipal or 3
	1186	+	governmental entity or officer, or the appropriate officer for an unincorporated 4
	1187	+	town or gore or for the Unified Towns and Gores of Essex County, as well as 5
	1188	+	private individuals, partnerships, and corporations. 6
	1189	+	(b) Group health insurance is a form of health insurance that covers one or 7
	1190	+	more persons, with or without their dependents, that is issued upon the 8
	1191	+	following basis: 9
	1192	+	(1)(A) Under a policy issued to an employer, who is deemed the 10
	1193	+	policyholder, insuring at least one employee of the employer, for the benefit of 11
	1194	+	persons other than the employer. 12
	1195	+	(B) In accordance with section 3368 of this title, an employer 13
	1196	+	domiciled in a jurisdiction other than Vermont that has more than 25 14
	1197	+	certificate-holder employees whose principal worksite and domicile is in 15
	1198	+	Vermont and that is defined as a large group in its own jurisdiction and under 16
	1199	+	the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, § 1304, 17
	1200	+	as amended by the Health Care and Education Reconciliation Act of 2010, 18
	1201	+	Pub. L. No. 111-152, may purchase insurance in the large group health 19
	1202	+	insurance market for its Vermont-domiciled certificate-holder employees. 20
	1203	+	(2)(A) Under a policy issued: 21 BILL AS INTRODUCED S.30
2063	1204		2025 Page 50 of 181
2064		-	(i)toanassociation,atrust,oroneormoretrusteesofafund
2065		-	establishedbyoneormoreassociationsotherwiseeligiblefortheissuanceofa
2066		-	policyunderthissubdivision(2)andmaintained,directlyorindirectly,byone
2067		-	ormoreassociationsforthebenefitofitsmembersoracontractorplanissued
2068		-	bysuchanassociationortrust;or
2069		-	(ii)byamultipleemployerwelfarearrangementasdefinedinthe
2070		-	EmployeeRetirementIncomeSecurityActof1974,asamended.
2071		-	(B)(i)Theassociationorassociationsshallhave:
2072		-	(I)aminimumof100personsatthetimeofincorporationor
2073		-	formation;
2074		-	(II)beenorganizedandmaintainedingoodfaithforpurposes
2075		-	otherthanthatofobtaininginsurance;
2076		-	(III)beeninactiveexistenceforatleastoneyear;and
2077		-	(IV)aconstitutionandbylawsthatprovidethat:
2078		-	(aa)theassociationorassociationsholdregularmeetings
2079		-	notlessthanannuallytofurtherpurposesofthemembers;
2080		-	(bb)exceptforcreditunions,theassociationorassociations
2081		-	collectduesorsolicitcontributionsfrommembers;and
2082		-	(cc)themembersconstituteamajorityofthevotingpower
2083		-	oftheassociationforallpurposesandhaverepresentationonthegoverning
2084		-	boardandcommittees.
2085		-	1
2086		-	2
2087		-	3
2088		-	4
2089		-	5
2090		-	6
2091		-	7
2092		-	8
2093		-	9
2094		-	10
2095		-	11
2096		-	12
2097		-	13
2098		-	14
2099		-	15
2100		-	16
2101		-	17
2102		-	18
2103		-	19
2104		-	20
2105		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1205	+
	1206	+
	1207	+	VT LEG #380165 v.1
	1208	+	(i) to an association, a trust, or one or more trustees of a fund 1
	1209	+	established by one or more associations otherwise eligible for the issuance of a 2
	1210	+	policy under this subdivision (2) and maintained, directly or indirectly, by one 3
	1211	+	or more associations for the benefit of its members or a contract or plan issued 4
	1212	+	by such an association or trust; or 5
	1213	+	(ii) by a multiple employer welfare arrangement as defined in the 6
	1214	+	Employee Retirement Income Security Act of 1974, as amended. 7
	1215	+	(B)(i) The association or associations shall have: 8
	1216	+	(I) a minimum of 100 persons at the time of incorporation or 9
	1217	+	formation; 10
	1218	+	(II) been organized and maintained in good faith for purposes 11
	1219	+	other than that of obtaining insurance; 12
	1220	+	(III) been in active existence for at least one year; and 13
	1221	+	(IV) a constitution and bylaws that provide that: 14
	1222	+	(aa) the association or associations hold regular meetings 15
	1223	+	not less than annually to further purposes of the members; 16
	1224	+	(bb) except for credit unions, the association or associations 17
	1225	+	collect dues or solicit contributions from members; and 18
	1226	+	(cc) the members constitute a majority of the voting power 19
	1227	+	of the association for all purposes and have representation on the governing 20
	1228	+	board and committees. 21 BILL AS INTRODUCED S.30
2106	1229		2025 Page 51 of 181
2107		-	(ii)(I)Theassociationorassociationsshallnotbecontrolledbya
2108		-	healthinsurer,asevidencedbytheoperationoftheassociationorassociations.
2109		-	(II)Thefollowingfactorsmaybeusedasevidenceto
2110		-	determinewhetheranassociationisahealthinsurer-operatedassociation;
2111		-	provided,however,thatthepresenceorabsenceofoneormoreofthese
2112		-	factorsshallnotservetolimitorbedispositiveofsuchadetermination:
2113		-	(aa)commonboardmembers,officers,executives,or
2114		-	employees;
2115		-	(bb)commonownershipofthehealthinsurerandthe
2116		-	association,oroftheassociationandanothereligiblegroup;and
2117		-	(cc)commonuseofofficespaceorequipmentusedbythe
2118		-	healthinsurertotransactinsurance.
2119		-	(C)Anassociation’smembersshallhaveasharedorcommon
2120		-	purposethatisnotprimarilyabusinessorcustomerrelationship.
2121		-	(D)(i)Apolicyissuedbyanassociationshallnotinsurepersons
2122		-	otherthanthemembersoremployeesoftheassociationorassociations,or
2123		-	employeesofmembers,orallofanyclassorclassesofemployeesofthe
2124		-	association,associations,ormembers,together,ineachcase,withthe
2125		-	employees’ormembers’dependents,asapplicable,forthebenefitofpersons
2126		-	otherthantheemployee’semployer.
2127		-	1
2128		-	2
2129		-	3
2130		-	4
2131		-	5
2132		-	6
2133		-	7
2134		-	8
2135		-	9
2136		-	10
2137		-	11
2138		-	12
2139		-	13
2140		-	14
2141		-	15
2142		-	16
2143		-	17
2144		-	18
2145		-	19
2146		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1230	+
	1231	+
	1232	+	VT LEG #380165 v.1
	1233	+	(ii)(I) The association or associations shall not be controlled by a 1
	1234	+	health insurer, as evidenced by the operation of the association or associations. 2
	1235	+	(II) The following factors may be used as evidence to 3
	1236	+	determine whether an association is a health insurer-operated association; 4
	1237	+	provided, however, that the presence or absence of one or more of these factors 5
	1238	+	shall not serve to limit or be dispositive of such a determination: 6
	1239	+	(aa) common board members, officers, executives, or 7
	1240	+	employees; 8
	1241	+	(bb) common ownership of the health insurer and the 9
	1242	+	association, or of the association and another eligible group; and 10
	1243	+	(cc) common use of office space or equipment used by the 11
	1244	+	health insurer to transact insurance. 12
	1245	+	(C) An association’s members shall have a shared or common 13
	1246	+	purpose that is not primarily a business or customer relationship. 14
	1247	+	(D)(i) A policy issued by an association shall not insure persons other 15
	1248	+	than the members or employees of the association or associations, or 16
	1249	+	employees of members, or all of any class or classes of employees of the 17
	1250	+	association, associations, or members, together, in each case, with the 18
	1251	+	employees’ or members’ dependents, as applicable, for the benefit of persons 19
	1252	+	other than the employee’s employer. 20 BILL AS INTRODUCED S.30
2147	1253		2025 Page 52 of 181
2148		-	(ii)Apolicyissuedbyanassociationshallinsurealleligible
2149		-	persons,exceptthosewhorejectcoverageinwriting.
2150		-	(E)Anassociationshallnotusethesolicitationofinsuranceasthe
2151		-	primarymethodofobtainingnewmembers.
2152		-	(F)Ifahealthinsurercollectsmembershipfeesorduesonbehalfof
2153		-	anassociation,thehealthinsurershalldisclosetothemembersofthe
2154		-	associationthatthehealthinsurerisbillingandcollectingmembershipfees
2155		-	andduesonbehalfoftheassociation.
2156		-	(3)(A)Underapolicyissuedtoatrust,ortooneormoretrusteesofa
2157		-	fundestablishedandmaintained,directlyorindirectly,by:
2158		-	(i)twoormoreemployers;
2159		-	(ii)oneormorelaborunionsorsimilaremployeeorganizations;
2160		-	or
2161		-	(iii)oneormoreemployersandoneormorelaborunionsor
2162		-	similaremployeeorganizations.
2163		-	(B)(i)Apolicyunderthissubdivision(3)mustbeissuedtothetrust
2164		-	ortrusteesforthepurposeofinsuringalloftheemployeesoftheemployersor
2165		-	allofthemembersoftheunionsororganizations,orallofanyclassorclasses
2166		-	ofemployeesormembers,together,ineachcase,withtheemployees’or
2167		-	members’dependents,asapplicable,forthebenefitofpersonsotherthanthe
2168		-	employersortheunionsororganizations.
2169		-	1
2170		-	2
2171		-	3
2172		-	4
2173		-	5
2174		-	6
2175		-	7
2176		-	8
2177		-	9
2178		-	10
2179		-	11
2180		-	12
2181		-	13
2182		-	14
2183		-	15
2184		-	16
2185		-	17
2186		-	18
2187		-	19
2188		-	20
2189		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1254	+
	1255	+
	1256	+	VT LEG #380165 v.1
	1257	+	(ii) A policy issued by an association shall insure all eligible 1
	1258	+	persons, except those who reject coverage in writing. 2
	1259	+	(E) An association shall not use the solicitation of insurance as the 3
	1260	+	primary method of obtaining new members. 4
	1261	+	(F) If a health insurer collects membership fees or dues on behalf of 5
	1262	+	an association, the health insurer shall disclose to the members of the 6
	1263	+	association that the health insurer is billing and collecting membership fees and 7
	1264	+	dues on behalf of the association. 8
	1265	+	(3)(A) Under a policy issued to a trust, or to one or more trustees of a 9
	1266	+	fund established and maintained, directly or indirectly, by: 10
	1267	+	(i) two or more employers; 11
	1268	+	(ii) one or more labor unions or similar employee organizations; 12
	1269	+	or 13
	1270	+	(iii) one or more employers and one or more labor unions or 14
	1271	+	similar employee organizations. 15
	1272	+	(B)(i) A policy under this subdivision (3) must be issued to the trust 16
	1273	+	or trustees for the purpose of insuring all of the employees of the employers or 17
	1274	+	all of the members of the unions or organizations, or all of any class or classes 18
	1275	+	of employees or members, together, in each case, with the employees’ or 19
	1276	+	members’ dependents, as applicable, for the benefit of persons other than the 20
	1277	+	employers or the unions or organizations. 21 BILL AS INTRODUCED S.30
2190	1278		2025 Page 53 of 181
2191		-	(ii)Apolicyissuedtoatrustshallinsurealleligiblepersons,
2192		-	exceptthosewhorejectcoverageinwriting.
2193		-	(4)Underapolicyissuedtoanyothersubstantiallysimilargroupthat,
2194		-	inthediscretionoftheCommissioner,maybesubjecttotheissuanceofa
2195		-	groupaccidentandsicknesspolicyorcontract.
2196		-	§ 4042.GROUPINSURANCEPOLICIES;REQUIREDPOLICY
2197		-	PROVISIONS
2198		-	(a)Termsandconditions.Nogrouphealthinsurancepolicyshallcontain
2199		-	anyprovisionrelatingtonoticeofclaim,proofsofloss,timeofpaymentof
2200		-	claims,ortimewithinwhichlegalactionmustbebroughtuponthepolicythat,
2201		-	intheopinionoftheCommissioner,islessfavorabletothepersonsinsured
2202		-	thanwouldbepermittedbytheprovisionssetforthinsection4029ofthistitle.
2203		-	Inaddition,eachsuchpolicyshallcontaininsubstancethefollowing
2204		-	provisions:
2205		-	(1)Aprovisionthatthepolicy;theapplicationofthepolicyholder,ifan
2206		-	applicationorcopyisattachedtothepolicy;andtheindividualapplications,if
2207		-	any,submittedbytheemployeesormembersinconnectionwiththepolicy
2208		-	shallconstitutetheentirecontractbetweentheparties,andthatallstatements,
2209		-	intheabsenceoffraud,madebyanyapplicantorapplicantsshallbedeemed
2210		-	representationsandnotwarranties,andthatnosuchstatementshallavoidthe
2211		-	1
2212		-	2
2213		-	3
2214		-	4
2215		-	5
2216		-	6
2217		-	7
2218		-	8
2219		-	9
2220		-	10
2221		-	11
2222		-	12
2223		-	13
2224		-	14
2225		-	15
2226		-	16
2227		-	17
2228		-	18
2229		-	19
2230		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1279	+
	1280	+
	1281	+	VT LEG #380165 v.1
	1282	+	(ii) A policy issued to a trust shall insure all eligible persons, 1
	1283	+	except those who reject coverage in writing. 2
	1284	+	(4) Under a policy issued to any other substantially similar group that, in 3
	1285	+	the discretion of the Commissioner, may be subject to the issuance of a group 4
	1286	+	accident and sickness policy or contract. 5
	1287	+	§ 4042. GROUP INSURANCE POLICIES; REQUIRED POLICY 6
	1288	+	PROVISIONS 7
	1289	+	(a) Terms and conditions. No group health insurance policy shall contain 8
	1290	+	any provision relating to notice of claim, proofs of loss, time of payment of 9
	1291	+	claims, or time within which legal action must be brought upon the policy that, 10
	1292	+	in the opinion of the Commissioner, is less favorable to the persons insured 11
	1293	+	than would be permitted by the provisions set forth in section 4029 of this title. 12
	1294	+	In addition, each such policy shall contain in substance the following 13
	1295	+	provisions: 14
	1296	+	(1) A provision that the policy; the application of the policyholder, if an 15
	1297	+	application or copy is attached to the policy; and the individual applications, if 16
	1298	+	any, submitted by the employees or members in connection with the policy 17
	1299	+	shall constitute the entire contract between the parties, and that all statements, 18
	1300	+	in the absence of fraud, made by any applicant or applicants shall be deemed 19
	1301	+	representations and not warranties, and that no such statement shall avoid the 20 BILL AS INTRODUCED S.30
2231	1302		2025 Page 54 of 181
2232		-	insuranceorreducebenefitsunderthepolicyunlesscontainedinawritten
2233		-	application,ofwhichacopyisattachedtothepolicy.
2234		-	(2)Aprovisionthatthehealthinsurerwillfurnishtothepolicyholder,
2235		-	fordeliverytoeachemployeeormemberoftheinsuredgroup,anindividual
2236		-	certificatesettingforthinsummaryformastatementoftheessentialfeatures
2237		-	oftheinsurancecoverageoftheemployeeormemberandtowhombenefits
2238		-	arepayableunderthepolicy.Ifdependentsareincludedinthecoverage,only
2239		-	onecertificateneedbeissuedforeachfamilyunit.
2240		-	(3)Aprovisionthattothegrouporiginallyinsuredmaybeaddedfrom
2241		-	timetotimeeligiblenewemployeesormembersordependents,asthecase
2242		-	maybe,inaccordancewiththetermsofthepolicy.
2243		-	(4)Aprovisionthatthehealthinsurershallnotexcludepart-time
2244		-	employeesandshallofferthesamegrouphealthbenefitstopart-time
2245		-	employeesasitofferstotheemployeegroupsofwhichthepart-time
2246		-	employeeswouldbemembersiftheywerefull-timeemployees.Thehealth
2247		-	insurershalloffertoincludethepart-timeemployeesaspartoftheemployer’s
2248		-	employeegroup,atthefullratetobepaidbytheemployerandtheemployee,
2249		-	atarateproratedbetweentheemployerandtheemployee,oratthe
2250		-	employee’sexpense.Asusedinthissubdivision,“part-timeemployee”means
2251		-	anyemployeewhoworksaminimumofatleast17.5hoursperweek.
2252		-	1
2253		-	2
2254		-	3
2255		-	4
2256		-	5
2257		-	6
2258		-	7
2259		-	8
2260		-	9
2261		-	10
2262		-	11
2263		-	12
2264		-	13
2265		-	14
2266		-	15
2267		-	16
2268		-	17
2269		-	18
2270		-	19
2271		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1303	+
	1304	+
	1305	+	VT LEG #380165 v.1
	1306	+	insurance or reduce benefits under the policy unless contained in a written 1
	1307	+	application, of which a copy is attached to the policy. 2
	1308	+	(2) A provision that the health insurer will furnish to the policyholder, 3
	1309	+	for delivery to each employee or member of the insured group, an individual 4
	1310	+	certificate setting forth in summary form a statement of the essential features 5
	1311	+	of the insurance coverage of the employee or member and to whom benefits 6
	1312	+	are payable under the policy. If dependents are included in the coverage, only 7
	1313	+	one certificate need be issued for each family unit. 8
	1314	+	(3) A provision that to the group originally insured may be added from 9
	1315	+	time to time eligible new employees or members or dependents, as the case 10
	1316	+	may be, in accordance with the terms of the policy. 11
	1317	+	(4) A provision that the health insurer shall not exclude part-time 12
	1318	+	employees and shall offer the same group health benefits to part-time 13
	1319	+	employees as it offers to the employee groups of which the part-time 14
	1320	+	employees would be members if they were full-time employees. The health 15
	1321	+	insurer shall offer to include the part-time employees as part of the employer’s 16
	1322	+	employee group, at the full rate to be paid by the employer and the employee, 17
	1323	+	at a rate prorated between the employer and the employee, or at the employee’s 18
	1324	+	expense. As used in this subdivision, “part-time employee” means any 19
	1325	+	employee who works a minimum of at least 17.5 hours per week. 20 BILL AS INTRODUCED S.30
2272	1326		2025 Page 55 of 181
2273		-	(b)Protectionsforcoveredindividuals.
2274		-	(1)Preexistingconditionexclusions.Agroupinsurancepolicyshallnot
2275		-	containanyprovisionthatexcludes,restricts,orotherwiselimitscoverage
2276		-	underthepolicyforoneormorepreexistinghealthconditions.
2277		-	(2)Annuallimitationsoncostsharing.
2278		-	(A)(i)Theannuallimitationoncostsharingforself-onlycoverage
2279		-	foranyyearshallbethesameasthedollarlimitestablishedbythefederal
2280		-	governmentforself-onlycoverageforthatyearinaccordancewith45C.F.R.
2281		-	§ 156.130.
2282		-	(ii)Theannuallimitationoncostsharingforotherthanself-only
2283		-	coverageforanyyearshallbetwicethedollarlimitforself-onlycoverage
2284		-	describedinsubdivision(i)ofthissubdivision(A).
2285		-	(B)(i)Intheeventthatthefederalgovernmentdoesnotestablishan
2286		-	annuallimitationoncostsharingforanyplanyear,theannuallimitationon
2287		-	costsharingforself-onlycoverageforthatyearshallbethedollarlimitfor
2288		-	self-onlycoverageintheprecedingcalendaryear,increasedbyanypercentage
2289		-	bywhichtheaveragepercapitapremiumforhealthinsurancecoveragein
2290		-	Vermontfortheprecedingcalendaryearexceedstheaveragepercapita
2291		-	premiumfortheyearbeforethat.
2292		-	(ii)Theannuallimitationoncostsharingforotherthanself-only
2293		-	coverageforanyyearinwhichthefederalgovernmentdoesnotestablishan
2294		-	1
2295		-	2
2296		-	3
2297		-	4
2298		-	5
2299		-	6
2300		-	7
2301		-	8
2302		-	9
2303		-	10
2304		-	11
2305		-	12
2306		-	13
2307		-	14
2308		-	15
2309		-	16
2310		-	17
2311		-	18
2312		-	19
2313		-	20
2314		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1327	+
	1328	+
	1329	+	VT LEG #380165 v.1
	1330	+	(b) Protections for covered individuals. 1
	1331	+	(1) Preexisting condition exclusions. A group insurance policy shall not 2
	1332	+	contain any provision that excludes, restricts, or otherwise limits coverage 3
	1333	+	under the policy for one or more preexisting health conditions. 4
	1334	+	(2) Annual limitations on cost sharing. 5
	1335	+	(A)(i) The annual limitation on cost sharing for self-only coverage 6
	1336	+	for any year shall be the same as the dollar limit established by the federal 7
	1337	+	government for self-only coverage for that year in accordance with 45 C.F.R. 8
	1338	+	§ 156.130. 9
	1339	+	(ii) The annual limitation on cost sharing for other than self-only 10
	1340	+	coverage for any year shall be twice the dollar limit for self-only coverage 11
	1341	+	described in subdivision (i) of this subdivision (A). 12
	1342	+	(B)(i) In the event that the federal government does not establish an 13
	1343	+	annual limitation on cost sharing for any plan year, the annual limitation on 14
	1344	+	cost sharing for self-only coverage for that year shall be the dollar limit for 15
	1345	+	self-only coverage in the preceding calendar year, increased by any percentage 16
	1346	+	by which the average per capita premium for health insurance coverage in 17
	1347	+	Vermont for the preceding calendar year exceeds the average per capita 18
	1348	+	premium for the year before that. 19
	1349	+	(ii) The annual limitation on cost sharing for other than self-only 20
	1350	+	coverage for any year in which the federal government does not establish an 21 BILL AS INTRODUCED S.30
2315	1351		2025 Page 56 of 181
2316		-	annuallimitationoncostsharingshallbetwicethedollarlimitforself-only
2317		-	coveragedescribedinsubdivision(i)ofthissubdivision(B).
2318		-	(3)Banonannualandlifetimelimits.Agroupinsurancepolicyshall
2319		-	notestablishanyannualorlifetimelimitonthedollaramountofessential
2320		-	healthbenefits,asdefinedinSection1302(b)ofthePatientProtectionand
2321		-	AffordableCareActof2010,Pub.L.No.111-148,asamendedbytheHealth
2322		-	CareandEducationReconciliationActof2010,Pub.L.No.111-152,and
2323		-	applicableregulationsandfederalguidance,foranyindividualinsuredunder
2324		-	thepolicy,regardlessofwhethertheservicesareprovidedin-networkorout-
2325		-	of-network.
2326		-	(4)Nocostsharingforpreventiveservices.
2327		-	(A)Agroupinsurancepolicyshallnotimposeanyco-payment,
2328		-	coinsurance,ordeductiblerequirementsfor:
2329		-	(i)preventiveservicesthathavean“A”or“B”ratinginthe
2330		-	currentrecommendationsoftheU.S.PreventiveServicesTaskForce;
2331		-	(ii)immunizationsforroutineuseinchildren,adolescents,and
2332		-	adultsthathaveineffectarecommendationfromtheAdvisoryCommitteeon
2333		-	ImmunizationPracticesoftheCentersforDiseaseControlandPreventionwith
2334		-	respecttotheindividualinvolved;
2335		-	(iii)withrespecttoinfants,children,andadolescents,evidence-
2336		-	informedpreventivecareandscreeningsassetforthincomprehensive
2337		-	1
2338		-	2
2339		-	3
2340		-	4
2341		-	5
2342		-	6
2343		-	7
2344		-	8
2345		-	9
2346		-	10
2347		-	11
2348		-	12
2349		-	13
2350		-	14
2351		-	15
2352		-	16
2353		-	17
2354		-	18
2355		-	19
2356		-	20
2357		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1352	+
	1353	+
	1354	+	VT LEG #380165 v.1
	1355	+	annual limitation on cost sharing shall be twice the dollar limit for self-only 1
	1356	+	coverage described in subdivision (i) of this subdivision (B). 2
	1357	+	(3) Ban on annual and lifetime limits. A group insurance policy shall 3
	1358	+	not establish any annual or lifetime limit on the dollar amount of essential 4
	1359	+	health benefits, as defined in Section 1302(b) of the Patient Protection and 5
	1360	+	Affordable Care Act of 2010, Pub. L. No. 111-148, as amended by the Health 6
	1361	+	Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, and 7
	1362	+	applicable regulations and federal guidance, for any individual insured under 8
	1363	+	the policy, regardless of whether the services are provided in-network or out-9
	1364	+	of-network. 10
	1365	+	(4) No cost sharing for preventive services. 11
	1366	+	(A) A group insurance policy shall not impose any co-payment, 12
	1367	+	coinsurance, or deductible requirements for: 13
	1368	+	(i) preventive services that have an “A” or “B” rating in the 14
	1369	+	current recommendations of the U.S. Preventive Services Task Force; 15
	1370	+	(ii) immunizations for routine use in children, adolescents, and 16
	1371	+	adults that have in effect a recommendation from the Advisory Committee on 17
	1372	+	Immunization Practices of the Centers for Disease Control and Prevention with 18
	1373	+	respect to the individual involved; 19
	1374	+	(iii) with respect to infants, children, and adolescents, evidence-20
	1375	+	informed preventive care and screenings as set forth in comprehensive 21 BILL AS INTRODUCED S.30
2358	1376		2025 Page 57 of 181
2359		-	guidelinessupportedbythefederalHealthResourcesandServices
2360		-	Administration;and
2361		-	(iv)withrespecttowomen,totheextentnotincludedin
2362		-	subdivision(i)ofthissubdivision(4)(A),evidence-informedpreventivecare
2363		-	andscreeningssetforthinbindingcomprehensivehealthplancoverage
2364		-	guidelinessupportedbythefederalHealthResourcesandServices
2365		-	Administration.
2366		-	(B)Subdivision(A)ofthissubdivision(4)shallapplytoahigh-
2367		-	deductiblehealthplanonlytotheextentthatitwouldnotdisqualifytheplan
2368		-	fromeligibilityforahealthsavingsaccountpursuantto26U.S.C.§223.
2369		-	(5)Definitionof“groupinsurancepolicy.”Asusedinthissubsection,
2370		-	“groupinsurancepolicy”hasthesamemeaningas“grouphealthplan”and
2371		-	shallbesubjecttothesameexceptedbenefits,ineachcase,assetforthin
2372		-	45 C.F.R.§146.145,asineffectasofDecember31,2017.
2373		-	§ 4043.ASSOCIATIONHEALTHPLANS
2374		-	(a)(1)Asusedinthissection,“associationhealthplan”meansapolicy
2375		-	issuedtoanassociation;toatrust;ortooneormoretrusteesofafund
2376		-	established,created,ormaintainedforthebenefitofthemembersofoneor
2377		-	moreassociationsoracontractorplanissuedbyanassociationortrustorbya
2378		-	multipleemployerwelfarearrangementasdefinedintheEmployeeRetirement
2379		-	IncomeSecurityActof1974,29U.S.C.§1001etseq.
2380		-	1
2381		-	2
2382		-	3
2383		-	4
2384		-	5
2385		-	6
2386		-	7
2387		-	8
2388		-	9
2389		-	10
2390		-	11
2391		-	12
2392		-	13
2393		-	14
2394		-	15
2395		-	16
2396		-	17
2397		-	18
2398		-	19
2399		-	20
2400		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1377	+
	1378	+
	1379	+	VT LEG #380165 v.1
	1380	+	guidelines supported by the federal Health Resources and Services 1
	1381	+	Administration; and 2
	1382	+	(iv) with respect to women, to the extent not included in 3
	1383	+	subdivision (i) of this subdivision (4)(A), evidence-informed preventive care 4
	1384	+	and screenings set forth in binding comprehensive health plan coverage 5
	1385	+	guidelines supported by the federal Health Resources and Services 6
	1386	+	Administration. 7
	1387	+	(B) Subdivision (A) of this subdivision (4) shall apply to a high-8
	1388	+	deductible health plan only to the extent that it would not disqualify the plan 9
	1389	+	from eligibility for a health savings account pursuant to 26 U.S.C. § 223. 10
	1390	+	(5) Definition of “group insurance policy.” As used in this subsection, 11
	1391	+	“group insurance policy” has the same meaning as “group health plan” and 12
	1392	+	shall be subject to the same excepted benefits, in each case, as set forth in 13
	1393	+	45 C.F.R. § 146.145, as in effect as of December 31, 2017. 14
	1394	+	§ 4043. ASSOCIATION HEALTH PLANS 15
	1395	+	(a)(1) As used in this section, “association health plan” means a policy 16
	1396	+	issued to an association; to a trust; or to one or more trustees of a fund 17
	1397	+	established, created, or maintained for the benefit of the members of one or 18
	1398	+	more associations or a contract or plan issued by an association or trust or by a 19
	1399	+	multiple employer welfare arrangement as defined in the Employee Retirement 20
	1400	+	Income Security Act of 1974, 29 U.S.C. § 1001 et seq. 21 BILL AS INTRODUCED S.30
2401	1401		2025 Page 58 of 181
2402		-	(2)Noassociationhealthplanshallbeissued,offered,orrenewedin
2403		-	thisStatetoanypersonotherthananassociationthatwasformedorcould
2404		-	havebeenformedundertheEmployeeRetirementIncomeSecurityActof
2405		-	1974,29U.S.C.§1001et.seq.,andaccompanyingU.S.DepartmentofLabor
2406		-	regulationsandguidance,ineachcase,asineffectasofJanuary19,2017.
2407		-	(b)TheCommissionershalladoptrulespursuantto3V.S.A.chapter25
2408		-	regulatingassociationhealthplansinordertoprotectVermontconsumersand
2409		-	promotethestabilityofVermont’shealthinsurancemarkets,totheextent
2410		-	permittedunderfederallaw,includingrulesregardinglicensure,solvencyand
2411		-	reserverequirements,andratingrequirements.
2412		-	(c)Theprovisionsofsection3661ofthistitleshallapplytoassociation
2413		-	healthplans.
2414		-	Subchapter4.ContinuationandConversionof
2415		-	GroupHealthInsurancePolicies
2416		-	§ 4047a.CONTINUATIONOFGROUP
2417		-	(a)Allgroupmajormedicalinsuranceanddentalinsurancepoliciesshall
2418		-	providethatanypersonwhoseinsuranceunderthegrouppolicywould
2419		-	terminatebecauseoftheoccurrenceofaqualifyingeventasdefinedin
2420		-	subsection(b)ofthissectionshallbeentitledtocontinuetheperson’shealth
2421		-	insuranceunderthatgrouppolicy.
2422		-	(b)Forpurposesofthissubchapter,“qualifyingevent”means:
2423		-	1
2424		-	2
2425		-	3
2426		-	4
2427		-	5
2428		-	6
2429		-	7
2430		-	8
2431		-	9
2432		-	10
2433		-	11
2434		-	12
2435		-	13
2436		-	14
2437		-	15
2438		-	16
2439		-	17
2440		-	18
2441		-	19
2442		-	20
2443		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1402	+
	1403	+
	1404	+	VT LEG #380165 v.1
	1405	+	(2) No association health plan shall be issued, offered, or renewed in 1
	1406	+	this State to any person other than an association that was formed or could 2
	1407	+	have been formed under the Employee Retirement Income Security Act of 3
	1408	+	1974, 29 U.S.C. § 1001 et. seq., and accompanying U.S. Department of Labor 4
	1409	+	regulations and guidance, in each case, as in effect as of January 19, 2017. 5
	1410	+	(b) The Commissioner shall adopt rules pursuant to 3 V.S.A. chapter 25 6
	1411	+	regulating association health plans in order to protect Vermont consumers and 7
	1412	+	promote the stability of Vermont’s health insurance markets, to the extent 8
	1413	+	permitted under federal law, including rules regarding licensure, solvency and 9
	1414	+	reserve requirements, and rating requirements. 10
	1415	+	(c) The provisions of section 3661 of this title shall apply to association 11
	1416	+	health plans. 12
	1417	+	Subchapter 4. Continuation and Conversion of 13
	1418	+	Group Health Insurance Policies 14
	1419	+	§ 4047a. CONTINUATION OF GROUP 15
	1420	+	(a) All group major medical insurance and dental insurance policies shall 16
	1421	+	provide that any person whose insurance under the group policy would 17
	1422	+	terminate because of the occurrence of a qualifying event as defined in 18
	1423	+	subsection (b) of this section shall be entitled to continue the person’s health 19
	1424	+	insurance under that group policy. 20
	1425	+	(b) For purposes of this subchapter, “qualifying event” means: 21 BILL AS INTRODUCED S.30
2444	1426		2025 Page 59 of 181
2445		-	(1)lossofemployment,includingareductioninhoursthatresultsin
2446		-	ineligibilityforemployer-sponsoredcoverage;
2447		-	(2)divorce,dissolution,orlegalseparationofthecoveredemployee
2448		-	fromtheemployee’sspouseorcivilunionpartner;
2449		-	(3)adependentchildceasingtoqualifyasadependentchildunderthe
2450		-	generallyapplicablerequirementsofthepolicy;or
2451		-	(4)deathofthecoveredemployeeormember.
2452		-	(c)Theprovisionsofthissectionshallnotapplyifoneormoreofthe
2453		-	followingconditionsapplies:
2454		-	(1)Thedeceasedpersonoremployeewasnotinsuredunderthegroup
2455		-	policyonthedateofthequalifyingevent.
2456		-	(2)ThepersoniscoveredbyMedicare.
2457		-	(3)Thepersoniscoveredbyanyothergroupinsuredoruninsured
2458		-	arrangementthatprovidesdentalcoverageorhospitalandmedicalcoverage
2459		-	forindividualsinagroupandunderwhichthepersonwasnotcovered
2460		-	immediatelypriortothequalifyingevent,andnopreexistingcondition
2461		-	exclusionapplies;provided,however,thatthepersonshallremaineligiblefor
2462		-	continuationcoveragesthatarenotavailableundertheinsuredoruninsured
2463		-	arrangement.
2464		-	(4)Thepersonhasalossofemploymentduetomisconductasdefined
2465		-	in21V.S.A.§1344.
2466		-	1
2467		-	2
2468		-	3
2469		-	4
2470		-	5
2471		-	6
2472		-	7
2473		-	8
2474		-	9
2475		-	10
2476		-	11
2477		-	12
2478		-	13
2479		-	14
2480		-	15
2481		-	16
2482		-	17
2483		-	18
2484		-	19
2485		-	20
2486		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1427	+
	1428	+
	1429	+	VT LEG #380165 v.1
	1430	+	(1) loss of employment, including a reduction in hours that results in 1
	1431	+	ineligibility for employer-sponsored coverage; 2
	1432	+	(2) divorce, dissolution, or legal separation of the covered employee 3
	1433	+	from the employee’s spouse or civil union partner; 4
	1434	+	(3) a dependent child ceasing to qualify as a dependent child under the 5
	1435	+	generally applicable requirements of the policy; or 6
	1436	+	(4) death of the covered employee or member. 7
	1437	+	(c) The provisions of this section shall not apply if one or more of the 8
	1438	+	following conditions applies: 9
	1439	+	(1) The deceased person or employee was not insured under the group 10
	1440	+	policy on the date of the qualifying event. 11
	1441	+	(2) The person is covered by Medicare. 12
	1442	+	(3) The person is covered by any other group insured or uninsured 13
	1443	+	arrangement that provides dental coverage or hospital and medical coverage 14
	1444	+	for individuals in a group and under which the person was not covered 15
	1445	+	immediately prior to the qualifying event, and no preexisting condition 16
	1446	+	exclusion applies; provided, however, that the person shall remain eligible for 17
	1447	+	continuation coverages that are not available under the insured or uninsured 18
	1448	+	arrangement. 19
	1449	+	(4) The person has a loss of employment due to misconduct as defined 20
	1450	+	in 21 V.S.A. § 1344. 21 BILL AS INTRODUCED S.30
2487	1451		2025 Page 60 of 181
2488		-	(d)Thecontinuationrequiredbythissectiononlyappliestomajormedical
2489		-	insuranceanddentalinsurancebenefits.
2490		-	(e)Noticeofthecontinuationprivilegeshallbeincludedineachcertificate
2491		-	ofcoverageandshallbeprovidedbytheemployertotheemployeewithin30
2492		-	daysfollowingtheoccurrenceofanyqualifyingevent.
2493		-	§ 4047b.CONTINUATION;NOTICE;TERMS
2494		-	(a)Apersonelectingcontinuationshallnotifythehealthinsurer,orthe
2495		-	policyholder,orthecontractor,oragentforthegroupifthepolicyholderdid
2496		-	notcontractforthepolicydirectlywiththehealthinsurer,ofsuchelectionin
2497		-	writingwithin60daysafterreceivingnoticefollowingtheoccurrenceofa
2498		-	qualifyingeventpursuanttosubsection4047a(e)ofthistitle.Noticeof
2499		-	electiontocontinueunderthegrouppolicyshallbeaccompaniedbytheinitial
2500		-	contribution,whichshallincludepaymentfortheperiodfromthequalifying
2501		-	eventthroughtheendofthemonthinwhichtheelectionismade.
2502		-	(b)Contributionsshallbedueonamonthlybasisinadvancetothehealth
2503		-	insurerorthehealthinsurer’sagent,andshallnotbemorethan102percentof
2504		-	thegroupratefortheinsurancebeingcontinuedunderthegrouppolicyonthe
2505		-	duedateofeachpayment.
2506		-	1
2507		-	2
2508		-	3
2509		-	4
2510		-	5
2511		-	6
2512		-	7
2513		-	8
2514		-	9
2515		-	10
2516		-	11
2517		-	12
2518		-	13
2519		-	14
2520		-	15
2521		-	16
2522		-	17
2523		-	18 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1452	+
	1453	+
	1454	+	VT LEG #380165 v.1
	1455	+	(d) The continuation required by this section only applies to major medical 1
	1456	+	insurance and dental insurance benefits. 2
	1457	+	(e) Notice of the continuation privilege shall be included in each certificate 3
	1458	+	of coverage and shall be provided by the employer to the employee within 30 4
	1459	+	days following the occurrence of any qualifying event. 5
	1460	+	§ 4047b. CONTINUATION; NOTICE; TERMS 6
	1461	+	(a) A person electing continuation shall notify the health insurer, or the 7
	1462	+	policyholder, or the contractor, or agent for the group if the policyholder did 8
	1463	+	not contract for the policy directly with the health insurer, of such election in 9
	1464	+	writing within 60 days after receiving notice following the occurrence of a 10
	1465	+	qualifying event pursuant to subsection 4047a(e) of this title. Notice of 11
	1466	+	election to continue under the group policy shall be accompanied by the initial 12
	1467	+	contribution, which shall include payment for the period from the qualifying 13
	1468	+	event through the end of the month in which the election is made. 14
	1469	+	(b) Contributions shall be due on a monthly basis in advance to the health 15
	1470	+	insurer or the health insurer’s agent, and shall not be more than 102 percent of 16
	1471	+	the group rate for the insurance being continued under the group policy on the 17
	1472	+	due date of each payment. 18 BILL AS INTRODUCED S.30
2524	1473		2025 Page 61 of 181
2525		-	§ 4047c.TERMINATIONOFCOVERAGE
2526		-	Continuationofinsuranceunderthegrouppolicyshallterminateuponthe
2527		-	occurrenceofanyofthefollowing:
2528		-	(1)Thedate18monthsafterthedatethatinsuranceunderthepolicy
2529		-	wouldhaveterminatedduetoaqualifyingevent,asdefinedinsubsection
2530		-	4047a(b)ofthistitle.
2531		-	(2)Thepersonfailstomaketimelypaymentoftherequired
2532		-	contribution.
2533		-	(3)ThepersoniscoveredbyMedicare.
2534		-	(4)Thepersoniscoveredbyanyothergroupinsuredoruninsured
2535		-	arrangementthatprovidesdentalcoverageorhospitalandmedicalcoverage
2536		-	forindividualsinagroup,underwhichthepersonwasnotcovered
2537		-	immediatelypriortotheoccurrenceofaqualifyingevent,asdefinedin
2538		-	subsection4047a(b)ofthistitle,andnopreexistingconditionexclusion
2539		-	applies;provided,however,thatthepersonshallremaineligiblefor
2540		-	continuationcoveragesthatarenotavailableundertheinsuredoruninsured
2541		-	arrangement.
2542		-	(5)Thedateonwhichthegrouppolicyisterminatedor,inthecaseof
2543		-	anemployee,thedateonwhichthedecedent’sorterminatedemployee’s
2544		-	employerterminatesparticipationunderthegrouppolicy.Ifsuchcoverageis
2545		-	replacedbysimilarcoverageunderanothergrouppolicy:
2546		-	1
2547		-	2
2548		-	3
2549		-	4
2550		-	5
2551		-	6
2552		-	7
2553		-	8
2554		-	9
2555		-	10
2556		-	11
2557		-	12
2558		-	13
2559		-	14
2560		-	15
2561		-	16
2562		-	17
2563		-	18
2564		-	19
2565		-	20
2566		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1474	+
	1475	+
	1476	+	VT LEG #380165 v.1
	1477	+	§ 4047c. TERMINATION OF COVERAGE 1
	1478	+	Continuation of insurance under the group policy shall terminate upon the 2
	1479	+	occurrence of any of the following: 3
	1480	+	(1) The date 18 months after the date that insurance under the policy 4
	1481	+	would have terminated due to a qualifying event, as defined in subsection 5
	1482	+	4047a(b) of this title. 6
	1483	+	(2) The person fails to make timely payment of the required 7
	1484	+	contribution. 8
	1485	+	(3) The person is covered by Medicare. 9
	1486	+	(4) The person is covered by any other group insured or uninsured 10
	1487	+	arrangement that provides dental coverage or hospital and medical coverage 11
	1488	+	for individuals in a group, under which the person was not covered 12
	1489	+	immediately prior to the occurrence of a qualifying event, as defined in 13
	1490	+	subsection 4047a(b) of this title, and no preexisting condition exclusion 14
	1491	+	applies; provided, however, that the person shall remain eligible for 15
	1492	+	continuation coverages that are not available under the insured or uninsured 16
	1493	+	arrangement. 17
	1494	+	(5) The date on which the group policy is terminated or, in the case of 18
	1495	+	an employee, the date on which the decedent’s or terminated employee’s 19
	1496	+	employer terminates participation under the group policy. If such coverage is 20
	1497	+	replaced by similar coverage under another group policy: 21 BILL AS INTRODUCED S.30
2567	1498		2025 Page 62 of 181
2568		-	(A)thepersonshallhavetherighttobecomecoveredunderthat
2569		-	replacementpolicyforthebalanceoftheperiodthatthepersonwouldhave
2570		-	remainedcoveredunderthepriorgrouppolicy;
2571		-	(B)theminimumlevelofbenefitstobeprovidedbythereplacement
2572		-	policyshallbetheapplicablelevelofbenefitsofthepriorgrouppolicy
2573		-	reducedbyanybenefitspayableunderthatpriorgrouppolicy;and
2574		-	(C)thepriorgrouppolicyshallcontinuetoprovidebenefitstothe
2575		-	extentofitsaccruedliabilitiesandextensionsofbenefitsasifthereplacement
2576		-	hasnotoccurred.
2577		-	Subchapter5.GroupHealthInsuranceTerminationandReplacement
2578		-	§ 4048a.DEFINITIONS;POLICIESANDCONTRACTSCOVERED
2579		-	(a)Asusedinthissubchapter,“grouphealthinsurancepolicyorsubscriber
2580		-	contract”meansapolicyorcontractthatmeetsthefollowingconditions:
2581		-	(1)coverageisprovidedthroughinsurancepoliciesorsubscriber
2582		-	contractstoclassesofemployeesormembersofanorganizationorgroup;
2583		-	(2)thecoverageisnotavailabletothegeneralpublicandcanbe
2584		-	obtainedandmaintainedonlybecauseofthecoveredindividual’semployment
2585		-	ormembershipinanorganizationorgroup;
2586		-	(3)therearearrangementsforbulkpaymentofpremiumsor
2587		-	subscriptionchargestothehealthinsurer;and
2588		-	1
2589		-	2
2590		-	3
2591		-	4
2592		-	5
2593		-	6
2594		-	7
2595		-	8
2596		-	9
2597		-	10
2598		-	11
2599		-	12
2600		-	13
2601		-	14
2602		-	15
2603		-	16
2604		-	17
2605		-	18
2606		-	19
2607		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1499	+
	1500	+
	1501	+	VT LEG #380165 v.1
	1502	+	(A) the person shall have the right to become covered under that 1
	1503	+	replacement policy for the balance of the period that the person would have 2
	1504	+	remained covered under the prior group policy; 3
	1505	+	(B) the minimum level of benefits to be provided by the replacement 4
	1506	+	policy shall be the applicable level of benefits of the prior group policy 5
	1507	+	reduced by any benefits payable under that prior group policy; and 6
	1508	+	(C) the prior group policy shall continue to provide benefits to the 7
	1509	+	extent of its accrued liabilities and extensions of benefits as if the replacement 8
	1510	+	has not occurred. 9
	1511	+	Subchapter 5. Group Health Insurance Termination and Replacement 10
	1512	+	§ 4048a. DEFINITIONS; POLICIES AND CONTRACTS COVERED 11
	1513	+	(a) As used in this subchapter, “group health insurance policy or subscriber 12
	1514	+	contract” means a policy or contract that meets the following conditions: 13
	1515	+	(1) coverage is provided through insurance policies or subscriber 14
	1516	+	contracts to classes of employees or members of an organization or group; 15
	1517	+	(2) the coverage is not available to the general public and can be 16
	1518	+	obtained and maintained only because of the covered individual’s employment 17
	1519	+	or membership in an organization or group; 18
	1520	+	(3) there are arrangements for bulk payment of premiums or 19
	1521	+	subscription charges to the health insurer; and 20 BILL AS INTRODUCED S.30
2608	1522		2025 Page 63 of 181
2609		-	(4)thereissponsorshipoftheplanbytheemployer,organization,or
2610		-	group.
2611		-	(b)Agrouphealthinsurancepolicyorsubscribercontractshallnotbe
2612		-	issuedorprovidedbyahealthinsurerunlessthepolicyorcontractcomplies
2613		-	withtheprovisionsofthissubchapterandtherulesadoptedpursuanttothis
2614		-	subchapter.
2615		-	§ 4048b.TERMINATIONFORNONPAYMENT OFPREMIUMOR
2616		-	SUBSCRIPTIONCHARGES
2617		-	(a)Ifagrouphealthinsurancepolicyorsubscribercontractprovidesfor
2618		-	automaticterminationofthepolicyorcontractafterapremiumorsubscription
2619		-	chargehasremainedunpaidthroughthegraceperiodallowedforsuch
2620		-	payment,thehealthinsurershallbeliableforvalidclaimsforcoveredlosses
2621		-	incurredpriortotheendofthegraceperiod.
2622		-	(b)Iftheactionsofthehealthinsureraftertheendofthegraceperiod
2623		-	indicatethatitconsidersthepolicyorcontracttobecontinuinginforce
2624		-	beyondtheendofthegraceperiod,includingactionssuchascontinuingto
2625		-	recognizeclaimssubsequentlyincurred,thehealthinsurershallbeliablefor
2626		-	validclaimsforlossesincurredpriortotheeffectivedateofwrittennoticeof
2627		-	terminationtothepolicyholderorotherentityresponsibleformaking
2628		-	paymentsorsubmittingsubscriptionchargestothehealthinsurer.
2629		-	1
2630		-	2
2631		-	3
2632		-	4
2633		-	5
2634		-	6
2635		-	7
2636		-	8
2637		-	9
2638		-	10
2639		-	11
2640		-	12
2641		-	13
2642		-	14
2643		-	15
2644		-	16
2645		-	17
2646		-	18
2647		-	19
2648		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1523	+
	1524	+
	1525	+	VT LEG #380165 v.1
	1526	+	(4) there is sponsorship of the plan by the employer, organization, or 1
	1527	+	group. 2
	1528	+	(b) A group health insurance policy or subscriber contract shall not be 3
	1529	+	issued or provided by a health insurer unless the policy or contract complies 4
	1530	+	with the provisions of this subchapter and the rules adopted pursuant to this 5
	1531	+	subchapter. 6
	1532	+	§ 4048b. TERMINATION FOR NONPAYMENT OF PREMIUM OR 7
	1533	+	SUBSCRIPTION CHARGES 8
	1534	+	(a) If a group health insurance policy or subscriber contract provides for 9
	1535	+	automatic termination of the policy or contract after a premium or subscription 10
	1536	+	charge has remained unpaid through the grace period allowed for such 11
	1537	+	payment, the health insurer shall be liable for valid claims for covered losses 12
	1538	+	incurred prior to the end of the grace period. 13
	1539	+	(b) If the actions of the health insurer after the end of the grace period 14
	1540	+	indicate that it considers the policy or contract to be continuing in force beyond 15
	1541	+	the end of the grace period, including actions such as continuing to recognize 16
	1542	+	claims subsequently incurred, the health insurer shall be liable for valid claims 17
	1543	+	for losses incurred prior to the effective date of written notice of termination to 18
	1544	+	the policyholder or other entity responsible for making payments or submitting 19
	1545	+	subscription charges to the health insurer. 20 BILL AS INTRODUCED S.30
2649	1546		2025 Page 64 of 181
2650		-	(c)Thehealthinsurershallnotifyapolicyholderorotherresponsibleentity
2651		-	ofanypremiumpaymentdueonapolicyatleast21daysbeforetheduedate.
2652		-	Theeffectivedateofterminationofapolicyorcontractshallnotbepriorto
2653		-	midnightattheendofthe14thdayfollowingmailingofnoticeoftermination.
2654		-	§ 4048c.NOTICEOFTERMINATION
2655		-	(a)Anoticeofterminationofahealthinsurer’sgrouphealthinsurance
2656		-	policyorsubscribercontractshall:
2657		-	(1)requestthegrouppolicyholderorotherentityinvolvedtonotify
2658		-	employeesormemberscoveredunderthepolicyorsubscribercontractofthe
2659		-	dateofterminationofthepolicyorcontractandtoadvisetheemployeesor
2660		-	membersthat,unlessotherwiseprovidedinthepolicyorcontract,thehealth
2661		-	insurershallnotbeliableforclaimsforlossesincurredaftersuchdate;and
2662		-	(2)advise,inanyinstanceinwhichtheplaninvolvesemployee
2663		-	contributions,thatifthepolicyholderorotherentitycontinuestocollect
2664		-	contributionsforthecoveragebeyondthedateoftermination,thepolicyholder
2665		-	orotherentitymaybeheldsolelyliableforthebenefitswithrespecttowhich
2666		-	thecontributionshavebeencollected.
2667		-	(b)Thehealthinsurergivingnoticeofterminationshallprepareand
2668		-	furnishtothepolicyholderorotherentityatthetimeofnoticeasupplyofa
2669		-	noticeformtobedistributedtocoveredemployeesormembers.Theform
2670		-	shallstatethefactofterminationandtheeffectivedateoftermination.The
2671		-	1
2672		-	2
2673		-	3
2674		-	4
2675		-	5
2676		-	6
2677		-	7
2678		-	8
2679		-	9
2680		-	10
2681		-	11
2682		-	12
2683		-	13
2684		-	14
2685		-	15
2686		-	16
2687		-	17
2688		-	18
2689		-	19
2690		-	20
2691		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1547	+
	1548	+
	1549	+	VT LEG #380165 v.1
	1550	+	(c) The health insurer shall notify a policyholder or other responsible entity 1
	1551	+	of any premium payment due on a policy at least 21 days before the due date. 2
	1552	+	The effective date of termination of a policy or contract shall not be prior to 3
	1553	+	midnight at the end of the 14th day following mailing of notice of termination. 4
	1554	+	§ 4048c. NOTICE OF TERMINATION 5
	1555	+	(a) A notice of termination of a health insurer’s group health insurance 6
	1556	+	policy or subscriber contract shall: 7
	1557	+	(1) request the group policyholder or other entity involved to notify 8
	1558	+	employees or members covered under the policy or subscriber contract of the 9
	1559	+	date of termination of the policy or contract and to advise the employees or 10
	1560	+	members that, unless otherwise provided in the policy or contract, the health 11
	1561	+	insurer shall not be liable for claims for losses incurred after such date; and 12
	1562	+	(2) advise, in any instance in which the plan involves employee 13
	1563	+	contributions, that if the policyholder or other entity continues to collect 14
	1564	+	contributions for the coverage beyond the date of termination, the policyholder 15
	1565	+	or other entity may be held solely liable for the benefits with respect to which 16
	1566	+	the contributions have been collected. 17
	1567	+	(b) The health insurer giving notice of termination shall prepare and furnish 18
	1568	+	to the policyholder or other entity at the time of notice a supply of a notice 19
	1569	+	form to be distributed to covered employees or members. The form shall state 20
	1570	+	the fact of termination and the effective date of termination. The form shall 21 BILL AS INTRODUCED S.30
2692	1571		2025 Page 65 of 181
2693		-	formshallcontainastatementdirectingemployeesormemberstorefertotheir
2694		-	certificatesorcontractsinordertodeterminetheirrights.
2695		-	§ 4048d.EXTENSIONOFBENEFITS
2696		-	(a)Eachgrouphealthinsurancepolicyorsubscribercontractshallprovide
2697		-	areasonableextensionofbenefitsintheeventthattheemployerormemberis
2698		-	inaconditionoftotaldisabilityonthedateofterminationofthegrouppolicy
2699		-	orcontractinaccordancewiththeprovisionsofthissection.
2700		-	(b)Apolicyorcontractprovidingbenefitsforlossoftimefromworkor
2701		-	specificindemnityduringhospitalconfinementshallprovidethattermination
2702		-	ofthepolicyorcontractduringalossoftimeorconfinementshallhaveno
2703		-	effectonbenefitspayableforthelossoftimeorconfinement.
2704		-	(c)Apolicyorcontractprovidinghospitalormedicalexpensecoverage
2705		-	benefitsshallprovideanextensionofbenefitsofatleast12monthsunder
2706		-	majormedicalinsurancecoverageandatleast90daysunderothertypesof
2707		-	hospitalormedicalexpensecoverage.
2708		-	(d)Theprovisionsofapolicyorcontractrelatingtoextensionofbenefits
2709		-	oraccruedliabilityshallbedescribedinthepolicyorcontractaswellasin
2710		-	groupinsurancecertificates.Thebenefitspayableduringaperiodofextension
2711		-	oraccruedliabilitymaybesubjecttothepolicy’sorcontract’sregularbenefit
2712		-	limits.
2713		-	1
2714		-	2
2715		-	3
2716		-	4
2717		-	5
2718		-	6
2719		-	7
2720		-	8
2721		-	9
2722		-	10
2723		-	11
2724		-	12
2725		-	13
2726		-	14
2727		-	15
2728		-	16
2729		-	17
2730		-	18
2731		-	19
2732		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1572	+
	1573	+
	1574	+	VT LEG #380165 v.1
	1575	+	contain a statement directing employees or members to refer to their 1
	1576	+	certificates or contracts in order to determine their rights. 2
	1577	+	§ 4048d. EXTENSION OF BENEFITS 3
	1578	+	(a) Each group health insurance policy or subscriber contract shall provide 4
	1579	+	a reasonable extension of benefits in the event that the employer or member is 5
	1580	+	in a condition of total disability on the date of termination of the group policy 6
	1581	+	or contract in accordance with the provisions of this section. 7
	1582	+	(b) A policy or contract providing benefits for loss of time from work or 8
	1583	+	specific indemnity during hospital confinement shall provide that termination 9
	1584	+	of the policy or contract during a loss of time or confinement shall have no 10
	1585	+	effect on benefits payable for the loss of time or confinement. 11
	1586	+	(c) A policy or contract providing hospital or medical expense coverage 12
	1587	+	benefits shall provide an extension of benefits of at least 12 months under 13
	1588	+	major medical insurance coverage and at least 90 days under other types of 14
	1589	+	hospital or medical expense coverage. 15
	1590	+	(d) The provisions of a policy or contract relating to extension of benefits 16
	1591	+	or accrued liability shall be described in the policy or contract as well as in 17
	1592	+	group insurance certificates. The benefits payable during a period of extension 18
	1593	+	or accrued liability may be subject to the policy’s or contract’s regular benefit 19
	1594	+	limits. 20 BILL AS INTRODUCED S.30
2733	1595		2025 Page 66 of 181
2734		-	(e)Nothinginthissectionshallbeconstruedtorequireanextensionof
2735		-	dentalbenefits.
2736		-	§ 4048e.REPLACEMENT COVERAGE
2737		-	(a)General.Whenthegrouphealthinsurancepolicyorsubscribercontract
2738		-	ofahealthinsurerreplacesapolicyorcontractprovidingsimilarbenefitsof
2739		-	anotherhealthinsurer,theliabilityofbothhealthinsurersshallbeasprovided
2740		-	inthissectionandrulesadoptedpursuanttothissection.
2741		-	(b)Liabilityofpriorhealthinsurer.Apriorhealthinsurerremainsliable
2742		-	afterterminationofitspolicyorcontractonlytotheextentofitsaccrued
2743		-	liabilitiesandextensionsofbenefits.
2744		-	(c)Liabilityofsucceedinghealthinsurer.
2745		-	(1)Asucceedinghealthinsurershallofferagrouphealthinsurance
2746		-	policyorsubscribercontracttoreplaceapriorhealthinsurer’spolicyor
2747		-	contractinaccordancewiththeprovisionsofthissubsection.
2748		-	(2)Asucceedinghealthinsurershallofferapolicyorcontracttocover
2749		-	allpersonswho:
2750		-	(A)arecoveredorareamemberofaclasseligibleforcoverage
2751		-	underthepriorhealthinsurer’spolicyorcontractonthedateofterminationof
2752		-	thepriorhealthinsurer’spolicyorcontract;or
2753		-	1
2754		-	2
2755		-	3
2756		-	4
2757		-	5
2758		-	6
2759		-	7
2760		-	8
2761		-	9
2762		-	10
2763		-	11
2764		-	12
2765		-	13
2766		-	14
2767		-	15
2768		-	16
2769		-	17
2770		-	18
2771		-	19 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1596	+
	1597	+
	1598	+	VT LEG #380165 v.1
	1599	+	(e) Nothing in this section shall be construed to require an extension of 1
	1600	+	dental benefits. 2
	1601	+	§ 4048e. REPLACEMENT COVERAGE 3
	1602	+	(a) General. When the group health insurance policy or subscriber contract 4
	1603	+	of a health insurer replaces a policy or contract providing similar benefits of 5
	1604	+	another health insurer, the liability of both health insurers shall be as provided 6
	1605	+	in this section and rules adopted pursuant to this section. 7
	1606	+	(b) Liability of prior health insurer. A prior health insurer remains liable 8
	1607	+	after termination of its policy or contract only to the extent of its accrued 9
	1608	+	liabilities and extensions of benefits. 10
	1609	+	(c) Liability of succeeding health insurer. 11
	1610	+	(1) A succeeding health insurer shall offer a group health insurance 12
	1611	+	policy or subscriber contract to replace a prior health insurer’s policy or 13
	1612	+	contract in accordance with the provisions of this subsection. 14
	1613	+	(2) A succeeding health insurer shall offer a policy or contract to cover 15
	1614	+	all persons who: 16
	1615	+	(A) are covered or are a member of a class eligible for coverage 17
	1616	+	under the prior health insurer’s policy or contract on the date of termination of 18
	1617	+	the prior health insurer’s policy or contract; or 19 BILL AS INTRODUCED S.30
2772	1618		2025 Page 67 of 181
2773		-	(B)areamemberofaclasseligibleforcoverageunderthe
2774		-	succeedinghealthinsurer’spolicyorcontractonthedateofterminationofthe
2775		-	priorhealthinsurer’spolicyorcontract.
2776		-	(3)Thesucceedinghealthinsurerisnotliableunderthissubsectionfor
2777		-	benefitsrequiredtobepaidbythepriorhealthinsurer.
2778		-	(4)Whenreplacingapriorhealthinsurer’splanthatisnotsubjectto
2779		-	section4048dofthistitle,thesucceedinghealthinsurershall,inadditionto
2780		-	thecoveragerequiredtobeofferedundersubdivision(2)ofthissubsection,
2781		-	offerapolicyorcontractthatprovidesalevelofbenefitequaltothelesserof:
2782		-	(A)theextensionofbenefitsthatwouldhavebeenrequiredifthe
2783		-	priorhealthinsurer’spolicyorcontractwassubjecttosection4048dofthis
2784		-	title;or
2785		-	(B)theextensionofbenefitsrequiredforthesucceedinghealth
2786		-	insurer’spolicyorcontract,exceptthatanysuchbenefitsmaybereducedby
2787		-	benefitsactuallypayableunderthepriorhealthinsurer’splan.
2788		-	(5)Thepreexistingconditionlimitationofasucceedinghealthinsurer’s
2789		-	policyorcontractshallprovidealevelofbenefitsequaltothelesserof:
2790		-	(A)thebenefitsofthesucceedinghealthinsurer’spolicyorcontract
2791		-	determinedwithoutapplicationofthepreexistingconditionslimitation;or
2792		-	(B)thebenefitsofthepriorhealthinsurer’spolicyorcontract.
2793		-	1
2794		-	2
2795		-	3
2796		-	4
2797		-	5
2798		-	6
2799		-	7
2800		-	8
2801		-	9
2802		-	10
2803		-	11
2804		-	12
2805		-	13
2806		-	14
2807		-	15
2808		-	16
2809		-	17
2810		-	18
2811		-	19
2812		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1619	+
	1620	+
	1621	+	VT LEG #380165 v.1
	1622	+	(B) are a member of a class eligible for coverage under the 1
	1623	+	succeeding health insurer’s policy or contract on the date of termination of the 2
	1624	+	prior health insurer’s policy or contract. 3
	1625	+	(3) The succeeding health insurer is not liable under this subsection for 4
	1626	+	benefits required to be paid by the prior health insurer. 5
	1627	+	(4) When replacing a prior health insurer’s plan that is not subject to 6
	1628	+	section 4048d of this title, the succeeding health insurer shall, in addition to the 7
	1629	+	coverage required to be offered under subdivision (2) of this subsection, offer a 8
	1630	+	policy or contract that provides a level of benefit equal to the lesser of: 9
	1631	+	(A) the extension of benefits that would have been required if the 10
	1632	+	prior health insurer’s policy or contract was subject to section 4048d of this 11
	1633	+	title; or 12
	1634	+	(B) the extension of benefits required for the succeeding health 13
	1635	+	insurer’s policy or contract, except that any such benefits may be reduced by 14
	1636	+	benefits actually payable under the prior health insurer’s plan. 15
	1637	+	(5) The preexisting condition limitation of a succeeding health insurer’s 16
	1638	+	policy or contract shall provide a level of benefits equal to the lesser of: 17
	1639	+	(A) the benefits of the succeeding health insurer’s policy or contract 18
	1640	+	determined without application of the preexisting conditions limitation; or 19
	1641	+	(B) the benefits of the prior health insurer’s policy or contract. 20 BILL AS INTRODUCED S.30
2813	1642		2025 Page 68 of 181
2814		-	(6)Thesucceedinghealthinsurer,inapplyingadeductibleorwaiting-
2815		-	periodprovisioninitspolicyorcontract,shallgivecreditforthesatisfaction
2816		-	ofthesameorsimilarprovisionsunderthepriorhealthinsurer’spolicyor
2817		-	contract.
2818		-	(7)Atthesucceedinghealthinsurer’srequest,thepriorhealthinsurer
2819		-	shallfurnishallinformationneededtodeterminethebenefitsavailableunder
2820		-	thepriorhealthinsurer’spolicyorcontract.
2821		-	(d)Rules.TheCommissionershalladoptrulesnecessarytocarryoutthe
2822		-	purposesofthissection.
2823		-	Subchapter6.OtherFormsofHealthCoverage
2824		-	§ 4051.MEDICARESUPPLEMENTINSURANCEPOLICIES
2825		-	(a)Communityrating.
2826		-	(1)Ahealthinsurershalluseacommunityratingmethodacceptableto
2827		-	theCommissionerfordeterminingpremiumsforMedicaresupplement
2828		-	insurancepolicies.
2829		-	(2)TheCommissionershalladoptrulesforstandardsandprocedurefor
2830		-	permittinghealthinsurersthatissueMedicaresupplementinsurancepoliciesto
2831		-	useoneormoreriskclassificationsintheircommunityratingmethod.The
2832		-	premiumchargedshallnotdeviatefromthecommunityrateandtherulesshall
2833		-	notpermitmedicalunderwritingandscreening,exceptthatahealthinsurer
2834		-	1
2835		-	2
2836		-	3
2837		-	4
2838		-	5
2839		-	6
2840		-	7
2841		-	8
2842		-	9
2843		-	10
2844		-	11
2845		-	12
2846		-	13
2847		-	14
2848		-	15
2849		-	16
2850		-	17
2851		-	18
2852		-	19
2853		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1643	+
	1644	+
	1645	+	VT LEG #380165 v.1
	1646	+	(6) The succeeding health insurer, in applying a deductible or waiting-1
	1647	+	period provision in its policy or contract, shall give credit for the satisfaction of 2
	1648	+	the same or similar provisions under the prior health insurer’s policy or 3
	1649	+	contract. 4
	1650	+	(7) At the succeeding health insurer’s request, the prior health insurer 5
	1651	+	shall furnish all information needed to determine the benefits available under 6
	1652	+	the prior health insurer’s policy or contract. 7
	1653	+	(d) Rules. The Commissioner shall adopt rules necessary to carry out the 8
	1654	+	purposes of this section. 9
	1655	+	Subchapter 6. Other Forms of Health Coverage 10
	1656	+	§ 4051. MEDICARE SUPPLEMENT INSURANCE POLICIES 11
	1657	+	(a) Community rating. 12
	1658	+	(1) A health insurer shall use a community rating method acceptable to 13
	1659	+	the Commissioner for determining premiums for Medicare supplement 14
	1660	+	insurance policies. 15
	1661	+	(2) The Commissioner shall adopt rules for standards and procedure for 16
	1662	+	permitting health insurers that issue Medicare supplement insurance policies to 17
	1663	+	use one or more risk classifications in their community rating method. The 18
	1664	+	premium charged shall not deviate from the community rate and the rules shall 19
	1665	+	not permit medical underwriting and screening, except that a health insurer 20 BILL AS INTRODUCED S.30
2854	1666		2025 Page 69 of 181
2855		-	maysetdifferentcommunityratesforpersonseligibleforMedicarebyreason
2856		-	ofageandpersonseligibleforMedicarebyreasonofdisability.
2857		-	(b)Premiumincreases.
2858		-	(1)Withinfivedaysafterreceivingarequestforapprovalofany
2859		-	compositeaveragerateincreaseinexcessofthreepercent,oranyother
2860		-	coveragechangesthattheCommissionerdetermineswillhaveacomparable
2861		-	impactoncostoravailabilityofcoverageforaMedicaresupplementinsurance
2862		-	policyissuedbyanyhealthinsurerwith5,000ormoretotallivesinthe
2863		-	VermontMedicaresupplementinsurancemarket,theCommissionershall
2864		-	notifytheDepartmentofDisabilities,Aging,andIndependentLivingofthe
2865		-	proposedpremiumincrease.Acompositeaveragerateistheenrollment-
2866		-	weightedaveragerateincreaseofallplansofferedbyahealthinsurer.
2867		-	(2)Withinfivedaysafterreceivingnotificationpursuanttosubdivision
2868		-	(1)ofthissubsection,theDepartmentofDisabilities,Aging,andIndependent
2869		-	LivingshallinformthemembersoftheAdvisoryBoardestablishedpursuant
2870		-	to33V.S.A.§505oftheproposedpremiumincrease.
2871		-	(3)(A)TheCommissionershallnotapproveanyrequesttoincrease
2872		-	Medicaresupplementinsurancepremiumratesunlesstheamountoftherate
2873		-	increasecomplieswiththestatutorystandardsforapprovalundersections
2874		-	4026,4513,4584,and5104ofthistitle.Anyapprovedrateincreaseshallnot
2875		-	bebasedonanunreasonablechangeinlossratiofromthepreviousyear,unless
2876		-	1
2877		-	2
2878		-	3
2879		-	4
2880		-	5
2881		-	6
2882		-	7
2883		-	8
2884		-	9
2885		-	10
2886		-	11
2887		-	12
2888		-	13
2889		-	14
2890		-	15
2891		-	16
2892		-	17
2893		-	18
2894		-	19
2895		-	20
2896		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1667	+
	1668	+
	1669	+	VT LEG #380165 v.1
	1670	+	may set different community rates for persons eligible for Medicare by reason 1
	1671	+	of age and persons eligible for Medicare by reason of disability. 2
	1672	+	(b) Premium increases. 3
	1673	+	(1) Within five days after receiving a request for approval of any 4
	1674	+	composite average rate increase in excess of three percent, or any other 5
	1675	+	coverage changes that the Commissioner determines will have a comparable 6
	1676	+	impact on cost or availability of coverage for a Medicare supplement insurance 7
	1677	+	policy issued by any health insurer with 5,000 or more total lives in the 8
	1678	+	Vermont Medicare supplement insurance market, the Commissioner shall 9
	1679	+	notify the Department of Disabilities, Aging, and Independent Living of the 10
	1680	+	proposed premium increase. A composite average rate is the enrollment-11
	1681	+	weighted average rate increase of all plans offered by a health insurer. 12
	1682	+	(2) Within five days after receiving notification pursuant to subdivision 13
	1683	+	(1) of this subsection, the Department of Disabilities, Aging, and Independent 14
	1684	+	Living shall inform the members of the Advisory Board established pursuant to 15
	1685	+	33 V.S.A. § 505 of the proposed premium increase. 16
	1686	+	(3)(A) The Commissioner shall not approve any request to increase 17
	1687	+	Medicare supplement insurance premium rates unless the amount of the rate 18
	1688	+	increase complies with the statutory standards for approval under sections 19
	1689	+	4026, 4513, 4584, and 5104 of this title. Any approved rate increase shall not 20
	1690	+	be based on an unreasonable change in loss ratio from the previous year, unless 21 BILL AS INTRODUCED S.30
2897	1691		2025 Page 70 of 181
2898		-	theCommissionermakeswrittenfindingsthatsuchchangeisnecessaryto
2899		-	preventasubstantialadverseimpactonthefinancialconditionofthehealth
2900		-	insurer.Inactingonsuchrateincreaserequests,theCommissionermaydeny
2901		-	therequest,approvetherateincreaseasrequested,orapprovearateincrease
2902		-	inanamountdifferentfromtheincreaserequested.Adecisionbythe
2903		-	Commissionerotherthananapprovaloftheraterequestedmaybeappealedby
2904		-	thehealthinsurer,providedthattheburdenofproofshallbeonthehealth
2905		-	insurertoshowthattheapprovedratedoesnotmeetthestatutorystandards
2906		-	establishedunderthissubsection.
2907		-	(B)Beforeactingontherateincreaserequested,theCommissioner
2908		-	maymakesuchexaminationorinvestigationastheCommissionerdeems
2909		-	necessary,includingwhereapplicablethereviewprocesssetforthin
2910		-	subdivision(C)ofthissubdivision(3).
2911		-	(C)(i)InreviewinganyMedicaresupplementinsurancerateincrease
2912		-	forwhichanindependentanalysishasbeenperformedpursuantto33V.S.A.
2913		-	§ 6706andinwhichthehealthinsurer’srequestedcompositeaverageincrease,
2914		-	theindependentexpert’srecommendedcompositeaveragerateincrease,orthe
2915		-	Departmentactuary’srecommendedcompositeaveragerateincreasedifferby
2916		-	twopercentagepointsormore,theCommissionershallholdapublichearing
2917		-	atwhichthehealthinsurer,theDepartment’sactuary,theindependentexpert,
2918		-	anyintervenor,andthepublicwillhavetheopportunitytopresentwrittenand
2919		-	1
2920		-	2
2921		-	3
2922		-	4
2923		-	5
2924		-	6
2925		-	7
2926		-	8
2927		-	9
2928		-	10
2929		-	11
2930		-	12
2931		-	13
2932		-	14
2933		-	15
2934		-	16
2935		-	17
2936		-	18
2937		-	19
2938		-	20
2939		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1692	+
	1693	+
	1694	+	VT LEG #380165 v.1
	1695	+	the Commissioner makes written findings that such change is necessary to 1
	1696	+	prevent a substantial adverse impact on the financial condition of the health 2
	1697	+	insurer. In acting on such rate increase requests, the Commissioner may deny 3
	1698	+	the request, approve the rate increase as requested, or approve a rate increase in 4
	1699	+	an amount different from the increase requested. A decision by the 5
	1700	+	Commissioner other than an approval of the rate requested may be appealed by 6
	1701	+	the health insurer, provided that the burden of proof shall be on the health 7
	1702	+	insurer to show that the approved rate does not meet the statutory standards 8
	1703	+	established under this subsection. 9
	1704	+	(B) Before acting on the rate increase requested, the Commissioner 10
	1705	+	may make such examination or investigation as the Commissioner deems 11
	1706	+	necessary, including where applicable the review process set forth in 12
	1707	+	subdivision (C) of this subdivision (3). 13
	1708	+	(C)(i) In reviewing any Medicare supplement insurance rate increase 14
	1709	+	for which an independent analysis has been performed pursuant to 33 V.S.A. 15
	1710	+	§ 6706 and in which the health insurer’s requested composite average increase, 16
	1711	+	the independent expert’s recommended composite average rate increase, or the 17
	1712	+	Department actuary’s recommended composite average rate increase differ by 18
	1713	+	two percentage points or more, the Commissioner shall hold a public hearing at 19
	1714	+	which the health insurer, the Department’s actuary, the independent expert, any 20
	1715	+	intervenor, and the public will have the opportunity to present written and oral 21 BILL AS INTRODUCED S.30
2940	1716		2025 Page 71 of 181
2941		-	oraltestimonyandwillbeavailabletoanswerquestionsoftheCommissioner
2942		-	andthosepresent.
2943		-	(ii)Thehearingshallbenoticedandheldatatimeandplacesoas
2944		-	tofacilitatepublicparticipation,andshallberecordedandbecomepartofthe
2945		-	recordbeforetheCommissioner.AttheCommissioner’sdiscretion,the
2946		-	hearingmaybeconductedremotely.
2947		-	(iii)Ifthecarrier’srequestedcompositeaverageincrease,the
2948		-	independentexpert’srecommendedcompositeaverageincrease,orthe
2949		-	Departmentactuary’srecommendedcompositeaverageincreasediffersbyless
2950		-	thantwopercentagepoints,theDepartmentandthepartiesshallconferby
2951		-	conferencecall,orbyanyotheravailablemedia,toreviewtheraterequests
2952		-	andrecommendations.However,apublichearingmaybeheldatthe
2953		-	Commissioner’sdiscretionforgoodcauseshown.
2954		-	(D)(i)Inanyreviewheldinaccordancewiththissubdivision(3),the
2955		-	Commissionershallpermitinterventionbyanypersonwhomthe
2956		-	Commissionerdetermineswillmateriallyadvancetheinterestsofthecovered
2957		-	individuals.Theintervenorshallhaveaccesstoandmayusetheinformation
2958		-	oftheindependentexpertappointedunder33V.S.A.§6706.
2959		-	(ii)Thereasonableandnecessarycostofinterventionas
2960		-	determinedbytheCommissionershallbepaidbytheaffectedpolicyholdersor
2961		-	certificateholders.Themaximumpaymentshallbe$2,500.00exceptwhen
2962		-	1
2963		-	2
2964		-	3
2965		-	4
2966		-	5
2967		-	6
2968		-	7
2969		-	8
2970		-	9
2971		-	10
2972		-	11
2973		-	12
2974		-	13
2975		-	14
2976		-	15
2977		-	16
2978		-	17
2979		-	18
2980		-	19
2981		-	20
2982		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1717	+
	1718	+
	1719	+	VT LEG #380165 v.1
	1720	+	testimony and will be available to answer questions of the Commissioner and 1
	1721	+	those present. 2
	1722	+	(ii) The hearing shall be noticed and held at a time and place so as 3
	1723	+	to facilitate public participation, and shall be recorded and become part of the 4
	1724	+	record before the Commissioner. At the Commissioner’s discretion, the 5
	1725	+	hearing may be conducted remotely. 6
	1726	+	(iii) If the carrier’s requested composite average increase, the 7
	1727	+	independent expert’s recommended composite average increase, or the 8
	1728	+	Department actuary’s recommended composite average increase differs by less 9
	1729	+	than two percentage points, the Department and the parties shall confer by 10
	1730	+	conference call, or by any other available media, to review the rate requests 11
	1731	+	and recommendations. However, a public hearing may be held at the 12
	1732	+	Commissioner’s discretion for good cause shown. 13
	1733	+	(D)(i) In any review held in accordance with this subdivision (3), the 14
	1734	+	Commissioner shall permit intervention by any person whom the 15
	1735	+	Commissioner determines will materially advance the interests of the covered 16
	1736	+	individuals. The intervenor shall have access to and may use the information 17
	1737	+	of the independent expert appointed under 33 V.S.A. § 6706. 18
	1738	+	(ii) The reasonable and necessary cost of intervention as 19
	1739	+	determined by the Commissioner shall be paid by the affected policyholders or 20
	1740	+	certificate holders. The maximum payment shall be $2,500.00 except when 21 BILL AS INTRODUCED S.30
2983	1741		2025 Page 72 of 181
2984		-	waivedbytheCommissionerforgoodcauseshown.The$2,500.00maximum
2985		-	amountmaybeadjustedtoreflect,attheCommissioner’sdiscretion,
2986		-	appropriateinflationfactors.
2987		-	(E)Nonproprietary,relevantinformationinanyMedicare
2988		-	supplementinsuranceratefiling,includinganyanalysisbytheDepartment’s
2989		-	actuaryandtheindependentexpert,shallbemadeavailabletothepublicupon
2990		-	request.
2991		-	(c)Disability.
2992		-	(1)AhealthinsurerthatissuesMedicaresupplementinsurancepolicies
2993		-	orcertificatestoapersoneligibleforMedicarebyreasonofageshallmake
2994		-	available,topersonseligibleforMedicarebyreasonofdisability,thesame
2995		-	policiesorcertificatesthatareofferedandsoldtopersonseligiblefor
2996		-	Medicarebyreasonofage.Theinitialenrollmentperiodforanysuchpolicies
2997		-	orcertificatesshallbeatleastsixmonthsfollowingthedatetheindividual
2998		-	becomeseligibleforMedicarebyreasonofdisability.Anyadditional
2999		-	enrollmentperiodsasrequiredbylawandofferedtoindividualseligibleby
3000		-	reasonofageshallbeofferedtoindividualseligiblebyreasonofdisability.
3001		-	(2)ThissubsectiondoesnotapplytopersonseligibleforMedicareby
3002		-	reasonofendstagerenaldisease.
3003		-	(d)Outreachandeducation.TheDepartmentofFinancialRegulationshall
3004		-	collaboratewithhealthinsurers,advocatesforolderVermontersandforother
3005		-	1
3006		-	2
3007		-	3
3008		-	4
3009		-	5
3010		-	6
3011		-	7
3012		-	8
3013		-	9
3014		-	10
3015		-	11
3016		-	12
3017		-	13
3018		-	14
3019		-	15
3020		-	16
3021		-	17
3022		-	18
3023		-	19
3024		-	20
3025		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1742	+
	1743	+
	1744	+	VT LEG #380165 v.1
	1745	+	waived by the Commissioner for good cause shown. The $2,500.00 maximum 1
	1746	+	amount may be adjusted to reflect, at the Commissioner’s discretion, 2
	1747	+	appropriate inflation factors. 3
	1748	+	(E) Nonproprietary, relevant information in any Medicare 4
	1749	+	supplement insurance rate filing, including any analysis by the Department’s 5
	1750	+	actuary and the independent expert, shall be made available to the public upon 6
	1751	+	request. 7
	1752	+	(c) Disability. 8
	1753	+	(1) A health insurer that issues Medicare supplement insurance policies 9
	1754	+	or certificates to a person eligible for Medicare by reason of age shall make 10
	1755	+	available, to persons eligible for Medicare by reason of disability, the same 11
	1756	+	policies or certificates that are offered and sold to persons eligible for 12
	1757	+	Medicare by reason of age. The initial enrollment period for any such policies 13
	1758	+	or certificates shall be at least six months following the date the individual 14
	1759	+	becomes eligible for Medicare by reason of disability. Any additional 15
	1760	+	enrollment periods as required by law and offered to individuals eligible by 16
	1761	+	reason of age shall be offered to individuals eligible by reason of disability. 17
	1762	+	(2) This subsection does not apply to persons eligible for Medicare by 18
	1763	+	reason of end stage renal disease. 19
	1764	+	(d) Outreach and education. The Department of Financial Regulation shall 20
	1765	+	collaborate with health insurers, advocates for older Vermonters and for other 21 BILL AS INTRODUCED S.30
3026	1766		2025 Page 73 of 181
3027		-	Medicare-eligibleadults,andtheOfficeoftheHealthCareAdvocateto
3028		-	educatethepublicaboutthebenefitsandlimitationsofMedicaresupplement
3029		-	insurancepoliciesandMedicareAdvantageplans,includinginformationto
3030		-	helpthepublicunderstandissuesrelatingtocoverage,costs,andprovider
3031		-	networks.
3032		-	§ 4052.BLANKETHEALTHINSURANCE
3033		-	(a)Blankethealthinsuranceisaformofhealthinsurancethat,totheextent
3034		-	permittedunderfederallaw,issupplementaltomajormedicalhealthinsurance
3035		-	orprovidescoverageotherthanthepaymentofalloraportionofthecostof
3036		-	healthcareservicesorproducts,andthatcoversspecialgroupsofpersonsas
3037		-	follows:
3038		-	(1)underapolicyorcontractissuedtoanycommoncarrier,whichshall
3039		-	bedeemedthepolicyholder,coveringagroupdefinedasallpersonswhomay
3040		-	becomepassengersonsuchcommoncarrier;
3041		-	(2)underapolicyorcontractissuedtoanemployer,whoshallbe
3042		-	deemedthepolicyholder,coveringanygroupofemployeesdefinedby
3043		-	referencetoexceptionalhazardsincidenttosuchemployment;
3044		-	(3)underapolicyorcontractissuedtoapublicschool,independent
3045		-	school,orapprovededucationprogram,asthosetermsaredefinedin
3046		-	16 V.S.A.§ 11;toapostsecondaryschool,asdefinedin16V.S.A.§ 176(b)(1);
3047		-	ortoaprequalifiedprivateprekindergartenprovider,asdefinedin16V.S.A.
3048		-	1
3049		-	2
3050		-	3
3051		-	4
3052		-	5
3053		-	6
3054		-	7
3055		-	8
3056		-	9
3057		-	10
3058		-	11
3059		-	12
3060		-	13
3061		-	14
3062		-	15
3063		-	16
3064		-	17
3065		-	18
3066		-	19
3067		-	20
3068		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1767	+
	1768	+
	1769	+	VT LEG #380165 v.1
	1770	+	Medicare-eligible adults, and the Office of the Health Care Advocate to 1
	1771	+	educate the public about the benefits and limitations of Medicare supplement 2
	1772	+	insurance policies and Medicare Advantage plans, including information to 3
	1773	+	help the public understand issues relating to coverage, costs, and provider 4
	1774	+	networks. 5
	1775	+	§ 4052. BLANKET HEALTH INSURANCE 6
	1776	+	(a) Blanket health insurance is a form of health insurance that, to the extent 7
	1777	+	permitted under federal law, is supplemental to major medical health insurance 8
	1778	+	or provides coverage other than the payment of all or a portion of the cost of 9
	1779	+	health care services or products, and that covers special groups of persons as 10
	1780	+	follows: 11
	1781	+	(1) under a policy or contract issued to any common carrier, which shall 12
	1782	+	be deemed the policyholder, covering a group defined as all persons who may 13
	1783	+	become passengers on such common carrier; 14
	1784	+	(2) under a policy or contract issued to an employer, who shall be 15
	1785	+	deemed the policyholder, covering any group of employees defined by 16
	1786	+	reference to exceptional hazards incident to such employment; 17
	1787	+	(3) under a policy or contract issued to a public school, independent 18
	1788	+	school, or approved education program, as those terms are defined in 19
	1789	+	16 V.S.A. § 11; to a postsecondary school, as defined in 16 V.S.A. 20
	1790	+	§ 176(b)(1); or to a prequalified private prekindergarten provider, as defined in 21 BILL AS INTRODUCED S.30
3069	1791		2025 Page 74 of 181
3070		-	§ 829(a)(3),ortotheheadorprincipaloftheschool,program,orprovider,
3071		-	whoorwhichshallbedeemedthepolicyholder,coveringstudentsorteachers,
3072		-	orboth;
3073		-	(4)underapolicyorcontractissuedinthenameofanyvolunteerfire
3074		-	department,emergencymedicalservicesprovider,orothersuchvolunteer
3075		-	group,whichshallbedeemedthepolicyholder,coveringallofthemembersof
3076		-	thedepartmentorgroupinconnectionwiththeirdepartmentorgroup
3077		-	activities;or
3078		-	(5)underapolicyorcontractissuedtoanyothersubstantiallysimilar
3079		-	groupthat,inthediscretionoftheCommissionerandafterthepriorapproval
3080		-	bytheCommissionerofthegroup,maybesubjecttotheissuanceofablanket
3081		-	healthpolicyorcontract.
3082		-	(b)(1)Noblankethealthinsurancepolicyshallcontainanyprovision
3083		-	relatingtonoticeofclaim,proofsofloss,timeofpaymentofclaims,ortime
3084		-	withinwhichlegalactionmustbebroughtuponthepolicythat,intheopinion
3085		-	oftheCommissioner,islessfavorabletothepersonsinsuredthanwouldbe
3086		-	permittedbytheprovisionssetforthinsection4029ofthistitle.
3087		-	(2)Anindividualapplicationshallnotberequiredfromaperson
3088		-	coveredunderablankethealthpolicyorcontract,norshallitbenecessaryfor
3089		-	theinsurertofurnisheachpersonacertificate.
3090		-	1
3091		-	2
3092		-	3
3093		-	4
3094		-	5
3095		-	6
3096		-	7
3097		-	8
3098		-	9
3099		-	10
3100		-	11
3101		-	12
3102		-	13
3103		-	14
3104		-	15
3105		-	16
3106		-	17
3107		-	18
3108		-	19
3109		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1792	+
	1793	+
	1794	+	VT LEG #380165 v.1
	1795	+	16 V.S.A. § 829(a)(3), or to the head or principal of the school, program, or 1
	1796	+	provider, who or which shall be deemed the policyholder, covering students or 2
	1797	+	teachers, or both; 3
	1798	+	(4) under a policy or contract issued in the name of any volunteer fire 4
	1799	+	department, emergency medical services provider, or other such volunteer 5
	1800	+	group, which shall be deemed the policyholder, covering all of the members of 6
	1801	+	the department or group in connection with their department or group 7
	1802	+	activities; or 8
	1803	+	(5) under a policy or contract issued to any other substantially similar 9
	1804	+	group that, in the discretion of the Commissioner and after the prior approval 10
	1805	+	by the Commissioner of the group, may be subject to the issuance of a blanket 11
	1806	+	health policy or contract. 12
	1807	+	(b)(1) No blanket health insurance policy shall contain any provision 13
	1808	+	relating to notice of claim, proofs of loss, time of payment of claims, or time 14
	1809	+	within which legal action must be brought upon the policy that, in the opinion 15
	1810	+	of the Commissioner, is less favorable to the persons insured than would be 16
	1811	+	permitted by the provisions set forth in section 4029 of this title. 17
	1812	+	(2) An individual application shall not be required from a person 18
	1813	+	covered under a blanket health policy or contract, nor shall it be necessary for 19
	1814	+	the insurer to furnish each person a certificate. 20 BILL AS INTRODUCED S.30
3110	1815		2025 Page 75 of 181
3111		-	(3)Allbenefitsunderanyblankethealthpolicyshall,unlessforhospital
3112		-	andphysicianserviceorsurgicalbenefits,bepayabletothepersoninsured,or
3113		-	totheperson’sdesignatedbeneficiaryorbeneficiaries,ortotheperson’s
3114		-	estate,exceptthatifthepersoninsuredisaminor,thebenefitsmaybemade
3115		-	payabletotheminor’sparent,guardian,orotherpersonactuallysupporting
3116		-	theminor.
3117		-	(4)Nothinginthissectionshallbedeemedtoaffectthelegalliabilityof
3118		-	policyholdersforthedeathof,orinjuryto,anymembersofthegroup.
3119		-	(c)Noblankethealthinsurancepolicythatprovidescoverageforthe
3120		-	paymentofalloraportionofthecostofhealthcareservicesorproductsshall
3121		-	containanyprovisionthatdoesnotcomplywitharequirementofthistitle,or
3122		-	aruleadoptedpursuanttothistitleapplicabletohealthinsurance,otherthan
3123		-	thoserequirementsapplicabletonongrouphealthinsuranceorsmallgroup
3124		-	healthinsurance.TheCommissionermaywaivetheapplicationtoablanket
3125		-	insurancepolicyofoneormoreofthehealthinsurancerequirementsofthis
3126		-	title,oraruleadoptedpursuanttothistitle,iftherequirementisnotrelevant
3127		-	tothetypesofrisksanddurationofrisksinsuredagainstintheblanket
3128		-	insurancepolicy.
3129		-	§ 4053.SHORT-TERM,LIMITED-DURATIONHEALTHINSURANCE
3130		-	(a)Asusedinthissection,“short-term,limited-durationhealthinsurance”
3131		-	meanshealthinsurancethatprovidesmedical,hospital,ormajormedical
3132		-	1
3133		-	2
3134		-	3
3135		-	4
3136		-	5
3137		-	6
3138		-	7
3139		-	8
3140		-	9
3141		-	10
3142		-	11
3143		-	12
3144		-	13
3145		-	14
3146		-	15
3147		-	16
3148		-	17
3149		-	18
3150		-	19
3151		-	20
3152		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1816	+
	1817	+
	1818	+	VT LEG #380165 v.1
	1819	+	(3) All benefits under any blanket health policy shall, unless for hospital 1
	1820	+	and physician service or surgical benefits, be payable to the person insured, or 2
	1821	+	to the person’s designated beneficiary or beneficiaries, or to the person’s 3
	1822	+	estate, except that if the person insured is a minor, the benefits may be made 4
	1823	+	payable to the minor’s parent, guardian, or other person actually supporting the 5
	1824	+	minor. 6
	1825	+	(4) Nothing in this section shall be deemed to affect the legal liability of 7
	1826	+	policyholders for the death of, or injury to, any members of the group. 8
	1827	+	(c) No blanket health insurance policy that provides coverage for the 9
	1828	+	payment of all or a portion of the cost of health care services or products shall 10
	1829	+	contain any provision that does not comply with a requirement of this title, or a 11
	1830	+	rule adopted pursuant to this title applicable to health insurance, other than 12
	1831	+	those requirements applicable to nongroup health insurance or small group 13
	1832	+	health insurance. The Commissioner may waive the application to a blanket 14
	1833	+	insurance policy of one or more of the health insurance requirements of this 15
	1834	+	title, or a rule adopted pursuant to this title, if the requirement is not relevant to 16
	1835	+	the types of risks and duration of risks insured against in the blanket insurance 17
	1836	+	policy. 18
	1837	+	§ 4053. SHORT-TERM, LIMITED-DURATION HEALTH INSURANCE 19
	1838	+	(a) As used in this section, “short-term, limited-duration health insurance” 20
	1839	+	means health insurance that provides medical, hospital, or major medical 21 BILL AS INTRODUCED S.30
3153	1840		2025 Page 76 of 181
3154		-	expensebenefitscoveragepursuanttoapolicyorcontractwithahealthinsurer
3155		-	andthathasanexpirationdatespecifiedinthepolicyorcontractthatisthree
3156		-	monthsorlessaftertheoriginaleffectivedateofthepolicyorcontract.
3157		-	(b)Nopersonshallprovideshort-term,limited-durationhealthinsurance
3158		-	coveragewithoutacertificateofauthorityfromtheCommissionertooffer
3159		-	healthinsuranceinthisStateunlessthepersonisexemptedbysubdivision
3160		-	3368(a)(4)ofthistitle.
3161		-	(c)Ashort-term,limited-durationhealthinsurancepolicyorcontractshall
3162		-	benonrenewable,andahealthinsurershallnotissueashort-term,limited-
3163		-	durationhealthinsurancepolicyorcontracttoanypersoniftheissuance
3164		-	wouldresultinthepersonbeingcoveredbyshort-term,limited-durationhealth
3165		-	insurancecoverageformorethanthreemonthsinany12-monthperiod.
3166		-	(d)Apolicyorcontractforshort-term,limited-durationhealthinsurance
3167		-	coverageshalldisplayprominentlyinthepolicyorcontractandinany
3168		-	applicationmaterialsprovidedinconnectionwithenrollmentinthatcoverage,
3169		-	inatleast14-pointtype,certaindisclosuresregardingthescopeofshort-term,
3170		-	limited-durationhealthinsurancecoverage,includingthetypesofbenefitsand
3171		-	consumerprotectionsthatareandarenotincluded.TheCommissionershall
3172		-	determinethespecificdisclosurelanguagethatshallbeusedinallshort-term,
3173		-	limited-durationhealthinsurancepolicies,contracts,andapplicationmaterials
3174		-	andshallprovidethelanguagetothehealthinsurersofferingthatcoverage.
3175		-	1
3176		-	2
3177		-	3
3178		-	4
3179		-	5
3180		-	6
3181		-	7
3182		-	8
3183		-	9
3184		-	10
3185		-	11
3186		-	12
3187		-	13
3188		-	14
3189		-	15
3190		-	16
3191		-	17
3192		-	18
3193		-	19
3194		-	20
3195		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1841	+
	1842	+
	1843	+	VT LEG #380165 v.1
	1844	+	expense benefits coverage pursuant to a policy or contract with a health insurer 1
	1845	+	and that has an expiration date specified in the policy or contract that is three 2
	1846	+	months or less after the original effective date of the policy or contract. 3
	1847	+	(b) No person shall provide short-term, limited-duration health insurance 4
	1848	+	coverage without a certificate of authority from the Commissioner to offer 5
	1849	+	health insurance in this State unless the person is exempted by subdivision 6
	1850	+	3368(a)(4) of this title. 7
	1851	+	(c) A short-term, limited-duration health insurance policy or contract shall 8
	1852	+	be nonrenewable, and a health insurer shall not issue a short-term, limited-9
	1853	+	duration health insurance policy or contract to any person if the issuance would 10
	1854	+	result in the person being covered by short-term, limited-duration health 11
	1855	+	insurance coverage for more than three months in any 12-month period. 12
	1856	+	(d) A policy or contract for short-term, limited-duration health insurance 13
	1857	+	coverage shall display prominently in the policy or contract and in any 14
	1858	+	application materials provided in connection with enrollment in that coverage, 15
	1859	+	in at least 14-point type, certain disclosures regarding the scope of short-term, 16
	1860	+	limited-duration health insurance coverage, including the types of benefits and 17
	1861	+	consumer protections that are and are not included. The Commissioner shall 18
	1862	+	determine the specific disclosure language that shall be used in all short-term, 19
	1863	+	limited-duration health insurance policies, contracts, and application materials 20
	1864	+	and shall provide the language to the health insurers offering that coverage. 21 BILL AS INTRODUCED S.30
3196	1865		2025 Page 77 of 181
3197		-	(e)TheCommissionershalladoptrulespursuantto3V.S.A.chapter25:
3198		-	(1)establishingtheminimumfinancial,marketing,service,andother
3199		-	requirementsforregistrationofahealthinsurertoprovideshort-term,limited-
3200		-	durationhealthinsurancecoveragetoindividualsinthisState;
3201		-	(2)requiringahealthinsurerseekingtoprovideshort-term,limited-
3202		-	durationhealthinsurancecoveragetoindividualsinthisStatetofileitsrates
3203		-	andformswiththeCommissionerfortheCommissioner’sapproval;
3204		-	(3)requiringahealthinsurerseekingtoprovideshort-term,limited-
3205		-	durationhealthinsurancecoveragetoindividualsinthisStatetofileits
3206		-	advertisingmaterialswiththeCommissionerfortheCommissioner’sapproval;
3207		-	and
3208		-	(4)establishingsuchotherrequirementsastheCommissionerdeems
3209		-	necessarytoprotectVermontconsumersandpromotethestabilityof
3210		-	Vermont’shealthinsurancemarkets.
3211		-	(f)Theprovisionsofsection4063ofthistitle,andanyrulesadoptedunder
3212		-	thatsection,shallapplytoshort-term,limited-durationhealthinsurance
3213		-	coverage.
3214		-	Subchapter7.ChildandDependentCoverage
3215		-	§ 4057.COVERAGEOFCHILDREN
3216		-	1
3217		-	2
3218		-	3
3219		-	4
3220		-	5
3221		-	6
3222		-	7
3223		-	8
3224		-	9
3225		-	10
3226		-	11
3227		-	12
3228		-	13
3229		-	14
3230		-	15
3231		-	16
3232		-	17
3233		-	18
3234		-	19 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1866	+
	1867	+
	1868	+	VT LEG #380165 v.1
	1869	+	(e) The Commissioner shall adopt rules pursuant to 3 V.S.A. chapter 25: 1
	1870	+	(1) establishing the minimum financial, marketing, service, and other 2
	1871	+	requirements for registration of a health insurer to provide short-term, limited-3
	1872	+	duration health insurance coverage to individuals in this State; 4
	1873	+	(2) requiring a health insurer seeking to provide short-term, limited-5
	1874	+	duration health insurance coverage to individuals in this State to file its rates 6
	1875	+	and forms with the Commissioner for the Commissioner’s approval; 7
	1876	+	(3) requiring a health insurer seeking to provide short-term, limited-8
	1877	+	duration health insurance coverage to individuals in this State to file its 9
	1878	+	advertising materials with the Commissioner for the Commissioner’s approval; 10
	1879	+	and 11
	1880	+	(4) establishing such other requirements as the Commissioner deems 12
	1881	+	necessary to protect Vermont consumers and promote the stability of 13
	1882	+	Vermont’s health insurance markets. 14
	1883	+	(f) The provisions of section 4063 of this title, and any rules adopted under 15
	1884	+	that section, shall apply to short-term, limited-duration health insurance 16
	1885	+	coverage. 17
	1886	+	Subchapter 7. Child and Dependent Coverage 18
	1887	+	§ 4057. COVERAGE OF CHILDREN 19 BILL AS INTRODUCED S.30
3235	1888		2025 Page 78 of 181
3236		-	(a)Definition.“Healthinsuranceplan”hasthesamemeaningasinsection
3237		-	4011ofthischapterandshallbesubjecttothesameexceptedbenefits,ineach
3238		-	case,assetforthin45C.F.R.§146.145,asineffectasofDecember31,2017.
3239		-	(b)Newborncoverage.
3240		-	(1)Ahealthinsuranceplanthatprovidesdependentcoverageof
3241		-	childrenshallalsoprovidethathealthinsurancebenefitsapplicabletochildren
3242		-	arepayablewithrespecttoanewlybornchildoftheinsuredorsubscriber
3243		-	fromthemomentofbirth.Coverageforanewlybornchildshallinclude
3244		-	coverageofinjury,sickness,andnecessarycareandtreatmentofmedically
3245		-	diagnosedcongenitaldefectorbirthabnormality.
3246		-	(2)Coverageforanewlybornchildshallbeprovidedwithoutnoticeor
3247		-	additionalpremiumfornotlessthan60daysafterthedateofbirth.If
3248		-	paymentofaspecificpremiumorsubscriptionfeeisrequiredinordertohave
3249		-	thecoveragecontinuebeyondsuch60-dayperiod,thepolicymayrequirethat
3250		-	notificationofthebirthofthenewlybornchildandpaymentoftherequired
3251		-	premiumorfeesbefurnishedtothehealthinsurerwithinaperiodofnotless
3252		-	than60daysafterthedateofbirth.
3253		-	(c)Adoptedchildcoverage.
3254		-	(1)Asusedinthissection:
3255		-	1
3256		-	2
3257		-	3
3258		-	4
3259		-	5
3260		-	6
3261		-	7
3262		-	8
3263		-	9
3264		-	10
3265		-	11
3266		-	12
3267		-	13
3268		-	14
3269		-	15
3270		-	16
3271		-	17
3272		-	18
3273		-	19 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1889	+
	1890	+
	1891	+	VT LEG #380165 v.1
	1892	+	(a) Definition. “Health insurance plan” has the same meaning as in section 1
	1893	+	4011 of this chapter and shall be subject to the same excepted benefits, in each 2
	1894	+	case, as set forth in 45 C.F.R. § 146.145, as in effect as of December 31, 2017. 3
	1895	+	(b) Newborn coverage. 4
	1896	+	(1) A health insurance plan that provides dependent coverage of 5
	1897	+	children shall also provide that health insurance benefits applicable to children 6
	1898	+	are payable with respect to a newly born child of the insured or subscriber 7
	1899	+	from the moment of birth. Coverage for a newly born child shall include 8
	1900	+	coverage of injury, sickness, and necessary care and treatment of medically 9
	1901	+	diagnosed congenital defect or birth abnormality. 10
	1902	+	(2) Coverage for a newly born child shall be provided without notice or 11
	1903	+	additional premium for not less than 60 days after the date of birth. If payment 12
	1904	+	of a specific premium or subscription fee is required in order to have the 13
	1905	+	coverage continue beyond such 60-day period, the policy may require that 14
	1906	+	notification of the birth of the newly born child and payment of the required 15
	1907	+	premium or fees be furnished to the health insurer within a period of not less 16
	1908	+	than 60 days after the date of birth. 17
	1909	+	(c) Adopted child coverage. 18
	1910	+	(1) As used in this section: 19 BILL AS INTRODUCED S.30
3274	1911		2025 Page 79 of 181
3275		-	(A)“Child”means,inconnectionwithanyadoptionorplacementfor
3276		-	adoptionofthechild,anindividualwhohasnotattained18yearsofageasof
3277		-	thedateoftheadoptionorplacementforadoption.
3278		-	(B)“Placementforadoption”meanstheassumptionandretentionby
3279		-	apersonofalegalobligationfortotalorpartialsupportofachildin
3280		-	anticipationoftheadoptionofthechild.Thechild’splacementwithaperson
3281		-	terminatesupontheterminationofsuchlegalobligations.
3282		-	(2)Inanycaseinwhichahealthinsuranceplanprovidescoveragefor
3283		-	dependentchildrenofcoveredindividuals,theplanshallprovidebenefitsto
3284		-	dependentchildrenplacedwithcoveredindividualsforadoptionunderthe
3285		-	sametermsandconditionsasapplytothenatural,dependentchildrenofthe
3286		-	coveredindividuals,irrespectiveofwhethertheadoptionhasbecomefinal.
3287		-	(3)Ahealthinsuranceplanshallnotrestrictcoverageundertheplanof
3288		-	anydependentchildadoptedbyacoveredindividual,orplacedwithacovered
3289		-	individualforadoption,solelyonthebasisofapreexistingconditionofthe
3290		-	childatthetimethatthechildwouldotherwisebecomeeligibleforcoverage
3291		-	undertheplan,iftheadoptionorplacementforadoptionoccurswhilethe
3292		-	coveredindividualiseligibleforcoverageundertheplan.
3293		-	(d)Coveragerequireduntil26yearsofage.Ahealthinsuranceplanthat
3294		-	providesdependentcoverageofchildrenshallcontinuetomakethatcoverage
3295		-	availableforanadultchilduntilthechildattains26yearsofage,providedthat
3296		-	1
3297		-	2
3298		-	3
3299		-	4
3300		-	5
3301		-	6
3302		-	7
3303		-	8
3304		-	9
3305		-	10
3306		-	11
3307		-	12
3308		-	13
3309		-	14
3310		-	15
3311		-	16
3312		-	17
3313		-	18
3314		-	19
3315		-	20
3316		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1912	+
	1913	+
	1914	+	VT LEG #380165 v.1
	1915	+	(A) “Child” means, in connection with any adoption or placement for 1
	1916	+	adoption of the child, an individual who has not attained 18 years of age as of 2
	1917	+	the date of the adoption or placement for adoption. 3
	1918	+	(B) “Placement for adoption” means the assumption and retention by 4
	1919	+	a person of a legal obligation for total or partial support of a child in 5
	1920	+	anticipation of the adoption of the child. The child’s placement with a person 6
	1921	+	terminates upon the termination of such legal obligations. 7
	1922	+	(2) In any case in which a health insurance plan provides coverage for 8
	1923	+	dependent children of covered individuals, the plan shall provide benefits to 9
	1924	+	dependent children placed with covered individuals for adoption under the 10
	1925	+	same terms and conditions as apply to the natural, dependent children of the 11
	1926	+	covered individuals, irrespective of whether the adoption has become final. 12
	1927	+	(3) A health insurance plan shall not restrict coverage under the plan of 13
	1928	+	any dependent child adopted by a covered individual, or placed with a covered 14
	1929	+	individual for adoption, solely on the basis of a preexisting condition of the 15
	1930	+	child at the time that the child would otherwise become eligible for coverage 16
	1931	+	under the plan, if the adoption or placement for adoption occurs while the 17
	1932	+	covered individual is eligible for coverage under the plan. 18
	1933	+	(d) Coverage required until 26 years of age. A health insurance plan that 19
	1934	+	provides dependent coverage of children shall continue to make that coverage 20
	1935	+	available for an adult child until the child attains 26 years of age, provided that 21 BILL AS INTRODUCED S.30
3317	1936		2025 Page 80 of 181
3318		-	thissubsectionshallnotapplytoaplanprovidingcoverageforaspecified
3319		-	diseaseorotherlimitedbenefitcoverage,andfurtherprovidedthatnothingin
3320		-	thissubsectionshallrequireaplantomakecoverageavailableforthechildof
3321		-	achildreceivingdependentcoverage.
3322		-	(e)Coverageofadultchildwithadisability.
3323		-	(1)Ahealthinsuranceplanthatprovidesforterminatingthecoverageof
3324		-	adependentchilduponattainmentofthelimitingagefordependentchildren
3325		-	specifiedinthepolicyshallnotlimitorrestrictcoveragewithrespecttoan
3326		-	unmarriedchildwhomeetsallofthefollowingcriteria:
3327		-	(A)isincapableofself-sustainingemploymentbyreasonofamental
3328		-	orphysicaldisabilitythathasbeenfoundtobeadisabilitythatqualifiesor
3329		-	wouldqualifythechildforbenefitsusingthedefinitions,standards,and
3330		-	methodologyin20C.F.R.Part404,SubpartP;
3331		-	(B)becamesoincapablepriortoattainmentofthelimitingage;and
3332		-	(C)ischieflydependentupontheemployee,member,subscriber,or
3333		-	policyholderforsupportandmaintenance.
3334		-	(2)Coverageundersubdivision(1)ofthissubsectionshallnotbe
3335		-	deniedanypersonbasedupontheexistenceofsuchacondition;provided,
3336		-	however,thatahealthinsuranceplanmayrequirereasonableperiodicproofof
3337		-	acontinuingconditionnotmorefrequentlythanonceeveryyear.
3338		-	1
3339		-	2
3340		-	3
3341		-	4
3342		-	5
3343		-	6
3344		-	7
3345		-	8
3346		-	9
3347		-	10
3348		-	11
3349		-	12
3350		-	13
3351		-	14
3352		-	15
3353		-	16
3354		-	17
3355		-	18
3356		-	19
3357		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1937	+
	1938	+
	1939	+	VT LEG #380165 v.1
	1940	+	this subsection shall not apply to a plan providing coverage for a specified 1
	1941	+	disease or other limited benefit coverage, and further provided that nothing in 2
	1942	+	this subsection shall require a plan to make coverage available for the child of 3
	1943	+	a child receiving dependent coverage. 4
	1944	+	(e) Coverage of adult child with a disability. 5
	1945	+	(1) A health insurance plan that provides for terminating the coverage of 6
	1946	+	a dependent child upon attainment of the limiting age for dependent children 7
	1947	+	specified in the policy shall not limit or restrict coverage with respect to an 8
	1948	+	unmarried child who meets all of the following criteria: 9
	1949	+	(A) is incapable of self-sustaining employment by reason of a mental 10
	1950	+	or physical disability that has been found to be a disability that qualifies or 11
	1951	+	would qualify the child for benefits using the definitions, standards, and 12
	1952	+	methodology in 20 C.F.R. Part 404, Subpart P; 13
	1953	+	(B) became so incapable prior to attainment of the limiting age; and 14
	1954	+	(C) is chiefly dependent upon the employee, member, subscriber, or 15
	1955	+	policyholder for support and maintenance. 16
	1956	+	(2) Coverage under subdivision (1) of this subsection shall not be denied 17
	1957	+	any person based upon the existence of such a condition; provided, however, 18
	1958	+	that a health insurance plan may require reasonable periodic proof of a 19
	1959	+	continuing condition not more frequently than once every year. 20 BILL AS INTRODUCED S.30
3358	1960		2025 Page 81 of 181
3359		-	(f)Coverageofleaveofabsencefromcollege.Ahealthinsuranceplan
3360		-	thatcoversdependentchildrenwhoarefull-timecollegestudentsbeyond18
3361		-	yearsofageshallincludecoverageforadependent’smedicallynecessary
3362		-	leaveofabsencefromschoolforaperiodnottoexceed24monthsorthedate
3363		-	onwhichcoveragewouldotherwiseendpursuanttothetermsandconditions
3364		-	ofthepolicyorcoverage,whichevercomesfirst,exceptthatcoveragemay
3365		-	continueundersubsection(b)ofthissectionasappropriate.Toestablish
3366		-	entitlementtocoverageunderthissubsection,documentationandcertification
3367		-	bythestudent’streatinghealthcareprofessionalofthemedicalnecessityofa
3368		-	leaveofabsenceshallbesubmittedtothehealthinsureror,forself-insured
3369		-	plans,thehealthplanadministrator.Thehealthinsuranceplanmayrequire
3370		-	reasonableperiodicprooffromthestudent’streatinghealthcareprofessional
3371		-	thattheleaveofabsencecontinuestobemedicallynecessary.
3372		-	(g)Parentalrights.Whenachildhashealthcoveragethroughthehealth
3373		-	insurerofaparent,thehealthinsurershall:
3374		-	(1)providesuchinformationtoeitherparentasmaybenecessaryfor
3375		-	thechildtoobtainbenefitsthroughthatcoverage;
3376		-	(2)permiteitherparent,aproviderwithparentalauthorization,theState
3377		-	Medicaidagencyasassignee,oranyStateagencyadministeringhealth
3378		-	benefitsorahealthbenefitplanforwhichMedicaidisasourceoffundingto
3379		-	1
3380		-	2
3381		-	3
3382		-	4
3383		-	5
3384		-	6
3385		-	7
3386		-	8
3387		-	9
3388		-	10
3389		-	11
3390		-	12
3391		-	13
3392		-	14
3393		-	15
3394		-	16
3395		-	17
3396		-	18
3397		-	19
3398		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1961	+
	1962	+
	1963	+	VT LEG #380165 v.1
	1964	+	(f) Coverage of leave of absence from college. A health insurance plan that 1
	1965	+	covers dependent children who are full-time college students beyond 18 years 2
	1966	+	of age shall include coverage for a dependent’s medically necessary leave of 3
	1967	+	absence from school for a period not to exceed 24 months or the date on which 4
	1968	+	coverage would otherwise end pursuant to the terms and conditions of the 5
	1969	+	policy or coverage, whichever comes first, except that coverage may continue 6
	1970	+	under subsection (b) of this section as appropriate. To establish entitlement to 7
	1971	+	coverage under this subsection, documentation and certification by the 8
	1972	+	student’s treating health care professional of the medical necessity of a leave of 9
	1973	+	absence shall be submitted to the health insurer or, for self-insured plans, the 10
	1974	+	health plan administrator. The health insurance plan may require reasonable 11
	1975	+	periodic proof from the student’s treating health care professional that the 12
	1976	+	leave of absence continues to be medically necessary. 13
	1977	+	(g) Parental rights. When a child has health coverage through the health 14
	1978	+	insurer of a parent, the health insurer shall: 15
	1979	+	(1) provide such information to either parent as may be necessary for the 16
	1980	+	child to obtain benefits through that coverage; 17
	1981	+	(2) permit either parent, a provider with parental authorization, the State 18
	1982	+	Medicaid agency as assignee, or any State agency administering health benefits 19
	1983	+	or a health benefit plan for which Medicaid is a source of funding to submit 20 BILL AS INTRODUCED S.30
3399	1984		2025 Page 82 of 181
3400		-	submitclaimsforcoveredservices,andtoappealthedenialofanybenefit,
3401		-	withouttheapprovaloftheotherparent;and
3402		-	(3)makepaymentsonclaimssubmittedinaccordancewithsubdivision
3403		-	(2)ofthissubsectiondirectlytotheparentwhopaidtheprovider,theprovider
3404		-	asassignee,theStateMedicaidagency,oranyStateagencyadministering
3405		-	healthbenefitsorahealthbenefitplanforwhichMedicaidisasourceof
3406		-	funding.
3407		-	(h)Childvaccinecoverage.Nohealthinsurershallreduceitscoveragefor
3408		-	pediatricvaccinesbelowthecoverageprovidedasofMay1,1993.
3409		-	§ 4058.MEDICALSUPPORTORDERS
3410		-	(a)Asusedinthissection:
3411		-	(1)“Dependentcoverage”meansfamilycoverage,orcoverageforone
3412		-	ormorepersonsaslongasthecoverageforoneormorepersonsisgreaterthan
3413		-	orequaltothecoverageavailableunderfamilycoverage.
3414		-	(2)“Healthinsuranceplan”hasthesamemeaningasinsection4011of
3415		-	thischapterandshallbesubjecttothesameexceptedbenefits,ineachcase,as
3416		-	setforthin45C.F.R.§146.145,asineffectasofDecember31,2017.
3417		-	(b)Ahealthinsurershallnotdenyenrollmentofachildunderthehealth
3418		-	insuranceplanofthechild’sparentwhoisorderedtoprovidemedicalsupport
3419		-	onthegroundsthat:
3420		-	(1)thechildwasborntounmarriedparents;
3421		-	1
3422		-	2
3423		-	3
3424		-	4
3425		-	5
3426		-	6
3427		-	7
3428		-	8
3429		-	9
3430		-	10
3431		-	11
3432		-	12
3433		-	13
3434		-	14
3435		-	15
3436		-	16
3437		-	17
3438		-	18
3439		-	19
3440		-	20
3441		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	1985	+
	1986	+
	1987	+	VT LEG #380165 v.1
	1988	+	claims for covered services, and to appeal the denial of any benefit, without the 1
	1989	+	approval of the other parent; and 2
	1990	+	(3) make payments on claims submitted in accordance with subdivision 3
	1991	+	(2) of this subsection directly to the parent who paid the provider, the provider 4
	1992	+	as assignee, the State Medicaid agency, or any State agency administering 5
	1993	+	health benefits or a health benefit plan for which Medicaid is a source of 6
	1994	+	funding. 7
	1995	+	(h) Child vaccine coverage. No health insurer shall reduce its coverage for 8
	1996	+	pediatric vaccines below the coverage provided as of May 1, 1993. 9
	1997	+	§ 4058. MEDICAL SUPPORT ORDERS 10
	1998	+	(a) As used in this section: 11
	1999	+	(1) “Dependent coverage” means family coverage, or coverage for one 12
	2000	+	or more persons as long as the coverage for one or more persons is greater than 13
	2001	+	or equal to the coverage available under family coverage. 14
	2002	+	(2) “Health insurance plan” has the same meaning as in section 4011 of 15
	2003	+	this chapter and shall be subject to the same excepted benefits, in each case, as 16
	2004	+	set forth in 45 C.F.R. § 146.145, as in effect as of December 31, 2017. 17
	2005	+	(b) A health insurer shall not deny enrollment of a child under the health 18
	2006	+	insurance plan of the child’s parent who is ordered to provide medical support 19
	2007	+	on the grounds that: 20
	2008	+	(1) the child was born to unmarried parents; 21 BILL AS INTRODUCED S.30
3442	2009		2025 Page 83 of 181
3443		-	(2)thechildisnotclaimedasadependentontheparent’sfederaltax
3444		-	return;or
3445		-	(3)thechilddoesnotresidewiththeparentorinthehealthinsurer’s
3446		-	servicearea.
3447		-	(c)Whenaparentisrequiredbyacourtoradministrativeordertoprovide
3448		-	healthcoverageforachild,andtheparentiseligiblefordependenthealth
3449		-	coverage,thehealthinsurershallberequired:
3450		-	(1)Toenroll,underthedependentcoverage,achildwhoisotherwise
3451		-	eligibleforthecoveragewithoutregardtoanyenrollmentseasonrestrictions
3452		-	oranyseasonalrestrictionsonswitchingfromoneplantoanother,upon
3453		-	applicationofeitherparent,theemployer,theStateagencyadministeringthe
3454		-	Medicaidprogram,anyStateagencyadministeringhealthbenefitsorahealth
3455		-	insuranceplanforwhichMedicaidisasourceoffunding,orthechildsupport
3456		-	enforcementprogram.
3457		-	(2)Nottodisenrolloreliminatecoverageofthechildunlessthehealth
3458		-	insurerisprovidedsatisfactorywrittenevidencethat:
3459		-	(A)thecourtoradministrativeorderisnolongerineffect;
3460		-	(B)thechildisorwillbeenrolledincomparablehealthcoverage
3461		-	throughanotherhealthinsurerthatwilltakeeffectnotlaterthantheeffective
3462		-	dateofdisenrollment;or
3463		-	1
3464		-	2
3465		-	3
3466		-	4
3467		-	5
3468		-	6
3469		-	7
3470		-	8
3471		-	9
3472		-	10
3473		-	11
3474		-	12
3475		-	13
3476		-	14
3477		-	15
3478		-	16
3479		-	17
3480		-	18
3481		-	19
3482		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2010	+
	2011	+
	2012	+	VT LEG #380165 v.1
	2013	+	(2) the child is not claimed as a dependent on the parent’s federal tax 1
	2014	+	return; or 2
	2015	+	(3) the child does not reside with the parent or in the health insurer’s 3
	2016	+	service area. 4
	2017	+	(c) When a parent is required by a court or administrative order to provide 5
	2018	+	health coverage for a child, and the parent is eligible for dependent health 6
	2019	+	coverage, the health insurer shall be required: 7
	2020	+	(1) To enroll, under the dependent coverage, a child who is otherwise 8
	2021	+	eligible for the coverage without regard to any enrollment season restrictions 9
	2022	+	or any seasonal restrictions on switching from one plan to another, upon 10
	2023	+	application of either parent, the employer, the State agency administering the 11
	2024	+	Medicaid program, any State agency administering health benefits or a health 12
	2025	+	insurance plan for which Medicaid is a source of funding, or the child support 13
	2026	+	enforcement program. 14
	2027	+	(2) Not to disenroll or eliminate coverage of the child unless the health 15
	2028	+	insurer is provided satisfactory written evidence that: 16
	2029	+	(A) the court or administrative order is no longer in effect; 17
	2030	+	(B) the child is or will be enrolled in comparable health coverage 18
	2031	+	through another health insurer that will take effect not later than the effective 19
	2032	+	date of disenrollment; or 20 BILL AS INTRODUCED S.30
3483	2033		2025 Page 84 of 181
3484		-	(C)theemployerhaseliminateddependenthealthcoverageforallof
3485		-	itsemployeesifallowedbylaw.
3486		-	(3)Toprovideenrollmentundersubdivision(1)ofthissubsectionwith
3487		-	coverageeffectivethreedaysafterthemailingofnoticeofthecourtor
3488		-	administrativeordertothehealthinsureroruponactualreceiptofnoticeby
3489		-	thehealthinsurer,whicheverissooner.Thehealthinsurershallhave10days
3490		-	fromnoticetoprocesstheenrollmentandshallbeentitledtopremiumsfrom
3491		-	theeffectivedateofenrollment.
3492		-	(d)AhealthinsurershallnotimposerequirementsonaStateagencythat
3493		-	hasbeenassignedtherightsofanindividualeligibleformedicalassistance
3494		-	underMedicaidandcoveredforhealthbenefitsfromthehealthinsurerthatare
3495		-	differentfromrequirementsapplicabletoanagentorassigneeofanyother
3496		-	individualsocovered.
3497		-	(e)Anyhealthinsurerthatfailstoenrollachildafternoticeunder
3498		-	15 V.S.A.§663(d)or33V.S.A.§4110(a)(4)shallbedirectlyliableforany
3499		-	medicalexpensesofthechildthatwouldhavebeencoveredunderthehealth
3500		-	insuranceplanhadthehealthinsurerenrolledthechilduponreceivingnotice.
3501		-	(f)Noticebyfirstclassmail,postageprepaid,orbyanyothermethod
3502		-	showingactualreceipt,shallbepresumptiveevidenceofitsreceiptbythe
3503		-	healthinsurertowhomitisaddressed.Anyperiodoftimethatisdetermined
3504		-	underthissectionbythegivingofnoticeshallcommencetorunfromthedate
3505		-	1
3506		-	2
3507		-	3
3508		-	4
3509		-	5
3510		-	6
3511		-	7
3512		-	8
3513		-	9
3514		-	10
3515		-	11
3516		-	12
3517		-	13
3518		-	14
3519		-	15
3520		-	16
3521		-	17
3522		-	18
3523		-	19
3524		-	20
3525		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2034	+
	2035	+
	2036	+	VT LEG #380165 v.1
	2037	+	(C) the employer has eliminated dependent health coverage for all of 1
	2038	+	its employees if allowed by law. 2
	2039	+	(3) To provide enrollment under subdivision (1) of this subsection with 3
	2040	+	coverage effective three days after the mailing of notice of the court or 4
	2041	+	administrative order to the health insurer or upon actual receipt of notice by the 5
	2042	+	health insurer, whichever is sooner. The health insurer shall have 10 days from 6
	2043	+	notice to process the enrollment and shall be entitled to premiums from the 7
	2044	+	effective date of enrollment. 8
	2045	+	(d) A health insurer shall not impose requirements on a State agency that 9
	2046	+	has been assigned the rights of an individual eligible for medical assistance 10
	2047	+	under Medicaid and covered for health benefits from the health insurer that are 11
	2048	+	different from requirements applicable to an agent or assignee of any other 12
	2049	+	individual so covered. 13
	2050	+	(e) Any health insurer that fails to enroll a child after notice under 14
	2051	+	15 V.S.A. § 663(d) or 33 V.S.A. § 4110(a)(4) shall be directly liable for any 15
	2052	+	medical expenses of the child that would have been covered under the health 16
	2053	+	insurance plan had the health insurer enrolled the child upon receiving notice. 17
	2054	+	(f) Notice by first class mail, postage prepaid, or by any other method 18
	2055	+	showing actual receipt, shall be presumptive evidence of its receipt by the 19
	2056	+	health insurer to whom it is addressed. Any period of time that is determined 20
	2057	+	under this section by the giving of notice shall commence to run from the date 21 BILL AS INTRODUCED S.30
3526	2058		2025 Page 85 of 181
3527		-	ofmailing,ifthenoticeismailed,orthedateofactualreceiptifanother
3528		-	methodoftransmittingthenoticeisused.
3529		-	(g)Ahealthinsurermaycancelanyhealthinsuranceplanthatisthe
3530		-	subjectofamedicalsupportorderfornonpaymentofpremiumonlyifthe
3531		-	healthinsurermailsordeliversnoticeofcancellationtobothparentsandall
3532		-	otherpersonsoragenciesidentifiedinthemedicalsupportorder.Anyhealth
3533		-	insurercancellingahealthinsuranceplanfornonpaymentofpremiumshall
3534		-	reinstatethehealthinsuranceplaneffectivefromthedateofcancellationifthe
3535		-	nonpaymentofpremiumiscuredwithin45daysofthecancellation.
3536		-	§ 4059.COVERAGEFORCIVILUNIONS
3537		-	(a)Asusedinthissection:
3538		-	(1)“Dependentcoverage”meansfamilycoverageorcoverageforone
3539		-	ormorepersons.
3540		-	(2)“Partytoacivilunion”hasthesamemeaningasin15V.S.A.
3541		-	§ 1201.
3542		-	(b)Notwithstandinganyprovisionoflawtothecontrary,healthinsurers
3543		-	shallprovidedependentcoveragetopartiestoacivilunionthatisequivalent
3544		-	tothatprovidedtocoveredindividualswhoaremarried.Ahealthinsurance
3545		-	policythatprovidescoverageforaspouseorfamilymemberofthecovered
3546		-	individualshallalsoprovidetheequivalentcoverageforapartytoacivil
3547		-	union.
3548		-	1
3549		-	2
3550		-	3
3551		-	4
3552		-	5
3553		-	6
3554		-	7
3555		-	8
3556		-	9
3557		-	10
3558		-	11
3559		-	12
3560		-	13
3561		-	14
3562		-	15
3563		-	16
3564		-	17
3565		-	18
3566		-	19
3567		-	20
3568		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2059	+
	2060	+
	2061	+	VT LEG #380165 v.1
	2062	+	of mailing, if the notice is mailed, or the date of actual receipt if another 1
	2063	+	method of transmitting the notice is used. 2
	2064	+	(g) A health insurer may cancel any health insurance plan that is the subject 3
	2065	+	of a medical support order for nonpayment of premium only if the health 4
	2066	+	insurer mails or delivers notice of cancellation to both parents and all other 5
	2067	+	persons or agencies identified in the medical support order. Any health insurer 6
	2068	+	cancelling a health insurance plan for nonpayment of premium shall reinstate 7
	2069	+	the health insurance plan effective from the date of cancellation if the 8
	2070	+	nonpayment of premium is cured within 45 days of the cancellation. 9
	2071	+	§ 4059. COVERAGE FOR CIVIL UNIONS 10
	2072	+	(a) As used in this section: 11
	2073	+	(1) “Dependent coverage” means family coverage or coverage for one 12
	2074	+	or more persons. 13
	2075	+	(2) “Party to a civil union” has the same meaning as in 15 V.S.A. 14
	2076	+	§ 1201. 15
	2077	+	(b) Notwithstanding any provision of law to the contrary, health insurers 16
	2078	+	shall provide dependent coverage to parties to a civil union that is equivalent to 17
	2079	+	that provided to covered individuals who are married. A health insurance 18
	2080	+	policy that provides coverage for a spouse or family member of the covered 19
	2081	+	individual shall also provide the equivalent coverage for a party to a civil 20
	2082	+	union. 21 BILL AS INTRODUCED S.30
3569	2083		2025 Page 86 of 181
3570		-	§ 4060.COVERAGEFOREMPLOYEESOFANEMPLOYER
3571		-	DOMICILEDOUTSIDEVERMONT
3572		-	(a)Asusedinthissection:
3573		-	(1)“Marriage”hasthesamemeaningasin15V.S.A.§8.
3574		-	(2)“Partytoacivilunion”hasthesamemeaningasin15V.S.A.§
3575		-	1201.
3576		-	(b)Totheextentpermittedunderfederallaw,healthinsurancecoverage
3577		-	providedtoVermontresidentswhoworkforanemployerdomiciledoutside
3578		-	Vermontshallnotdistinguishbetweenpartiestoacivilunion,marriedsame-
3579		-	sexcouples,andmarriedopposite-sexcouples.
3580		-	Subchapter8.InternalandExternalReviews
3581		-	§ 4063.INDEPENDENTEXTERNALREVIEWOFHEALTHCARE
3582		-	SERVICEDECISIONS
3583		-	(a)Asusedinthissection,“coveredindividual”includesamemberofa
3584		-	healthinsuranceplannototherwisesubjecttotheDepartment’sjurisdiction
3585		-	thathasvoluntarilyagreedtousetheexternalreviewprocessprovidedunder
3586		-	thissection.
3587		-	(b)Acoveredindividualwhohasexhaustedallapplicableinternalreview
3588		-	proceduresprovidedbythehealthinsuranceplanshallhavetherighttoan
3589		-	independentexternalreviewofadecisionunderahealthinsuranceplanto
3590		-	deny,reduce,orterminatehealthcarecoverageortodenypaymentfora
3591		-	1
3592		-	2
3593		-	3
3594		-	4
3595		-	5
3596		-	6
3597		-	7
3598		-	8
3599		-	9
3600		-	10
3601		-	11
3602		-	12
3603		-	13
3604		-	14
3605		-	15
3606		-	16
3607		-	17
3608		-	18
3609		-	19
3610		-	20
3611		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2084	+
	2085	+
	2086	+	VT LEG #380165 v.1
	2087	+	§ 4060. COVERAGE FOR EMPLOYEES OF AN EMPLOYER 1
	2088	+	DOMICILED OUTSIDE VERMONT 2
	2089	+	(a) As used in this section: 3
	2090	+	(1) “Marriage” has the same meaning as in 15 V.S.A. § 8. 4
	2091	+	(2) “Party to a civil union” has the same meaning as in 15 V.S.A. § 5
	2092	+	1201. 6
	2093	+	(b) To the extent permitted under federal law, health insurance coverage 7
	2094	+	provided to Vermont residents who work for an employer domiciled outside 8
	2095	+	Vermont shall not distinguish between parties to a civil union, married same-9
	2096	+	sex couples, and married opposite-sex couples. 10
	2097	+	Subchapter 8. Internal and External Reviews 11
	2098	+	§ 4063. INDEPENDENT EXTERNAL REVIEW OF HEALTH CARE 12
	2099	+	SERVICE DECISIONS 13
	2100	+	(a) As used in this section, “covered individual” includes a member of a 14
	2101	+	health insurance plan not otherwise subject to the Department’s jurisdiction 15
	2102	+	that has voluntarily agreed to use the external review process provided under 16
	2103	+	this section. 17
	2104	+	(b) A covered individual who has exhausted all applicable internal review 18
	2105	+	procedures provided by the health insurance plan shall have the right to an 19
	2106	+	independent external review of a decision under a health insurance plan to 20
	2107	+	deny, reduce, or terminate health care coverage or to deny payment for a health 21 BILL AS INTRODUCED S.30
3612	2108		2025 Page 87 of 181
3613		-	healthcareservice.Theindependentreviewshallbeavailablewhenrequested
3614		-	inwritingbytheaffectedcoveredindividual,providedthedecisiontobe
3615		-	reviewedrequirestheplantoexpendatleast$100.00fortheserviceandthe
3616		-	decisionbytheplanisbasedononeofthefollowingreasons:
3617		-	(1)Thehealthcareserviceisacoveredbenefitthatthehealthinsurer
3618		-	hasdeterminedtobenotmedicallynecessary.
3619		-	(2)Alimitationisplacedontheselectionofahealthcareproviderthat
3620		-	isclaimedbythecoveredindividualtobeinconsistentwithlimitsimposedby
3621		-	thehealthinsuranceplanandanyapplicablelawsandrules.
3622		-	(3)Thehealthcaretreatmenthasbeendeterminedtobeexperimentalor
3623		-	investigationalorisanoff-labeldrug.Ahealthinsuranceplanthatdeniesuse
3624		-	ofaprescriptiondrugforthetreatmentofcancerasnotmedicallynecessaryor
3625		-	asanexperimentalorinvestigationaluseshalltreatanyinternalappealofsuch
3626		-	denialasanemergencyorurgentappealandshalldecidetheappealwithinthe
3627		-	timeframesapplicabletoemergencyandurgentinternalappealsunderrules
3628		-	adoptedbytheCommissioner.
3629		-	(4)Thehealthcareserviceinvolvesamedicallybaseddecisionthata
3630		-	conditionispreexisting.
3631		-	(5)Thedecisioninvolvesanadversedeterminationrelatedtosurprise
3632		-	medicalbilling,asestablishedunderSection2799A-1or2799A-2ofthe
3633		-	PublicHealthServiceAct,includingwithrespecttowhetheranitemorservice
3634		-	1
3635		-	2
3636		-	3
3637		-	4
3638		-	5
3639		-	6
3640		-	7
3641		-	8
3642		-	9
3643		-	10
3644		-	11
3645		-	12
3646		-	13
3647		-	14
3648		-	15
3649		-	16
3650		-	17
3651		-	18
3652		-	19
3653		-	20
3654		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2109	+
	2110	+
	2111	+	VT LEG #380165 v.1
	2112	+	care service. The independent review shall be available when requested in 1
	2113	+	writing by the affected covered individual, provided the decision to be 2
	2114	+	reviewed requires the plan to expend at least $100.00 for the service and the 3
	2115	+	decision by the plan is based on one of the following reasons: 4
	2116	+	(1) The health care service is a covered benefit that the health insurer 5
	2117	+	has determined to be not medically necessary. 6
	2118	+	(2) A limitation is placed on the selection of a health care provider that 7
	2119	+	is claimed by the covered individual to be inconsistent with limits imposed by 8
	2120	+	the health insurance plan and any applicable laws and rules. 9
	2121	+	(3) The health care treatment has been determined to be experimental or 10
	2122	+	investigational or is an off-label drug. A health insurance plan that denies use 11
	2123	+	of a prescription drug for the treatment of cancer as not medically necessary or 12
	2124	+	as an experimental or investigational use shall treat any internal appeal of such 13
	2125	+	denial as an emergency or urgent appeal and shall decide the appeal within the 14
	2126	+	time frames applicable to emergency and urgent internal appeals under rules 15
	2127	+	adopted by the Commissioner. 16
	2128	+	(4) The health care service involves a medically based decision that a 17
	2129	+	condition is preexisting. 18
	2130	+	(5) The decision involves an adverse determination related to surprise 19
	2131	+	medical billing, as established under Section 2799A-1 or 2799A-2 of the 20
	2132	+	Public Health Service Act, including with respect to whether an item or service 21 BILL AS INTRODUCED S.30
3655	2133		2025 Page 88 of 181
3656		-	thatisthesubjectoftheadversedeterminationisanitemorservicetowhich
3657		-	Section2799A-1or2799A-2ofthePublicHealthServiceAct,orboth,
3658		-	applies.
3659		-	(c)Therighttoreviewunderthissectionshallnotbeconstruedtochange
3660		-	thetermsofcoverageunderahealthinsuranceplan.
3661		-	(d)TheDepartmentshalladoptrulesnecessarytocarryoutthepurposesof
3662		-	thissection.Therulesshallensurethattheindependentexternalreviewshave
3663		-	thefollowingcharacteristics:
3664		-	(1)Theindependentexternalreviewsshallbeconducted:
3665		-	(A)byindependentrevieworganizationspursuanttoacontractwith
3666		-	theDepartment,andthereviewersshallincludehealthcareproviders
3667		-	credentialedwithrespecttothehealthcareserviceunderreviewandshallhave
3668		-	noconflictofinterestrelatingtotheperformanceoftheirdutiesunderthis
3669		-	section;and
3670		-	(B)inaccordancewithstandardsofdecisionmakingbasedon
3671		-	objectiveclinicalevidence,shallresolveallissuesinatimelymanner,and
3672		-	shallprovideexpeditedresolutionwhenthedecisionrelatestoemergencyor
3673		-	urgenthealthcareservices.
3674		-	(2)Acoveredindividualshall:
3675		-	(A)Beprovidedwithadequatenoticeofthecoveredindividual’s
3676		-	reviewrightsunderthissection.
3677		-	1
3678		-	2
3679		-	3
3680		-	4
3681		-	5
3682		-	6
3683		-	7
3684		-	8
3685		-	9
3686		-	10
3687		-	11
3688		-	12
3689		-	13
3690		-	14
3691		-	15
3692		-	16
3693		-	17
3694		-	18
3695		-	19
3696		-	20
3697		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2134	+
	2135	+
	2136	+	VT LEG #380165 v.1
	2137	+	that is the subject of the adverse determination is an item or service to which 1
	2138	+	Section 2799A-1 or 2799A-2 of the Public Health Service Act, or both, 2
	2139	+	applies. 3
	2140	+	(c) The right to review under this section shall not be construed to change 4
	2141	+	the terms of coverage under a health insurance plan. 5
	2142	+	(d) The Department shall adopt rules necessary to carry out the purposes of 6
	2143	+	this section. The rules shall ensure that the independent external reviews have 7
	2144	+	the following characteristics: 8
	2145	+	(1) The independent external reviews shall be conducted: 9
	2146	+	(A) by independent review organizations pursuant to a contract with 10
	2147	+	the Department, and the reviewers shall include health care providers 11
	2148	+	credentialed with respect to the health care service under review and shall have 12
	2149	+	no conflict of interest relating to the performance of their duties under this 13
	2150	+	section; and 14
	2151	+	(B) in accordance with standards of decision making based on 15
	2152	+	objective clinical evidence, shall resolve all issues in a timely manner, and 16
	2153	+	shall provide expedited resolution when the decision relates to emergency or 17
	2154	+	urgent health care services. 18
	2155	+	(2) A covered individual shall: 19
	2156	+	(A) Be provided with adequate notice of the covered individual’s 20
	2157	+	review rights under this section. 21 BILL AS INTRODUCED S.30
3698	2158		2025 Page 89 of 181
3699		-	(B)Havetherighttouseoutsideassistanceduringthereviewprocess
3700		-	andtosubmitevidencerelatingtothehealthcareservice.
3701		-	(C)Payanapplicationfeeof$25.00foreachrequestforan
3702		-	independentexternalreviewofanappealabledecisionnottoexceedatotalof
3703		-	$75.00annually.Theapplicationfeemaybewaivedorreducedbasedona
3704		-	determinationbytheCommissionerthatthefinancialcircumstancesofthe
3705		-	coveredindividualwarrantawaiverorreduction.Theapplicationfeeshallbe
3706		-	paidbythehealthinsurer,notthecoveredindividual,iftheindependent
3707		-	revieworganizationreversesthehealthinsurer’sdecisiontodenypaymentfor
3708		-	ahealthcareservice.
3709		-	(D)Beprotectedfromretaliationforexercisingthecovered
3710		-	individual’srighttoanindependentexternalreviewunderthissection.
3711		-	(3)Othercostsoftheindependentreviewshallbepaidbythehealth
3712		-	insuranceplan.
3713		-	(4)Theindependentrevieworganizationshallissuetobothpartiesa
3714		-	writtenreviewdecisionthatisevidence-based.Thedecisionshallbebinding
3715		-	onthehealthinsuranceplan.
3716		-	(5)Theconfidentialityofanyhealthcareinformationacquiredor
3717		-	providedtotheindependentrevieworganizationshallbemaintainedin
3718		-	compliancewithanyapplicableStateorfederallaws.
3719		-	1
3720		-	2
3721		-	3
3722		-	4
3723		-	5
3724		-	6
3725		-	7
3726		-	8
3727		-	9
3728		-	10
3729		-	11
3730		-	12
3731		-	13
3732		-	14
3733		-	15
3734		-	16
3735		-	17
3736		-	18
3737		-	19
3738		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2159	+
	2160	+
	2161	+	VT LEG #380165 v.1
	2162	+	(B) Have the right to use outside assistance during the review process 1
	2163	+	and to submit evidence relating to the health care service. 2
	2164	+	(C) Pay an application fee of $25.00 for each request for an 3
	2165	+	independent external review of an appealable decision not to exceed a total of 4
	2166	+	$75.00 annually. The application fee may be waived or reduced based on a 5
	2167	+	determination by the Commissioner that the financial circumstances of the 6
	2168	+	covered individual warrant a waiver or reduction. The application fee shall be 7
	2169	+	paid by the health insurer, not the covered individual, if the independent 8
	2170	+	review organization reverses the health insurer’s decision to deny payment for 9
	2171	+	a health care service. 10
	2172	+	(D) Be protected from retaliation for exercising the covered 11
	2173	+	individual’s right to an independent external review under this section. 12
	2174	+	(3) Other costs of the independent review shall be paid by the health 13
	2175	+	insurance plan. 14
	2176	+	(4) The independent review organization shall issue to both parties a 15
	2177	+	written review decision that is evidence-based. The decision shall be binding 16
	2178	+	on the health insurance plan. 17
	2179	+	(5) The confidentiality of any health care information acquired or 18
	2180	+	provided to the independent review organization shall be maintained in 19
	2181	+	compliance with any applicable State or federal laws. 20 BILL AS INTRODUCED S.30
3739	2182		2025 Page 90 of 181
3740		-	(6)Therecordsof,andinternalmaterialspreparedfor,specificreviews
3741		-	byanyindependentrevieworganizationunderthissectionshallbeexempt
3742		-	frompublicinspectionandcopyingunderthePublicRecordsAct.
3743		-	(e)Decisionsrelatingtothefollowinghealthcareservicesshallnotbe
3744		-	reviewedunderthissectionbutshallbereviewedbythereviewprocess
3745		-	providedbylaw:
3746		-	(1)healthcareservicesprovidedbytheVermontMedicaidprogramor
3747		-	Medicaidbenefitsprovidedthroughacontractedhealthplan;and
3748		-	(2)healthcareservicesprovidedtoincarceratedindividualsbythe
3749		-	DepartmentofCorrections.
3750		-	§ 4064.MENTALHEALTHSERVICESREVIEW
3751		-	(a)Thepurposesofthissectionareto:
3752		-	(1)promotethedeliveryofqualitymentalhealthservicesinacost-
3753		-	effectivemanner;
3754		-	(2)fosterthepracticeofmentalhealthservicesreviewasaprofessional
3755		-	collaborativeprocess,theprimaryobjectiveofwhichistoenhancethe
3756		-	effectivenessofclinicaltreatment;
3757		-	(3)protectclientsandpatients,employers,andmentalhealthproviders
3758		-	byensuringthatreviewagentsarequalifiedtoperformservicereview
3759		-	activitiesandtomakeinformeddecisionsontheappropriatenessofmental
3760		-	healthcare;and
3761		-	1
3762		-	2
3763		-	3
3764		-	4
3765		-	5
3766		-	6
3767		-	7
3768		-	8
3769		-	9
3770		-	10
3771		-	11
3772		-	12
3773		-	13
3774		-	14
3775		-	15
3776		-	16
3777		-	17
3778		-	18
3779		-	19
3780		-	20
3781		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2183	+
	2184	+
	2185	+	VT LEG #380165 v.1
	2186	+	(6) The records of, and internal materials prepared for, specific reviews 1
	2187	+	by any independent review organization under this section shall be exempt 2
	2188	+	from public inspection and copying under the Public Records Act. 3
	2189	+	(e) Decisions relating to the following health care services shall not be 4
	2190	+	reviewed under this section but shall be reviewed by the review process 5
	2191	+	provided by law: 6
	2192	+	(1) health care services provided by the Vermont Medicaid program or 7
	2193	+	Medicaid benefits provided through a contracted health plan; and 8
	2194	+	(2) health care services provided to incarcerated individuals by the 9
	2195	+	Department of Corrections. 10
	2196	+	§ 4064. MENTAL HEALTH SERVICES REVIEW 11
	2197	+	(a) The purposes of this section are to: 12
	2198	+	(1) promote the delivery of quality mental health services in a cost-13
	2199	+	effective manner; 14
	2200	+	(2) foster the practice of mental health services review as a professional 15
	2201	+	collaborative process, the primary objective of which is to enhance the 16
	2202	+	effectiveness of clinical treatment; 17
	2203	+	(3) protect clients and patients, employers, and mental health providers 18
	2204	+	by ensuring that review agents are qualified to perform service review 19
	2205	+	activities and to make informed decisions on the appropriateness of mental 20
	2206	+	health care; and 21 BILL AS INTRODUCED S.30
3782	2207		2025 Page 91 of 181
3783		-	(4)ensuretheconfidentialityofclients’andpatients’mentalhealth
3784		-	recordsintheperformanceofservicereviewactivitiesinaccordancewith
3785		-	applicableStateandfederallaws.
3786		-	(b)Definitions.Asusedinthissection:
3787		-	(1)“License”meansareviewagent’slicensegrantedbythe
3788		-	Commissioner.
3789		-	(2)“Mentalhealthprovider”meansanyindividual,corporation,facility,
3790		-	orinstitutioncertifiedorlicensedbythisStatetoprovidementalhealth
3791		-	services,includingaphysician,nursewithrecognizedpsychiatricspecialties,
3792		-	hospitalorotherhealthcarefacility,psychologist,clinicalsocialworker,
3793		-	mentalhealthcounselor,alcoholordrugabusecounselor,oranemployeeor
3794		-	agentofsuchmentalhealthprovideractinginthecourseandscopeof
3795		-	employmentoranagencyrelatedtomentalhealthservices.
3796		-	(3)“Mentalhealthservices”meanactsofdiagnosis,treatment,
3797		-	evaluation,oradviceoranyotheractspermissibleunderthehealthcarelaws
3798		-	ofVermont,whetherperformedinanoutpatientorinstitutionalsetting,and
3799		-	includetreatmentforsubstanceusedisorder.
3800		-	(4)“Reviewagent”meansapersonorentityperformingservicereview
3801		-	activitieswithinoneyearfollowingthedateofsubmissionofafullycompliant
3802		-	applicationforlicensurewhoisaffiliatedwith,undercontractwith,oracting
3803		-	onbehalfofabusinessentityinthisStateandwhoprovidesoradministers
3804		-	1
3805		-	2
3806		-	3
3807		-	4
3808		-	5
3809		-	6
3810		-	7
3811		-	8
3812		-	9
3813		-	10
3814		-	11
3815		-	12
3816		-	13
3817		-	14
3818		-	15
3819		-	16
3820		-	17
3821		-	18
3822		-	19
3823		-	20
3824		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2208	+
	2209	+
	2210	+	VT LEG #380165 v.1
	2211	+	(4) ensure the confidentiality of clients’ and patients’ mental health 1
	2212	+	records in the performance of service review activities in accordance with 2
	2213	+	applicable State and federal laws. 3
	2214	+	(b) Definitions. As used in this section: 4
	2215	+	(1) “License” means a review agent’s license granted by the 5
	2216	+	Commissioner. 6
	2217	+	(2) “Mental health provider” means any individual, corporation, facility, 7
	2218	+	or institution certified or licensed by this State to provide mental health 8
	2219	+	services, including a physician, nurse with recognized psychiatric specialties, 9
	2220	+	hospital or other health care facility, psychologist, clinical social worker, 10
	2221	+	mental health counselor, alcohol or drug abuse counselor, or an employee or 11
	2222	+	agent of such mental health provider acting in the course and scope of 12
	2223	+	employment or an agency related to mental health services. 13
	2224	+	(3) “Mental health services” mean acts of diagnosis, treatment, 14
	2225	+	evaluation, or advice or any other acts permissible under the health care laws 15
	2226	+	of Vermont, whether performed in an outpatient or institutional setting, and 16
	2227	+	include treatment for substance use disorder. 17
	2228	+	(4) “Review agent” means a person or entity performing service review 18
	2229	+	activities within one year following the date of submission of a fully compliant 19
	2230	+	application for licensure who is affiliated with, under contract with, or acting 20
	2231	+	on behalf of a business entity in this State and who provides or administers 21 BILL AS INTRODUCED S.30
3825	2232		2025 Page 92 of 181
3826		-	mentalhealthbenefitstomembersofhealthinsuranceplanssubjecttothe
3827		-	Department’sjurisdiction,includingahealthinsurer.
3828		-	(5)“Servicereview”meansanysystemforreviewingtheappropriate
3829		-	andefficientallocationofmentalhealthservicesgivenorproposedtobegiven
3830		-	toaclientorpatient,ortoagroupofclientsorpatients,forthepurposeof
3831		-	recommendingordeterminingwhethertheservicesshouldbecoveredand
3832		-	includesactivitiesofutilizationreviewandmanagedcare,butdoesnotinclude
3833		-	professionalpeerreviewthatdoesnotaffectreimbursementfororprovisionof
3834		-	services.
3835		-	(c)Anypersonwhoapprovesordeniespayment,orwhorecommends
3836		-	approvalordenialofpayment,formentalhealthservices,orwhosereview
3837		-	resultsinapprovalordenialofpaymentformentalhealthservicesonacase-
3838		-	by-casebasis,shallnotreviewtheseservicesinthisStateunlessthe
3839		-	Commissionerhasgrantedthepersonareviewagent’slicense.The
3840		-	Commissionershalladoptrulestoimplementtheprovisionsofthissection,
3841		-	includingtheproceduresandstandardsforlicensure.Therulesshall
3842		-	differentiatebetweenhealthmaintenanceorganizationslicensedtodobusiness
3843		-	withinthisStateandotherformsofutilizationreview.Therulesshall
3844		-	establish:
3845		-	(1)Arequirementthatwithin10businessdaysafterreceivingarequest
3846		-	forthem,thereviewagentshallmakeavailableatnocosttotheclients,
3847		-	1
3848		-	2
3849		-	3
3850		-	4
3851		-	5
3852		-	6
3853		-	7
3854		-	8
3855		-	9
3856		-	10
3857		-	11
3858		-	12
3859		-	13
3860		-	14
3861		-	15
3862		-	16
3863		-	17
3864		-	18
3865		-	19
3866		-	20
3867		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2233	+
	2234	+
	2235	+	VT LEG #380165 v.1
	2236	+	mental health benefits to members of health insurance plans subject to the 1
	2237	+	Department’s jurisdiction, including a health insurer. 2
	2238	+	(5) “Service review” means any system for reviewing the appropriate 3
	2239	+	and efficient allocation of mental health services given or proposed to be given 4
	2240	+	to a client or patient, or to a group of clients or patients, for the purpose of 5
	2241	+	recommending or determining whether the services should be covered and 6
	2242	+	includes activities of utilization review and managed care, but does not include 7
	2243	+	professional peer review that does not affect reimbursement for or provision of 8
	2244	+	services. 9
	2245	+	(c) Any person who approves or denies payment, or who recommends 10
	2246	+	approval or denial of payment, for mental health services, or whose review 11
	2247	+	results in approval or denial of payment for mental health services on a case-12
	2248	+	by-case basis, shall not review these services in this State unless the 13
	2249	+	Commissioner has granted the person a review agent’s license. The 14
	2250	+	Commissioner shall adopt rules to implement the provisions of this section, 15
	2251	+	including the procedures and standards for licensure. The rules shall 16
	2252	+	differentiate between health maintenance organizations licensed to do business 17
	2253	+	within this State and other forms of utilization review. The rules shall 18
	2254	+	establish: 19
	2255	+	(1) A requirement that within 10 business days after receiving a request 20
	2256	+	for them, the review agent shall make available at no cost to the clients, 21 BILL AS INTRODUCED S.30
3868	2257		2025 Page 93 of 181
3869		-	patients,andprovidersaffectedbyitsservicereviewactivitiesthespecific
3870		-	reviewcriteriaandstandards,credentialsofthereviewingprofessionals,and
3871		-	proceduresandmethodstobeusedinevaluatingproposedordeliveredmental
3872		-	healthservices.
3873		-	(2)Atimeperiodwithinwhichanydeterminationregardingthe
3874		-	provisionorreimbursementofmentalhealthservicesshallbemade.
3875		-	(3)Arequirementthatanydeterminationregardingmentalhealth
3876		-	servicesrenderedortoberenderedtoaclientorpatientthatmayresultina
3877		-	denialofthird-partyreimbursementoradenialofprecertificationforthat
3878		-	serviceshallincludetheevaluation,findings,andconcurrenceofamental
3879		-	healthprofessionalwhosetrainingandexpertiseisatleastcomparabletothat
3880		-	ofthetreatingmentalhealthprovider.
3881		-	(4)Thetype,qualifications,andnumberofpersonnelrequiredto
3882		-	performservicereviewactivities.
3883		-	(5)Arequirementthatadeterminationbyareviewagentthatcare
3884		-	renderedortoberenderedisinappropriateshallnotbemadeuntilthereview
3885		-	agenthascommunicatedwiththepatient’sattendingmentalhealthprovider
3886		-	concerningthatcare.Thereviewshallbeprospectiveorconcurrentwiththe
3887		-	treatment.
3888		-	1
3889		-	2
3890		-	3
3891		-	4
3892		-	5
3893		-	6
3894		-	7
3895		-	8
3896		-	9
3897		-	10
3898		-	11
3899		-	12
3900		-	13
3901		-	14
3902		-	15
3903		-	16
3904		-	17
3905		-	18
3906		-	19 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2258	+
	2259	+
	2260	+	VT LEG #380165 v.1
	2261	+	patients, and providers affected by its service review activities the specific 1
	2262	+	review criteria and standards, credentials of the reviewing professionals, and 2
	2263	+	procedures and methods to be used in evaluating proposed or delivered mental 3
	2264	+	health services. 4
	2265	+	(2) A time period within which any determination regarding the 5
	2266	+	provision or reimbursement of mental health services shall be made. 6
	2267	+	(3) A requirement that any determination regarding mental health 7
	2268	+	services rendered or to be rendered to a client or patient that may result in a 8
	2269	+	denial of third-party reimbursement or a denial of precertification for that 9
	2270	+	service shall include the evaluation, findings, and concurrence of a mental 10
	2271	+	health professional whose training and expertise is at least comparable to that 11
	2272	+	of the treating mental health provider. 12
	2273	+	(4) The type, qualifications, and number of personnel required to 13
	2274	+	perform service review activities. 14
	2275	+	(5) A requirement that a determination by a review agent that care 15
	2276	+	rendered or to be rendered is inappropriate shall not be made until the review 16
	2277	+	agent has communicated with the patient’s attending mental health provider 17
	2278	+	concerning that care. The review shall be prospective or concurrent with the 18
	2279	+	treatment. 19 BILL AS INTRODUCED S.30
3907	2280		2025 Page 94 of 181
3908		-	(6)Arequirementthatanydeterminationthatcarerenderedortobe
3909		-	renderedisinappropriateshallincludethewrittenevaluationandfindingsof
3910		-	thereviewagent.
3911		-	(7)Aprocedureforclients,patients,mentalhealthproviders,and
3912		-	hospitalstoseekpromptreconsiderationbeforeanindependentreview
3913		-	organizationpursuanttosection4063ofthistitleofanadversedecisionbya
3914		-	reviewagent.Theexternalreviewerengagedbytheindependentreview
3915		-	organizationshallhavetrainingandexpertiseatleastcomparabletothatofthe
3916		-	treatinghealthcareprovider.
3917		-	(8)PoliciesandprocedurestoensurethatallapplicableStateand
3918		-	federallawstoprotecttheconfidentialityofindividualmentalhealthrecords
3919		-	arefollowed.
3920		-	(9)Policiesandproceduresthatensureappropriatenotificationand
3921		-	concurrenceofprovidersandtheirclientsorpatientsbeforeclientorpatient
3922		-	interviewsareconductedbythereviewagent.
3923		-	(10)(A)Prohibitionofanagreementbetweenthereviewagentanda
3924		-	businessentityorthird-partypayorinwhichpaymenttothereviewagent
3925		-	includesanincentiveorcontingentfeearrangementbasedonthereductionof
3926		-	mentalhealthservices,reductionoflengthofstay,reductionoftreatment,or
3927		-	treatmentsettingselected.
3928		-	1
3929		-	2
3930		-	3
3931		-	4
3932		-	5
3933		-	6
3934		-	7
3935		-	8
3936		-	9
3937		-	10
3938		-	11
3939		-	12
3940		-	13
3941		-	14
3942		-	15
3943		-	16
3944		-	17
3945		-	18
3946		-	19
3947		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2281	+
	2282	+
	2283	+	VT LEG #380165 v.1
	2284	+	(6) A requirement that any determination that care rendered or to be 1
	2285	+	rendered is inappropriate shall include the written evaluation and findings of 2
	2286	+	the review agent. 3
	2287	+	(7) A procedure for clients, patients, mental health providers, and 4
	2288	+	hospitals to seek prompt reconsideration before an independent review 5
	2289	+	organization pursuant to section 4063 of this title of an adverse decision by a 6
	2290	+	review agent. The external reviewer engaged by the independent review 7
	2291	+	organization shall have training and expertise at least comparable to that of the 8
	2292	+	treating health care provider. 9
	2293	+	(8) Policies and procedures to ensure that all applicable State and federal 10
	2294	+	laws to protect the confidentiality of individual mental health records are 11
	2295	+	followed. 12
	2296	+	(9) Policies and procedures that ensure appropriate notification and 13
	2297	+	concurrence of providers and their clients or patients before client or patient 14
	2298	+	interviews are conducted by the review agent. 15
	2299	+	(10)(A) Prohibition of an agreement between the review agent and a 16
	2300	+	business entity or third-party payor in which payment to the review agent 17
	2301	+	includes an incentive or contingent fee arrangement based on the reduction of 18
	2302	+	mental health services, reduction of length of stay, reduction of treatment, or 19
	2303	+	treatment setting selected. 20 BILL AS INTRODUCED S.30
3948	2304		2025 Page 95 of 181
3949		-	(B)Nothinginthissubdivision(10)shallprohibitcapitation
3950		-	arrangementsforreimbursementformentalhealthservices.
3951		-	(C)Aclinicaldecisionmadebytheattendingmentalhealthprovider
3952		-	regardingcontinuedtreatmentshallnotbeconstruedasadenialofservices
3953		-	subjecttotheprovisionsofthissection.
3954		-	(d)Reviewingagentsshallbesubjecttotheprovisionsofchapter129of
3955		-	thistitlegoverningunfairinsurancetradepractices.
3956		-	(e)TheCommissionershallhavetheauthoritytoexamine,take
3957		-	administrativeactionagainst,andpenalizereviewagentsasprovidedin
3958		-	chapters3,101,and129ofthistitle.Apersonwhoviolatesanyprovisionof
3959		-	thissectionorwhosubmitsanyfalseinformationinanapplicationrequiredby
3960		-	thissectionmaybefinednotmorethan$5,000.00foreachviolation.
3961		-	(f)Areviewagentshallpayalicensefeeof$200.00fortheyearof
3962		-	registrationandarenewalfeeof$200.00foreachyearthereafter.Inaddition,
3963		-	areviewagentshallpayanyadditionalexpensesincurredbythe
3964		-	Commissionertoexamineandinvestigateanapplicationoranamendmentto
3965		-	anapplication.
3966		-	(g)Theconfidentialityofanyhealthcareinformationacquiredbyor
3967		-	providedtoanindependentrevieworganizationpursuanttosection4063of
3968		-	thistitleshallbemaintainedincompliancewithanyapplicableStateorfederal
3969		-	laws.Recordsof,andinternalmaterialspreparedfor,specificreviewsunder
3970		-	1
3971		-	2
3972		-	3
3973		-	4
3974		-	5
3975		-	6
3976		-	7
3977		-	8
3978		-	9
3979		-	10
3980		-	11
3981		-	12
3982		-	13
3983		-	14
3984		-	15
3985		-	16
3986		-	17
3987		-	18
3988		-	19
3989		-	20
3990		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2305	+
	2306	+
	2307	+	VT LEG #380165 v.1
	2308	+	(B) Nothing in this subdivision (10) shall prohibit capitation 1
	2309	+	arrangements for reimbursement for mental health services. 2
	2310	+	(C) A clinical decision made by the attending mental health provider 3
	2311	+	regarding continued treatment shall not be construed as a denial of services 4
	2312	+	subject to the provisions of this section. 5
	2313	+	(d) Reviewing agents shall be subject to the provisions of chapter 129 of 6
	2314	+	this title governing unfair insurance trade practices. 7
	2315	+	(e) The Commissioner shall have the authority to examine, take 8
	2316	+	administrative action against, and penalize review agents as provided in 9
	2317	+	chapters 3, 101, and 129 of this title. A person who violates any provision of 10
	2318	+	this section or who submits any false information in an application required by 11
	2319	+	this section may be fined not more than $5,000.00 for each violation. 12
	2320	+	(f) A review agent shall pay a license fee of $200.00 for the year of 13
	2321	+	registration and a renewal fee of $200.00 for each year thereafter. In addition, 14
	2322	+	a review agent shall pay any additional expenses incurred by the 15
	2323	+	Commissioner to examine and investigate an application or an amendment to 16
	2324	+	an application. 17
	2325	+	(g) The confidentiality of any health care information acquired by or 18
	2326	+	provided to an independent review organization pursuant to section 4063 of 19
	2327	+	this title shall be maintained in compliance with any applicable State or federal 20
	2328	+	laws. Records of, and internal materials prepared for, specific reviews under 21 BILL AS INTRODUCED S.30
3991	2329		2025 Page 96 of 181
3992		-	thissectionshallbeexemptfrompublicinspectionandcopyingunderthe
3993		-	PublicRecordsAct.
3994		-	Subchapter9.RequiredCoveredBenefits
3995		-	§ 4067.APPLICATIONOFSUBCHAPTER
3996		-	(a)Unlessotherwisespecifiedandtotheextentnotinconsistentwith
3997		-	federallaw,thebenefitsrequiredinthissubchapter:
3998		-	(1)applyonlytomajormedicalinsuranceplans;
3999		-	(2)maybesubjecttodeductibles,co-paymentandcoinsuranceamounts,
4000		-	feeorbenefitlimits,practiceparameters,andutilizationreviewconsistentwith
4001		-	anyapplicablerulesandguidanceadoptedbytheDepartmentofFinancial
4002		-	Regulation;and
4003		-	(3)donotapplytoVermontMedicaid.
4004		-	(b)Ahealthinsurermayrequirebenefitsmandatedinthissubchaptertobe
4005		-	providedbyalicensedhealthcareproviderundercontractwiththehealth
4006		-	insurer;provided,however,thatthisprovisionshallnotbeconstruedtorelieve
4007		-	ahealthinsuranceplanfromcomplyingwiththeapplicablenetworkadequacy
4008		-	requirementsadoptedbytheCommissionerbyrule.
4009		-	§ 4068.CHIROPRACTICSERVICES
4010		-	(a)Ahealthinsuranceplanshallprovidecoverageforclinicallynecessary
4011		-	healthcareservicesprovidedbyachiropracticphysicianlicensedinthisState
4012		-	fortreatmentwithinthescopeofpracticedescribedin26V.S.A.chapter10,
4013		-	1
4014		-	2
4015		-	3
4016		-	4
4017		-	5
4018		-	6
4019		-	7
4020		-	8
4021		-	9
4022		-	10
4023		-	11
4024		-	12
4025		-	13
4026		-	14
4027		-	15
4028		-	16
4029		-	17
4030		-	18
4031		-	19
4032		-	20
4033		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2330	+
	2331	+
	2332	+	VT LEG #380165 v.1
	2333	+	this section shall be exempt from public inspection and copying under the 1
	2334	+	Public Records Act. 2
	2335	+	Subchapter 9. Required Covered Benefits 3
	2336	+	§ 4067. APPLICATION OF SUBCHAPTER 4
	2337	+	(a) Unless otherwise specified and to the extent not inconsistent with 5
	2338	+	federal law, the benefits required in this subchapter: 6
	2339	+	(1) apply only to major medical insurance plans; 7
	2340	+	(2) may be subject to deductibles, co-payment and coinsurance amounts, 8
	2341	+	fee or benefit limits, practice parameters, and utilization review consistent with 9
	2342	+	any applicable rules and guidance adopted by the Department of Financial 10
	2343	+	Regulation; and 11
	2344	+	(3) do not apply to Vermont Medicaid. 12
	2345	+	(b) A health insurer may require benefits mandated in this subchapter to be 13
	2346	+	provided by a licensed health care provider under contract with the health 14
	2347	+	insurer; provided, however, that this provision shall not be construed to relieve 15
	2348	+	a health insurance plan from complying with the applicable network adequacy 16
	2349	+	requirements adopted by the Commissioner by rule. 17
	2350	+	§ 4068. CHIROPRACTIC SERVICES 18
	2351	+	(a) A health insurance plan shall provide coverage for clinically necessary 19
	2352	+	health care services provided by a chiropractic physician licensed in this State 20
	2353	+	for treatment within the scope of practice described in 26 V.S.A. chapter 10, 21 BILL AS INTRODUCED S.30
4034	2354		2025 Page 97 of 181
4035		-	butlimitingadjunctivetherapiestophysiotherapymodalitiesandrehabilitative
4036		-	exercises.Ahealthinsuranceplandoesnothavetoprovidecoverageforthe
4037		-	treatmentofanyvisceralconditionarisingfromproblemsordysfunctionsof
4038		-	theabdominalorthoracicorgans.
4039		-	(b)Ahealthinsurermayrequirethatthechiropracticservicesbe
4040		-	provideduponreferralfromahealthcareproviderundercontractwiththe
4041		-	healthinsurer.
4042		-	(c)Forsilver-andbronze-levelqualifiedhealthbenefitplansandany
4043		-	reflectivehealthbenefitplansofferedatthesilverorbronzelevelpursuantto
4044		-	33V.S.A.chapter18,subchapter1,healthcareservicesprovidedbya
4045		-	chiropracticphysicianmaybesubjecttoaco-paymentrequirement,provided
4046		-	thatanyrequiredco-paymentamountshallbebetween125and150percentof
4047		-	theamountoftheco-paymentapplicabletocareandservicesprovidedbya
4048		-	primarycareproviderundertheplan.
4049		-	(d)Nothinginthissectionshallbeconstruedasimpedingorpreventing
4050		-	eithertheprovisionorcoverageofhealthcareservicesbylicensedchiropractic
4051		-	physicians,withinthelawfulscopeofchiropracticpractice,inhospital
4052		-	facilitiesonastafforemployeebasis.
4053		-	§ 4069.PROSTHETICDEVICES
4054		-	(a)Asusedinthissection,“prostheticdevice”meansanartificiallimb
4055		-	devicetoreplace,inwholeorinpart,anarmoraleg.
4056		-	1
4057		-	2
4058		-	3
4059		-	4
4060		-	5
4061		-	6
4062		-	7
4063		-	8
4064		-	9
4065		-	10
4066		-	11
4067		-	12
4068		-	13
4069		-	14
4070		-	15
4071		-	16
4072		-	17
4073		-	18
4074		-	19
4075		-	20
4076		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2355	+
	2356	+
	2357	+	VT LEG #380165 v.1
	2358	+	but limiting adjunctive therapies to physiotherapy modalities and rehabilitative 1
	2359	+	exercises. A health insurance plan does not have to provide coverage for the 2
	2360	+	treatment of any visceral condition arising from problems or dysfunctions of 3
	2361	+	the abdominal or thoracic organs. 4
	2362	+	(b) A health insurer may require that the chiropractic services be 5
	2363	+	provided upon referral from a health care provider under contract with the 6
	2364	+	health insurer. 7
	2365	+	(c) For silver- and bronze-level qualified health benefit plans and any 8
	2366	+	reflective health benefit plans offered at the silver or bronze level pursuant to 9
	2367	+	33 V.S.A. chapter 18, subchapter 1, health care services provided by a 10
	2368	+	chiropractic physician may be subject to a co-payment requirement, provided 11
	2369	+	that any required co-payment amount shall be between 125 and 150 percent of 12
	2370	+	the amount of the co-payment applicable to care and services provided by a 13
	2371	+	primary care provider under the plan. 14
	2372	+	(d) Nothing in this section shall be construed as impeding or preventing 15
	2373	+	either the provision or coverage of health care services by licensed chiropractic 16
	2374	+	physicians, within the lawful scope of chiropractic practice, in hospital 17
	2375	+	facilities on a staff or employee basis. 18
	2376	+	§ 4069. PROSTHETIC DEVICES 19
	2377	+	(a) As used in this section, “prosthetic device” means an artificial limb 20
	2378	+	device to replace, in whole or in part, an arm or a leg. 21 BILL AS INTRODUCED S.30
4077	2379		2025 Page 98 of 181
4078		-	(b)Ahealthinsuranceplanshallprovidecoverageforprostheticdevices
4079		-	thatisatleastequivalenttothecoverageprovidedbythefederalMedicare
4080		-	program.Coveragemaybelimitedtotheprostheticdevicethatisthemost
4081		-	appropriatemodelthatismedicallynecessarytomeetthepatient’smedical
4082		-	needs.Anydisputebetweenthecoveredindividualandthecarrierconcerning
4083		-	coverageandtheapplicationofthissectionshallbesubjecttoindependent
4084		-	externalreviewundersection4063ofthistitle.
4085		-	(c)Ahealthinsuranceplanmayrequirepriorauthorizationforprosthetic
4086		-	devicesinthesamemannerandtothesameextentaspriorauthorizationis
4087		-	requiredforanyothercoveredbenefit.
4088		-	(d)Ahealthinsuranceplanshallprovidecoverageunderthissectionfor
4089		-	themedicallynecessaryrepairorreplacementofaprostheticdevice.
4090		-	(e)Thecoverageforprostheticdevicesshallnotbesubjecttoadeductible,
4091		-	co-payment,orcoinsuranceprovisionthatislessfavorabletoacovered
4092		-	individualthanthedeductible,co-payment,orcoinsuranceprovisionsthat
4093		-	applygenerallytoothernonprimarycareitemsandservicesunderthehealth
4094		-	insuranceplan.
4095		-	§ 4070.HEARINGAIDCOVERAGEINLARGEGROUPHEALTH
4096		-	INSURANCEPLANS
4097		-	(a)Asusedinthissection:
4098		-	1
4099		-	2
4100		-	3
4101		-	4
4102		-	5
4103		-	6
4104		-	7
4105		-	8
4106		-	9
4107		-	10
4108		-	11
4109		-	12
4110		-	13
4111		-	14
4112		-	15
4113		-	16
4114		-	17
4115		-	18
4116		-	19
4117		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2380	+
	2381	+
	2382	+	VT LEG #380165 v.1
	2383	+	(b) A health insurance plan shall provide coverage for prosthetic devices 1
	2384	+	that is at least equivalent to the coverage provided by the federal Medicare 2
	2385	+	program. Coverage may be limited to the prosthetic device that is the most 3
	2386	+	appropriate model that is medically necessary to meet the patient’s medical 4
	2387	+	needs. Any dispute between the covered individual and the carrier concerning 5
	2388	+	coverage and the application of this section shall be subject to independent 6
	2389	+	external review under section 4063 of this title. 7
	2390	+	(c) A health insurance plan may require prior authorization for prosthetic 8
	2391	+	devices in the same manner and to the same extent as prior authorization is 9
	2392	+	required for any other covered benefit. 10
	2393	+	(d) A health insurance plan shall provide coverage under this section for 11
	2394	+	the medically necessary repair or replacement of a prosthetic device. 12
	2395	+	(e) The coverage for prosthetic devices shall not be subject to a deductible, 13
	2396	+	co-payment, or coinsurance provision that is less favorable to a covered 14
	2397	+	individual than the deductible, co-payment, or coinsurance provisions that 15
	2398	+	apply generally to other nonprimary care items and services under the health 16
	2399	+	insurance plan. 17
	2400	+	§ 4070. HEARING AID COVERAGE IN LARGE GROUP HEALTH 18
	2401	+	INSURANCE PLANS 19
	2402	+	(a) As used in this section: 20 BILL AS INTRODUCED S.30
4118	2403		2025 Page 99 of 181
4119		-	(1)“Hearingaid”meansanysmall,wearableelectronicinstrumentor
4120		-	devicedesignedandintendedfortheearforthepurposeofaidingor
4121		-	compensatingforimpairedhumanhearingandanyrelatedparts,attachments,
4122		-	oraccessories,includingearmoldsandassociatedremotemicrophonesthat
4123		-	pairwithhearingaidstoimprovewordcomprehensionindifficultlistening
4124		-	situationsinliveortelecommunicationsettings.Thetermdoesnotinclude
4125		-	large-audienceassistedlisteningdevices,suchasthosedesignedfor
4126		-	auditoriums,orstand-aloneassistedlisteningdevicesthatcanfunctionwithout
4127		-	ahearingaid.
4128		-	(2)“Hearingaidprofessionalservices”meansthepracticeoffitting,
4129		-	selecting,dispensing,selling,orservicinghearingaids,oracombination,
4130		-	including:
4131		-	(A)evaluationforahearingaid;
4132		-	(B)fittingofahearingaid;
4133		-	(C)programmingofahearingaid;
4134		-	(D)hearingaidrepairs;
4135		-	(E)follow-upadjustments,servicing,andmaintenanceofahearing
4136		-	aid;
4137		-	(F)earmoldimpressions;and
4138		-	(G)auditoryrehabilitationandtraining.
4139		-	1
4140		-	2
4141		-	3
4142		-	4
4143		-	5
4144		-	6
4145		-	7
4146		-	8
4147		-	9
4148		-	10
4149		-	11
4150		-	12
4151		-	13
4152		-	14
4153		-	15
4154		-	16
4155		-	17
4156		-	18
4157		-	19
4158		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2404	+
	2405	+
	2406	+	VT LEG #380165 v.1
	2407	+	(1) “Hearing aid” means any small, wearable electronic instrument or 1
	2408	+	device designed and intended for the ear for the purpose of aiding or 2
	2409	+	compensating for impaired human hearing and any related parts, attachments, 3
	2410	+	or accessories, including earmolds and associated remote microphones that 4
	2411	+	pair with hearing aids to improve word comprehension in difficult listening 5
	2412	+	situations in live or telecommunication settings. The term does not include 6
	2413	+	large-audience assisted listening devices, such as those designed for 7
	2414	+	auditoriums, or stand-alone assisted listening devices that can function without 8
	2415	+	a hearing aid. 9
	2416	+	(2) “Hearing aid professional services” means the practice of fitting, 10
	2417	+	selecting, dispensing, selling, or servicing hearing aids, or a combination, 11
	2418	+	including: 12
	2419	+	(A) evaluation for a hearing aid; 13
	2420	+	(B) fitting of a hearing aid; 14
	2421	+	(C) programming of a hearing aid; 15
	2422	+	(D) hearing aid repairs; 16
	2423	+	(E) follow-up adjustments, servicing, and maintenance of a hearing 17
	2424	+	aid; 18
	2425	+	(F) ear mold impressions; and 19
	2426	+	(G) auditory rehabilitation and training. 20 BILL AS INTRODUCED S.30
4159	2427		2025 Page 100 of 181
4160		-	(3)“Hearingcareprofessional”meansanaudiologistorhearingaid
4161		-	dispenserlicensedunder26V.S.A.chapter67,aphysicianlicensedunder
4162		-	26 V.S.A.chapter23or33,aphysicianassistantlicensedunder26V.S.A.
4163		-	chapter31,oranadvancedpracticeregisterednurselicensedunder26V.S.A.
4164		-	chapter28,workingwithinthatprofessional’sscopeofpractice.
4165		-	(4)“Largegrouphealthinsuranceplan”meansamajormedical
4166		-	insuranceplanthatmeetstherequirementsofsection4041ofthistitlebutthat
4167		-	isnot:
4168		-	(A)aqualifiedhealthbenefitplanorreflectivehealthbenefitplan
4169		-	offeredinaccordancewith33V.S.A.chapter18,subchapter1;or
4170		-	(B)ahealthbenefitplanofferedbyanintermunicipalinsurance
4171		-	associationtooneormoreentitiesprovidingeducationalservicespursuantto
4172		-	24V.S.A.chapter121,subchapter6.
4173		-	(b)(1)Alargegrouphealthinsuranceplanshallcoverthecostofahearing
4174		-	aidforeachearandtheassociatedhearingaidprofessionalserviceswhenthe
4175		-	hearingaidoraidsareprescribed,fitted,anddispensedbyahearingcare
4176		-	professional.Thecoverageshallincludehearingaidbatterieswhenprescribed
4177		-	byahearingcareprofessional.
4178		-	(2)Alargegrouphealthinsuranceplanmaylimitcoveragetonotmore
4179		-	thanonehearingaidpereareverythreeyears,exceptthataplanshallcover
4180		-	thecostofoneormorenewhearingaidsforacoveredindividualpriortothe
4181		-	1
4182		-	2
4183		-	3
4184		-	4
4185		-	5
4186		-	6
4187		-	7
4188		-	8
4189		-	9
4190		-	10
4191		-	11
4192		-	12
4193		-	13
4194		-	14
4195		-	15
4196		-	16
4197		-	17
4198		-	18
4199		-	19
4200		-	20
4201		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2428	+
	2429	+
	2430	+	VT LEG #380165 v.1
	2431	+	(3) “Hearing care professional” means an audiologist or hearing aid 1
	2432	+	dispenser licensed under 26 V.S.A. chapter 67, a physician licensed under 2
	2433	+	26 V.S.A. chapter 23 or 33, a physician assistant licensed under 26 V.S.A. 3
	2434	+	chapter 31, or an advanced practice registered nurse licensed under 26 V.S.A. 4
	2435	+	chapter 28, working within that professional’s scope of practice. 5
	2436	+	(4) “Large group health insurance plan” means a major medical 6
	2437	+	insurance plan that meets the requirements of section 4041 of this title but that 7
	2438	+	is not: 8
	2439	+	(A) a qualified health benefit plan or reflective health benefit plan 9
	2440	+	offered in accordance with 33 V.S.A. chapter 18, subchapter 1; or 10
	2441	+	(B) a health benefit plan offered by an intermunicipal insurance 11
	2442	+	association to one or more entities providing educational services pursuant to 12
	2443	+	24 V.S.A. chapter 121, subchapter 6. 13
	2444	+	(b)(1) A large group health insurance plan shall cover the cost of a hearing 14
	2445	+	aid for each ear and the associated hearing aid professional services when the 15
	2446	+	hearing aid or aids are prescribed, fitted, and dispensed by a hearing care 16
	2447	+	professional. The coverage shall include hearing aid batteries when prescribed 17
	2448	+	by a hearing care professional. 18
	2449	+	(2) A large group health insurance plan may limit coverage to not more 19
	2450	+	than one hearing aid per ear every three years, except that a plan shall cover 20
	2451	+	the cost of one or more new hearing aids for a covered individual prior to the 21 BILL AS INTRODUCED S.30
4202	2452		2025 Page 101 of 181
4203		-	expirationofthethree-yearperiodbasedonahearingcareprofessional’s
4204		-	determinationthatanewhearingaidforoneorbothearsismedically
4205		-	necessary.
4206		-	(c)(1)Subjecttothelimitationssetforthinsubdivision(b)(2)ofthis
4207		-	section,thecoverageprovidedbyalargegrouphealthinsuranceplanfor
4208		-	hearingaidsandassociatedservicesshallbelimitedonlybymedicalnecessity.
4209		-	(2)Acoveredindividualmayselectahearingaidthatexceedsthelimits
4210		-	setforthinsubdivision(1)ofthissubsectionandpaytheadditionalcost.
4211		-	(d)Thecoveragerequiredbythissectionshallnotbesubjecttoa
4212		-	deductible,co-payment,orcoinsuranceprovisionthatislessfavorabletoa
4213		-	coveredindividualthanthedeductible,co-payment,orcoinsuranceprovisions
4214		-	thatapplygenerallytoothernonprimarycareitemsandservicesunderthe
4215		-	largegrouphealthinsuranceplan.
4216		-	§ 4071.GENDER-AFFIRMINGHEALTHCARESERVICES
4217		-	(a)Asusedinthissection,“gender-affirminghealthcareservices”hasthe
4218		-	samemeaningasin1V.S.A.§150.
4219		-	(b)(1)Ahealthinsuranceplanshallprovidecoverageforgender-affirming
4220		-	healthcareservicesthat:
4221		-	(A)aremedicallynecessaryandclinicallyappropriateforthe
4222		-	individual’sdiagnosisorhealthcondition;and
4223		-	1
4224		-	2
4225		-	3
4226		-	4
4227		-	5
4228		-	6
4229		-	7
4230		-	8
4231		-	9
4232		-	10
4233		-	11
4234		-	12
4235		-	13
4236		-	14
4237		-	15
4238		-	16
4239		-	17
4240		-	18
4241		-	19
4242		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2453	+
	2454	+
	2455	+	VT LEG #380165 v.1
	2456	+	expiration of the three-year period based on a hearing care professional’s 1
	2457	+	determination that a new hearing aid for one or both ears is medically 2
	2458	+	necessary. 3
	2459	+	(c)(1) Subject to the limitations set forth in subdivision (b)(2) of this 4
	2460	+	section, the coverage provided by a large group health insurance plan for 5
	2461	+	hearing aids and associated services shall be limited only by medical necessity. 6
	2462	+	(2) A covered individual may select a hearing aid that exceeds the limits 7
	2463	+	set forth in subdivision (1) of this subsection and pay the additional cost. 8
	2464	+	(d) The coverage required by this section shall not be subject to a 9
	2465	+	deductible, co-payment, or coinsurance provision that is less favorable to a 10
	2466	+	covered individual than the deductible, co-payment, or coinsurance provisions 11
	2467	+	that apply generally to other nonprimary care items and services under the 12
	2468	+	large group health insurance plan. 13
	2469	+	§ 4071. GENDER-AFFIRMING HEALTH CARE SERVICES 14
	2470	+	(a) As used in this section, “gender-affirming health care services” has the 15
	2471	+	same meaning as in 1 V.S.A. § 150. 16
	2472	+	(b)(1) A health insurance plan shall provide coverage for gender-affirming 17
	2473	+	health care services that: 18
	2474	+	(A) are medically necessary and clinically appropriate for the 19
	2475	+	individual’s diagnosis or health condition; and 20 BILL AS INTRODUCED S.30
4243	2476		2025 Page 102 of 181
4244		-	(B)areincludedintheState’sessentialhealthbenefitsbenchmark
4245		-	plan.
4246		-	(2)Nothinginthissectionshallprohibitahealthinsuranceplanfrom
4247		-	providinggreatercoverageforgender-affirminghealthcareservicesthanis
4248		-	requiredunderthissection.
4249		-	(c)Costsharing.Ahealthinsuranceplanshallnotimposegreater
4250		-	coinsurance,co-payment,deductible,orothercost-sharingrequirementsfor
4251		-	coverageofgender-affirminghealthcareservicesthanapplytothediagnosis
4252		-	andtreatmentofanyotherphysicalormentalconditionundertheplan.
4253		-	(d)ThissectionshallapplytoMedicaidandanyotherpublichealthcare
4254		-	assistanceprogramofferedoradministeredbytheStateorbyanysubdivision
4255		-	orinstrumentalityoftheState.Thecoverageprovidedpursuanttothissection
4256		-	byMedicaidandotherpublichealthcareassistanceprogramsshallcomply
4257		-	withanyrequirementsimposedonsuchcoveragebytheCentersforMedicare
4258		-	andMedicaidServices.
4259		-	§ 4072.MENTALHEALTHANDSUBSTANCEUSEDISORDER
4260		-	SERVICES
4261		-	(a)ItisthegoaloftheGeneralAssemblythattreatmentformental
4262		-	conditionsberecognizedasanintegralcomponentofhealthcare,thathealth
4263		-	insuranceplanscoverallnecessaryandappropriatemedicalserviceswithout
4264		-	1
4265		-	2
4266		-	3
4267		-	4
4268		-	5
4269		-	6
4270		-	7
4271		-	8
4272		-	9
4273		-	10
4274		-	11
4275		-	12
4276		-	13
4277		-	14
4278		-	15
4279		-	16
4280		-	17
4281		-	18
4282		-	19
4283		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2477	+
	2478	+
	2479	+	VT LEG #380165 v.1
	2480	+	(B) are included in the State’s essential health benefits benchmark 1
	2481	+	plan. 2
	2482	+	(2) Nothing in this section shall prohibit a health insurance plan from 3
	2483	+	providing greater coverage for gender-affirming health care services than is 4
	2484	+	required under this section. 5
	2485	+	(c) Cost sharing. A health insurance plan shall not impose greater 6
	2486	+	coinsurance, co-payment, deductible, or other cost-sharing requirements for 7
	2487	+	coverage of gender-affirming health care services than apply to the diagnosis 8
	2488	+	and treatment of any other physical or mental condition under the plan. 9
	2489	+	(d) This section shall apply to Medicaid and any other public health care 10
	2490	+	assistance program offered or administered by the State or by any subdivision 11
	2491	+	or instrumentality of the State. The coverage provided pursuant to this section 12
	2492	+	by Medicaid and other public health care assistance programs shall comply 13
	2493	+	with any requirements imposed on such coverage by the Centers for Medicare 14
	2494	+	and Medicaid Services. 15
	2495	+	§ 4072. MENTAL HEALTH AND SUBSTAN CE USE DISORDER 16
	2496	+	SERVICES 17
	2497	+	(a) It is the goal of the General Assembly that treatment for mental 18
	2498	+	conditions be recognized as an integral component of health care, that health 19
	2499	+	insurance plans cover all necessary and appropriate medical services without 20 BILL AS INTRODUCED S.30
4284	2500		2025 Page 103 of 181
4285		-	imposingpracticesthatcreatebarrierstoreceivingappropriatecare,andthat
4286		-	integrationofhealthcareberecognizedasthestandardforcareinthisState.
4287		-	(b)Asusedinthissection:
4288		-	(1)“Mentalcondition”meansanyconditionordisorderinvolving
4289		-	psychiatricdisabilitiesorsubstanceusedisorderthatfallsunderanyofthe
4290		-	diagnosticcategorieslistedinthementaldisorderssectionoftheInternational
4291		-	ClassificationofDiseases,asperiodicallyrevised.
4292		-	(2)“Mentalhealthprovider”meansanyindividual,corporation,facility,
4293		-	orinstitutioncertifiedorlicensedbythisStatetoprovidementalhealth
4294		-	services,includingaphysician,nursewithrecognizedpsychiatricspecialties,
4295		-	hospitalorotherhealthcarefacility,psychologist,clinicalsocialworker,
4296		-	mentalhealthcounselor,alcoholordrugabusecounselor,oranemployeeor
4297		-	agentofsuchprovideractinginthecourseandscopeofemploymentoran
4298		-	agencyrelatedtomentalhealthservices.
4299		-	(3)“Rate,term,orcondition”meansanylifetimeorannualpayment
4300		-	limits,deductibles,copayments,coinsurance,andanyothercost-sharing
4301		-	requirements,out-of-pocketlimits,visitlimits,andanyotherfinancial
4302		-	componentofhealthinsurancecoveragethataffectsthecoveredindividual.
4303		-	(c)Ahealthinsuranceplanshallprovidecoveragefortreatmentofa
4304		-	mentalconditionandshall:
4305		-	1
4306		-	2
4307		-	3
4308		-	4
4309		-	5
4310		-	6
4311		-	7
4312		-	8
4313		-	9
4314		-	10
4315		-	11
4316		-	12
4317		-	13
4318		-	14
4319		-	15
4320		-	16
4321		-	17
4322		-	18
4323		-	19
4324		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2501	+
	2502	+
	2503	+	VT LEG #380165 v.1
	2504	+	imposing practices that create barriers to receiving appropriate care, and that 1
	2505	+	integration of health care be recognized as the standard for care in this State. 2
	2506	+	(b) As used in this section: 3
	2507	+	(1) “Mental condition” means any condition or disorder involving 4
	2508	+	psychiatric disabilities or substance use disorder that falls under any of the 5
	2509	+	diagnostic categories listed in the mental disorders section of the International 6
	2510	+	Classification of Diseases, as periodically revised. 7
	2511	+	(2) “Mental health provider” means any individual, corporation, facility, 8
	2512	+	or institution certified or licensed by this State to provide mental health 9
	2513	+	services, including a physician, nurse with recognized psychiatric specialties, 10
	2514	+	hospital or other health care facility, psychologist, clinical social worker, 11
	2515	+	mental health counselor, alcohol or drug abuse counselor, or an employee or 12
	2516	+	agent of such provider acting in the course and scope of employment or an 13
	2517	+	agency related to mental health services. 14
	2518	+	(3) “Rate, term, or condition” means any lifetime or annual payment 15
	2519	+	limits, deductibles, copayments, coinsurance, and any other cost-sharing 16
	2520	+	requirements, out-of-pocket limits, visit limits, and any other financial 17
	2521	+	component of health insurance coverage that affects the covered individual. 18
	2522	+	(c) A health insurance plan shall provide coverage for treatment of a mental 19
	2523	+	condition and shall: 20 BILL AS INTRODUCED S.30
4325	2524		2025 Page 104 of 181
4326		-	(1)notestablishanyrate,term,orconditionthatplacesagreaterburden
4327		-	onacoveredindividualforaccesstotreatmentforamentalconditionthanfor
4328		-	accesstotreatmentforotherhealthconditions,includingnogreaterco-
4329		-	paymentforprimarymentalhealthcareorservicesthantheco-payment
4330		-	applicabletocareorservicesprovidedbyaprimarycareproviderundera
4331		-	coveredindividual’shealthinsuranceplanandnogreaterco-paymentfor
4332		-	specialtymentalhealthcareorservicesthantheco-paymentapplicabletocare
4333		-	orservicesprovidedbyaspecialistproviderunderacoveredindividual’s
4334		-	healthinsuranceplan;
4335		-	(2)notexcludefromitsnetworkorlistofauthorizedprovidersany
4336		-	licensedmentalhealthorsubstanceusedisordertreatmentproviderlocated
4337		-	withinthegeographiccoverageareaofthehealthinsuranceplanifthe
4338		-	provideriswillingtomeetthetermsandconditionsforparticipation
4339		-	establishedbythehealthinsurer;
4340		-	(3)makeanydeductibleorout-of-pocketlimitsrequiredunderahealth
4341		-	insuranceplancomprehensiveforcoverageofbothmentalandphysicalhealth
4342		-	conditions;and
4343		-	(4)ifthehealthinsuranceplanprovidesprescriptiondrugcoverage,
4344		-	ensurethatatleastonemedicationineachtherapeuticclassapprovedbythe
4345		-	U.S.FoodandDrugAdministrationforthetreatmentofsubstanceuse
4346		-	disorder,includingforopioidusedisorder,methadone,buprenorphine,and
4347		-	1
4348		-	2
4349		-	3
4350		-	4
4351		-	5
4352		-	6
4353		-	7
4354		-	8
4355		-	9
4356		-	10
4357		-	11
4358		-	12
4359		-	13
4360		-	14
4361		-	15
4362		-	16
4363		-	17
4364		-	18
4365		-	19
4366		-	20
4367		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2525	+
	2526	+
	2527	+	VT LEG #380165 v.1
	2528	+	(1) not establish any rate, term, or condition that places a greater burden 1
	2529	+	on a covered individual for access to treatment for a mental condition than for 2
	2530	+	access to treatment for other health conditions, including no greater co-3
	2531	+	payment for primary mental health care or services than the co-payment 4
	2532	+	applicable to care or services provided by a primary care provider under a 5
	2533	+	covered individual’s health insurance plan and no greater co-payment for 6
	2534	+	specialty mental health care or services than the co-payment applicable to care 7
	2535	+	or services provided by a specialist provider under a covered individual’s 8
	2536	+	health insurance plan; 9
	2537	+	(2) not exclude from its network or list of authorized providers any 10
	2538	+	licensed mental health or substance use disorder treatment provider located 11
	2539	+	within the geographic coverage area of the health insurance plan if the provider 12
	2540	+	is willing to meet the terms and conditions for participation established by the 13
	2541	+	health insurer; 14
	2542	+	(3) make any deductible or out-of-pocket limits required under a health 15
	2543	+	insurance plan comprehensive for coverage of both mental and physical health 16
	2544	+	conditions; and 17
	2545	+	(4) if the health insurance plan provides prescription drug coverage, 18
	2546	+	ensure that at least one medication in each therapeutic class approved by the 19
	2547	+	U.S. Food and Drug Administration for the treatment of substance use 20
	2548	+	disorder, including for opioid use disorder, methadone, buprenorphine, and 21 BILL AS INTRODUCED S.30
4368	2549		2025 Page 105 of 181
4369		-	naltrexone,isavailableonthelowestcost-sharingtieroftheplan’s
4370		-	prescriptiondrugformulary.
4371		-	(d)(1)(A)Ahealthinsuranceplanthatdoesnototherwiseprovidefor
4372		-	managementofcareundertheplan,orthatdoesnotprovideforthesame
4373		-	degreeofmanagementofcareforallhealthconditions,mayprovidecoverage
4374		-	fortreatmentofmentalconditionsthroughamanagedcareorganization,
4375		-	providedthatthemanagedcareorganizationisincompliancewithrules
4376		-	adoptedbytheCommissionerthatensurethatthesystemfordeliveryof
4377		-	treatmentformentalconditionsdoesnotdiminishornegatethepurposeofthis
4378		-	section.Inreviewingpolicyratesandformspursuanttosection4026ofthis
4379		-	title,theCommissionerortheGreenMountainCareBoardestablishedin
4380		-	18 V.S.A.chapter220,asappropriate,shallconsiderthecomplianceofthe
4381		-	policywiththeprovisionsofthissection.
4382		-	(B)TherulesadoptedbytheCommissionershallensurethat:
4383		-	(i)timelyandappropriateaccesstocareisavailable;
4384		-	(ii)thequantity,location,andspecialtydistributionofhealthcare
4385		-	providersisadequate;
4386		-	(iii)administrativeorclinicalprotocolsdonotservetoreduce
4387		-	accesstomedicallynecessarytreatmentforanycoveredindividual;
4388		-	1
4389		-	2
4390		-	3
4391		-	4
4392		-	5
4393		-	6
4394		-	7
4395		-	8
4396		-	9
4397		-	10
4398		-	11
4399		-	12
4400		-	13
4401		-	14
4402		-	15
4403		-	16
4404		-	17
4405		-	18
4406		-	19 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2550	+
	2551	+
	2552	+	VT LEG #380165 v.1
	2553	+	naltrexone, is available on the lowest cost-sharing tier of the plan’s 1
	2554	+	prescription drug formulary. 2
	2555	+	(d)(1)(A) A health insurance plan that does not otherwise provide for 3
	2556	+	management of care under the plan, or that does not provide for the same 4
	2557	+	degree of management of care for all health conditions, may provide coverage 5
	2558	+	for treatment of mental conditions through a managed care organization, 6
	2559	+	provided that the managed care organization is in compliance with rules 7
	2560	+	adopted by the Commissioner that ensure that the system for delivery of 8
	2561	+	treatment for mental conditions does not diminish or negate the purpose of this 9
	2562	+	section. In reviewing policy rates and forms pursuant to section 4026 of this 10
	2563	+	title, the Commissioner or the Green Mountain Care Board established in 11
	2564	+	18 V.S.A. chapter 220, as appropriate, shall consider the compliance of the 12
	2565	+	policy with the provisions of this section. 13
	2566	+	(B) The rules adopted by the Commissioner shall ensure that: 14
	2567	+	(i) timely and appropriate access to care is available; 15
	2568	+	(ii) the quantity, location, and specialty distribution of health care 16
	2569	+	providers is adequate; 17
	2570	+	(iii) administrative or clinical protocols do not serve to reduce 18
	2571	+	access to medically necessary treatment for any covered individual; 19 BILL AS INTRODUCED S.30
4407	2572		2025 Page 106 of 181
4408		-	(iv)utilizationreviewandotheradministrativeandclinical
4409		-	protocolsdonotdetertimelyandappropriatecare,includingemergency
4410		-	hospitaladmissions;
4411		-	(v)inthecaseofamanagedcareorganizationthatcontractswith
4412		-	ahealthinsurertoadministerthehealthinsurer’smentalhealthbenefits,the
4413		-	portionofahealthinsurer’spremiumrateattributabletothecoverageof
4414		-	mentalhealthbenefitsisreviewedundersection4026,4513,4584,or5104of
4415		-	thistitletodeterminewhetheritisexcessive,inadequate,unfairly
4416		-	discriminatory,unjust,unfair,inequitable,misleading,orcontrarytothelaws
4417		-	ofthisState;
4418		-	(vi)thehealthinsuranceplanisconsistentwiththeBlueprintfor
4419		-	Healthwithrespecttomentalconditions;
4420		-	(vii)aqualityimprovementprojectiscompletedannuallyasa
4421		-	jointprojectbetweenthehealthinsuranceplananditsmentalhealthmanaged
4422		-	careorganizationtoimplementpoliciesandincentivestoincrease
4423		-	collaborationamongprovidersthatwillfacilitateclinicalintegrationof
4424		-	servicesformedicalandmentalconditions,including:
4425		-	(I)evidenceofhowdatacollectedfromthequality
4426		-	improvementprojectarebeingusedtoinformthepractices,policies,and
4427		-	futuredirectionofcaremanagementprogramsformentalconditions;and
4428		-	1
4429		-	2
4430		-	3
4431		-	4
4432		-	5
4433		-	6
4434		-	7
4435		-	8
4436		-	9
4437		-	10
4438		-	11
4439		-	12
4440		-	13
4441		-	14
4442		-	15
4443		-	16
4444		-	17
4445		-	18
4446		-	19
4447		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2573	+
	2574	+
	2575	+	VT LEG #380165 v.1
	2576	+	(iv) utilization review and other administrative and clinical 1
	2577	+	protocols do not deter timely and appropriate care, including emergency 2
	2578	+	hospital admissions; 3
	2579	+	(v) in the case of a managed care organization that contracts with 4
	2580	+	a health insurer to administer the health insurer’s mental health benefits, the 5
	2581	+	portion of a health insurer’s premium rate attributable to the coverage of 6
	2582	+	mental health benefits is reviewed under section 4026, 4513, 4584, or 5104 of 7
	2583	+	this title to determine whether it is excessive, inadequate, unfairly 8
	2584	+	discriminatory, unjust, unfair, inequitable, misleading, or contrary to the laws 9
	2585	+	of this State; 10
	2586	+	(vi) the health insurance plan is consistent with the Blueprint for 11
	2587	+	Health with respect to mental conditions; 12
	2588	+	(vii) a quality improvement project is completed annually as a 13
	2589	+	joint project between the health insurance plan and its mental health managed 14
	2590	+	care organization to implement policies and incentives to increase 15
	2591	+	collaboration among providers that will facilitate clinical integration of 16
	2592	+	services for medical and mental conditions, including: 17
	2593	+	(I) evidence of how data collected from the quality 18
	2594	+	improvement project are being used to inform the practices, policies, and 19
	2595	+	future direction of care management programs for mental conditions; and 20 BILL AS INTRODUCED S.30
4448	2596		2025 Page 107 of 181
4449		-	(II)demonstrationofhowthequalityimprovementprojectis
4450		-	supportingtheincorporationofbestpracticesandevidence-basedguidelines
4451		-	intotheutilizationreviewofmentalconditions;
4452		-	(viii)anup-to-datelistofactivementalhealthprovidersinthe
4453		-	plan’snetworkisavailableonthehealthinsurer’sandmanagedcare
4454		-	organization’swebsitesandprovidedtoconsumersuponrequest;and
4455		-	(ix)thehealthinsurersandmanagedcareorganizationsmake
4456		-	accessibletoconsumersthetoll-freetelephonenumberfortheDepartmentof
4457		-	FinancialRegulation’sconsumerprotectionhelpline.
4458		-	(C)Priortotheadoptionofrulespursuanttothissubdivision(d)(1),
4459		-	theCommissionershallconsultwiththeCommissionerofMentalHealthand
4460		-	thetaskforceestablishedpursuanttosubsection(h)ofthissectionconcerning:
4461		-	(i)developingincentivesandothermeasuresaddressingthe
4462		-	availabilityofprovidersofcareandtreatmentformentalconditions,especially
4463		-	inmedicallyunderservedareas;
4464		-	(ii)incorporatingnationallyrecognizedbestpracticesand
4465		-	evidence-basedguidelinesintotheutilizationreviewofmentalconditions;and
4466		-	(iii)establishingbenefitdesign,infrastructuresupport,and
4467		-	paymentmethodologystandardsforevaluatingthehealthinsuranceplan’s
4468		-	consistencywiththeBlueprintforHealthwithrespecttothecareand
4469		-	treatmentofmentalconditions.
4470		-	1
4471		-	2
4472		-	3
4473		-	4
4474		-	5
4475		-	6
4476		-	7
4477		-	8
4478		-	9
4479		-	10
4480		-	11
4481		-	12
4482		-	13
4483		-	14
4484		-	15
4485		-	16
4486		-	17
4487		-	18
4488		-	19
4489		-	20
4490		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2597	+
	2598	+
	2599	+	VT LEG #380165 v.1
	2600	+	(II) demonstration of how the quality improvement project is 1
	2601	+	supporting the incorporation of best practices and evidence-based guidelines 2
	2602	+	into the utilization review of mental conditions; 3
	2603	+	(viii) an up-to-date list of active mental health providers in the 4
	2604	+	plan’s network is available on the health insurer’s and managed care 5
	2605	+	organization’s websites and provided to consumers upon request; and 6
	2606	+	(ix) the health insurers and managed care organizations make 7
	2607	+	accessible to consumers the toll-free telephone number for the Department of 8
	2608	+	Financial Regulation’s consumer protection help line. 9
	2609	+	(C) Prior to the adoption of rules pursuant to this subdivision (d)(1), 10
	2610	+	the Commissioner shall consult with the Commissioner of Mental Health and 11
	2611	+	the task force established pursuant to subsection (h) of this section concerning: 12
	2612	+	(i) developing incentives and other measures addressing the 13
	2613	+	availability of providers of care and treatment for mental conditions, especially 14
	2614	+	in medically underserved areas; 15
	2615	+	(ii) incorporating nationally recognized best practices and 16
	2616	+	evidence-based guidelines into the utilization review of mental conditions; and 17
	2617	+	(iii) establishing benefit design, infrastructure support, and 18
	2618	+	payment methodology standards for evaluating the health insurance plan’s 19
	2619	+	consistency with the Blueprint for Health with respect to the care and treatment 20
	2620	+	of mental conditions. 21 BILL AS INTRODUCED S.30
4491	2621		2025 Page 108 of 181
4492		-	(2)Amanagedcareorganizationprovidingoradministeringcoverage
4493		-	fortreatmentofmentalconditionsonbehalfofahealthinsuranceplanshall
4494		-	complywiththissection,sections4064and4724ofthistitle,and18V.S.A.
4495		-	§ 9414;withrulesadoptedpursuanttothoseprovisionsoflaw;andwithall
4496		-	otherobligations,underTitle18andunderthistitle,ofthehealthinsurance
4497		-	planandthehealthinsureronbehalfofwhichthemanagedcareorganization
4498		-	isprovidingoradministeringcoverage.Aviolationofanyprovisionofthis
4499		-	sectionshallconstituteanunfairactorpracticeinthebusinessofinsurancein
4500		-	violationofsection4723ofthistitle.
4501		-	(3)Ahealthinsurerthatcontractswithamanagedcareorganizationto
4502		-	provideoradministercoveragefortreatmentofmentalconditionsisfully
4503		-	responsiblefortheactsandomissionsofthemanagedcareorganization,
4504		-	includinganyviolationsofthissectionoraruleadoptedpursuanttothis
4505		-	section.
4506		-	(4)Inadditiontoanyotherremedyorsanctionprovidedforbylaw,if
4507		-	theCommissioner,afternoticeandanopportunitytobeheard,findsthata
4508		-	healthinsuranceplanormanagedcareorganizationhasviolatedthissectionor
4509		-	anyruleadoptedpursuanttothissection,theCommissionermay:
4510		-	(A)assessapenaltyonthehealthinsurerormanagedcare
4511		-	organizationundersection4726ofthistitle;
4512		-	1
4513		-	2
4514		-	3
4515		-	4
4516		-	5
4517		-	6
4518		-	7
4519		-	8
4520		-	9
4521		-	10
4522		-	11
4523		-	12
4524		-	13
4525		-	14
4526		-	15
4527		-	16
4528		-	17
4529		-	18
4530		-	19
4531		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2622	+
	2623	+
	2624	+	VT LEG #380165 v.1
	2625	+	(2) A managed care organization providing or administering coverage 1
	2626	+	for treatment of mental conditions on behalf of a health insurance plan shall 2
	2627	+	comply with this section, sections 4064 and 4724 of this title, and 18 V.S.A. 3
	2628	+	§ 9414; with rules adopted pursuant to those provisions of law; and with all 4
	2629	+	other obligations, under Title 18 and under this title, of the health insurance 5
	2630	+	plan and the health insurer on behalf of which the managed care organization is 6
	2631	+	providing or administering coverage. A violation of any provision of this 7
	2632	+	section shall constitute an unfair act or practice in the business of insurance in 8
	2633	+	violation of section 4723 of this title. 9
	2634	+	(3) A health insurer that contracts with a managed care organization to 10
	2635	+	provide or administer coverage for treatment of mental conditions is fully 11
	2636	+	responsible for the acts and omissions of the managed care organization, 12
	2637	+	including any violations of this section or a rule adopted pursuant to this 13
	2638	+	section. 14
	2639	+	(4) In addition to any other remedy or sanction provided for by law, if 15
	2640	+	the Commissioner, after notice and an opportunity to be heard, finds that a 16
	2641	+	health insurance plan or managed care organization has violated this section or 17
	2642	+	any rule adopted pursuant to this section, the Commissioner may: 18
	2643	+	(A) assess a penalty on the health insurer or managed care 19
	2644	+	organization under section 4726 of this title; 20 BILL AS INTRODUCED S.30
4532	2645		2025 Page 109 of 181
4533		-	(B)orderthehealthinsurerormanagedcareorganizationtocease
4534		-	anddesistinfurtherviolations;
4535		-	(C)orderthehealthinsurerormanagedcareorganizationto
4536		-	remediatetheviolation,includingissuinganordertothehealthinsurerto
4537		-	terminateitscontractwiththemanagedcareorganization;and
4538		-	(D)revokeorsuspendthelicenseofahealthinsurerormanagedcare
4539		-	organization,orpermitcontinuedlicensuresubjecttosuchconditionsasthe
4540		-	Commissionerdeemsnecessarytocarryoutthepurposesofthissection.
4541		-	(5)Asusedinthissubsection,theterm“managedcareorganization”
4542		-	includesanyofthefollowingentitiesthatprovideoradministerthecoverage
4543		-	ofmentalhealthbenefitsonbehalfofahealthinsuranceplan:
4544		-	(A)amentalhealthreviewagentasdefinedinsection4064ofthis
4545		-	title;
4546		-	(B)ahealthinsureroritsdelegate;
4547		-	(C)amanagedcareorganization,asdefinedin18V.S.A.§9402,or
4548		-	itsdelegate;and
4549		-	(D)anyotherpersonorentitythatmeetsthedefinitionofamanaged
4550		-	careorganizationunder18V.S.A.§ 9402orunderrulesadoptedbythe
4551		-	Commissioner.
4552		-	(e)Tobeeligibleforcoverageunderthissection,theserviceshallbe
4553		-	rendered:
4554		-	1
4555		-	2
4556		-	3
4557		-	4
4558		-	5
4559		-	6
4560		-	7
4561		-	8
4562		-	9
4563		-	10
4564		-	11
4565		-	12
4566		-	13
4567		-	14
4568		-	15
4569		-	16
4570		-	17
4571		-	18
4572		-	19
4573		-	20
4574		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2646	+
	2647	+
	2648	+	VT LEG #380165 v.1
	2649	+	(B) order the health insurer or managed care organization to cease 1
	2650	+	and desist in further violations; 2
	2651	+	(C) order the health insurer or managed care organization to 3
	2652	+	remediate the violation, including issuing an order to the health insurer to 4
	2653	+	terminate its contract with the managed care organization; and 5
	2654	+	(D) revoke or suspend the license of a health insurer or managed care 6
	2655	+	organization, or permit continued licensure subject to such conditions as the 7
	2656	+	Commissioner deems necessary to carry out the purposes of this section. 8
	2657	+	(5) As used in this subsection, the term “managed care organization” 9
	2658	+	includes any of the following entities that provide or administer the coverage 10
	2659	+	of mental health benefits on behalf of a health insurance plan: 11
	2660	+	(A) a mental health review agent as defined in section 4064 of this 12
	2661	+	title; 13
	2662	+	(B) a health insurer or its delegate; 14
	2663	+	(C) a managed care organization, as defined in 18 V.S.A. § 9402, or 15
	2664	+	its delegate; and 16
	2665	+	(D) any other person or entity that meets the definition of a managed 17
	2666	+	care organization under 18 V.S.A. § 9402 or under rules adopted by the 18
	2667	+	Commissioner. 19
	2668	+	(e) To be eligible for coverage under this section, the service shall be 20
	2669	+	rendered: 21 BILL AS INTRODUCED S.30
4575	2670		2025 Page 110 of 181
4576		-	(1)Fortreatmentofamentalcondition,either:
4577		-	(A)byalicensedorcertifiedmentalhealthprofessional;or
4578		-	(B)inamentalhealthfacilityqualifiedpursuanttorulesadoptedby
4579		-	theSecretaryofHumanServicesorinaninstitution,approvedbythe
4580		-	SecretaryofHumanServices,thatprovidesaprogramforthetreatmentofa
4581		-	mentalconditionpursuanttoawrittenplan.
4582		-	(2)Fortreatmentofsubstanceabusedisorder,either:
4583		-	(A)byalicensedalcoholanddrugabusecounselororotherperson
4584		-	approvedbytheSecretaryofHumanServicesbasedonrulesadoptedbythe
4585		-	Secretarythatestablishstandardsandcriteriafordeterminingeligibilityunder
4586		-	thissubdivision;or
4587		-	(B)inaninstitution,approvedbytheSecretaryofHumanServices,
4588		-	thatprovidesaprogramforthetreatmentofsubstanceusedisorderpursuantto
4589		-	awrittenplan.
4590		-	1
4591		-	2
4592		-	3
4593		-	4
4594		-	5
4595		-	6
4596		-	7
4597		-	8
4598		-	9
4599		-	10
4600		-	11
4601		-	12
4602		-	13
4603		-	14 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2671	+
	2672	+
	2673	+	VT LEG #380165 v.1
	2674	+	(1) For treatment of a mental condition, either: 1
	2675	+	(A) by a licensed or certified mental health professional; or 2
	2676	+	(B) in a mental health facility qualified pursuant to rules adopted by 3
	2677	+	the Secretary of Human Services or in an institution, approved by the Secretary 4
	2678	+	of Human Services, that provides a program for the treatment of a mental 5
	2679	+	condition pursuant to a written plan. 6
	2680	+	(2) For treatment of substance abuse disorder, either: 7
	2681	+	(A) by a licensed alcohol and drug abuse counselor or other person 8
	2682	+	approved by the Secretary of Human Services based on rules adopted by the 9
	2683	+	Secretary that establish standards and criteria for determining eligibility under 10
	2684	+	this subdivision; or 11
	2685	+	(B) in an institution, approved by the Secretary of Human Services, 12
	2686	+	that provides a program for the treatment of substance use disorder pursuant to 13
	2687	+	a written plan. 14
	2688	+	§ 4073. DIABETES TREATMENT 15
	2689	+	(a) A health insurance plan shall provide coverage for the equipment, 16
	2690	+	supplies, and outpatient self-management training and education, including 17
	2691	+	medical nutrition therapy, for the treatment of insulin-dependent diabetes, 18 BILL AS INTRODUCED S.30
4604	2692		2025 Page 111 of 181
4605		-	§ 4073.DIABETESTREATMENT
4606		-	(a)Ahealthinsuranceplanshallprovidecoveragefortheequipment,
4607		-	supplies,andoutpatientself-managementtrainingandeducation,including
4608		-	medicalnutritiontherapy,forthetreatmentofinsulin-dependentdiabetes,
4609		-	insulin-usingdiabetes,gestationaldiabetes,andnoninsulin-usingdiabetesif
4610		-	prescribedbyahealthcareprofessional.
4611		-	(b)Diabetesoutpatientself-managementtrainingandeducationrequiredto
4612		-	becoveredbythissectionshallbeprovidedbyacertified,registered,or
4613		-	licensedhealthcareprofessionalwithspecializedtrainingintheeducationand
4614		-	managementofdiabetes.
4615		-	§ 4074.TREATMENTOFINHERITEDMETABOLICDISORDERS
4616		-	(a)Asusedinthissection:
4617		-	(1)“Inheritedmetabolicdisorder”meansadisordercausedbyan
4618		-	inheritedabnormalityofbodychemistryforwhichtheStatescreensnewborn
4619		-	infants.
4620		-	(2)“Lowproteinmodifiedfoodproduct”meansafoodproductthatis
4621		-	specificallyformulatedtohavelessthanonegramofproteinperservingandis
4622		-	intendedtobeusedunderthedirectionofahealthcareprofessionalforthe
4623		-	dietarytreatmentofametabolicdisorder.
4624		-	1
4625		-	2
4626		-	3
4627		-	4
4628		-	5
4629		-	6
4630		-	7
4631		-	8
4632		-	9
4633		-	10
4634		-	11
4635		-	12
4636		-	13
4637		-	14
4638		-	15
4639		-	16
4640		-	17
4641		-	18
4642		-	19 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2693	+
	2694	+
	2695	+	VT LEG #380165 v.1
	2696	+	insulin-using diabetes, gestational diabetes, and noninsulin-using diabetes if 1
	2697	+	prescribed by a health care professional. 2
	2698	+	(b) Diabetes outpatient self-management training and education required to 3
	2699	+	be covered by this section shall be provided by a certified, registered, or 4
	2700	+	licensed health care professional with specialized training in the education and 5
	2701	+	management of diabetes. 6
	2702	+	§ 4074. TREATMENT OF INHERITED METABOLIC DISORDERS 7
	2703	+	(a) As used in this section: 8
	2704	+	(1) “Inherited metabolic disorder” means a disorder caused by an 9
	2705	+	inherited abnormality of body chemistry for which the State screens newborn 10
	2706	+	infants. 11
	2707	+	(2) “Low protein modified food product” means a food product that is 12
	2708	+	specifically formulated to have less than one gram of protein per serving and is 13
	2709	+	intended to be used under the direction of a health care professional for the 14
	2710	+	dietary treatment of a metabolic disorder. 15
	2711	+	(3) “Medical food” means an amino acid modified preparation that is 16
	2712	+	intended to be used under the direction of a health care professional for the 17
	2713	+	dietary treatment of an inherited metabolic disorder. 18
	2714	+	(b) A health insurance plan shall provide coverage for medical foods 19
	2715	+	prescribed for medically necessary treatment for an inherited metabolic 20
	2716	+	disorder. 21 BILL AS INTRODUCED S.30
4643	2717		2025 Page 112 of 181
4644		-	(3)“Medicalfood”meansanaminoacidmodifiedpreparationthatis
4645		-	intendedtobeusedunderthedirectionofahealthcareprofessionalforthe
4646		-	dietarytreatmentofaninheritedmetabolicdisorder.
4647		-	(b)Ahealthinsuranceplanshallprovidecoverageformedicalfoods
4648		-	prescribedformedicallynecessarytreatmentforaninheritedmetabolic
4649		-	disorder.
4650		-	(c)Coverageforlowproteinmodifiedfoodproductsprescribedfor
4651		-	medicallynecessarytreatmentofaninheritedmetabolicdisordershallbeat
4652		-	least$2,500.00duringanycontinuousperiodof12monthsforanycovered
4653		-	individual.
4654		-	§ 4075.CRANIOFACIALDISORDERS
4655		-	(a)(1)Ahealthinsuranceplanshallprovidecoveragefordiagnosisand
4656		-	medicallynecessarytreatment,includingsurgicalandnonsurgicalprocedures,
4657		-	foramusculoskeletaldisorderthataffectsanyboneorjointintheface,neck,
4658		-	orheadandistheresultofaccident,trauma,congenitaldefect,developmental
4659		-	defect,orpathology.Subjecttosubsection(b)ofthissection,thiscoverage
4660		-	shallbethesameasthatprovidedunderthehealthinsuranceplanforanyother
4661		-	musculoskeletaldisorderinthebodyandshallbecoveredwhenthediagnosis
4662		-	ortreatment,orboth,isprescribedoradministeredbyaphysicianoradentist.
4663		-	1
4664		-	2
4665		-	3
4666		-	4
4667		-	5
4668		-	6
4669		-	7
4670		-	8
4671		-	9
4672		-	10
4673		-	11
4674		-	12
4675		-	13
4676		-	14
4677		-	15
4678		-	16
4679		-	17
4680		-	18
4681		-	19 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2718	+
	2719	+
	2720	+	VT LEG #380165 v.1
	2721	+	(c) Coverage for low protein modified food products prescribed for 1
	2722	+	medically necessary treatment of an inherited metabolic disorder shall be at 2
	2723	+	least $2,500.00 during any continuous period of 12 months for any covered 3
	2724	+	individual. 4
	2725	+	§ 4075. CRANIOFACIAL DISORDERS 5
	2726	+	(a)(1) A health insurance plan shall provide coverage for diagnosis and 6
	2727	+	medically necessary treatment, including surgical and nonsurgical procedures, 7
	2728	+	for a musculoskeletal disorder that affects any bone or joint in the face, neck, 8
	2729	+	or head and is the result of accident, trauma, congenital defect, developmental 9
	2730	+	defect, or pathology. Subject to subsection (b) of this section, this coverage 10
	2731	+	shall be the same as that provided under the health insurance plan for any other 11
	2732	+	musculoskeletal disorder in the body and shall be covered when the diagnosis 12
	2733	+	or treatment, or both, is prescribed or administered by a physician or a dentist. 13
	2734	+	(2) This section shall not be construed to require coverage for dental 14
	2735	+	services for the diagnosis or treatment of dental disorders or dental pathology 15
	2736	+	primarily affecting the gums, teeth, or alveolar ridge. 16
	2737	+	(b) A health insurance plan may require a referral from a health care 17
	2738	+	provider under contract with the plan. 18
	2739	+	§ 4076. HOME HEALTH SERVICES 19
	2740	+	(a) As used in this section: 20 BILL AS INTRODUCED S.30
4682	2741		2025 Page 113 of 181
4683		-	(2)Thissectionshallnotbeconstruedtorequirecoveragefordental
4684		-	servicesforthediagnosisortreatmentofdentaldisordersordentalpathology
4685		-	primarilyaffectingthegums,teeth,oralveolarridge.
4686		-	(b)Ahealthinsuranceplanmayrequireareferralfromahealthcare
4687		-	providerundercontractwiththeplan.
4688		-	§ 4076.HOMEHEALTHSERVICES
4689		-	(a)Asusedinthissection:
4690		-	(1)“Homehealthagency”meansanonprofithomehealthagencythat
4691		-	hasbeencertifiedunderTitleXVIIIoftheSocialSecurityAct(42U.S.C.
4692		-	§ 1395etseq.).
4693		-	(2)“Homehealthcare”meanscareandtreatmentprovidedbyahome
4694		-	healthagencyanddesignedandsupervisedbyahealthcareprofessional,
4695		-	withoutwhichcareandtreatmentapersonwouldrequireadmissiontoa
4696		-	hospitalorskillednursingfacility,asthosetermsaredefinedbyMedicare
4697		-	regulations.Thecareandtreatmentshallconsistofoneormoreofthe
4698		-	following:
4699		-	(A)Part-timeorintermittentskillednursingcare.
4700		-	(B)Physicaltherapy.
4701		-	(C)Part-timeorintermittenthomehealthaideservicesthatconsist
4702		-	primarilyofcaringforthepatient.
4703		-	1
4704		-	2
4705		-	3
4706		-	4
4707		-	5
4708		-	6
4709		-	7
4710		-	8
4711		-	9
4712		-	10
4713		-	11
4714		-	12
4715		-	13
4716		-	14
4717		-	15
4718		-	16
4719		-	17
4720		-	18
4721		-	19
4722		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2742	+
	2743	+
	2744	+	VT LEG #380165 v.1
	2745	+	(1) “ Home health agency” means a nonprofit home health agency that 1
	2746	+	has been certified under Title XVIII of the Social Security Act (42 U.S.C. 2
	2747	+	§ 1395 et seq.). 3
	2748	+	(2) “Home health care” means care and treatment provided by a home 4
	2749	+	health agency and designed and supervised by a health care professional, 5
	2750	+	without which care and treatment a person would require admission to a 6
	2751	+	hospital or skilled nursing facility, as those terms are defined by Medicare 7
	2752	+	regulations. The care and treatment shall consist of one or more of the 8
	2753	+	following: 9
	2754	+	(A) Part-time or intermittent skilled nursing care. 10
	2755	+	(B) Physical therapy. 11
	2756	+	(C) Part-time or intermittent home health aide services that consist 12
	2757	+	primarily of caring for the patient. 13
	2758	+	(D) Medical supplies, drugs and equipment, and laboratory services 14
	2759	+	to the extent that laboratory services would have been covered if the patient 15
	2760	+	had been admitted to a hospital or skilled nursing facility. The medical 16
	2761	+	necessity of equipment may be reviewed by reference to the Medicare 17
	2762	+	guidelines for durable medical equipment. 18
	2763	+	(b)(1) A major medical insurance plan shall provide coverage for home 19
	2764	+	health care. 20 BILL AS INTRODUCED S.30
4723	2765		2025 Page 114 of 181
4724		-	(D)Medicalsupplies,drugsandequipment,andlaboratoryservices
4725		-	totheextentthatlaboratoryserviceswouldhavebeencoveredifthepatient
4726		-	hadbeenadmittedtoahospitalorskillednursingfacility.Themedical
4727		-	necessityofequipmentmaybereviewedbyreferencetotheMedicare
4728		-	guidelinesfordurablemedicalequipment.
4729		-	(b)(1)Amajormedicalinsuranceplanshallprovidecoverageforhome
4730		-	healthcare.
4731		-	(2)Ahealthinsurermayrequireevidenceofinsurabilityasa
4732		-	prerequisitetocoverage.
4733		-	(3)Thecoverageshallconsistofatleast40visitsbyahomehealth
4734		-	agencyinanycalendaryear,orinanycontinuousperiodof12months,for
4735		-	eachpersoncoveredunderthehealthinsuranceplan.
4736		-	(4)Eachvisitbyamemberofahomehealthcareagency,otherthana
4737		-	homehealthaide,shallbeconsideredonehomehealthcarevisit,andfour
4738		-	hoursofhomehealthaideserviceshallbeconsideredonehomehealthcare
4739		-	visit.Coverageshallbeprovidedformaternityandchildbirth.
4740		-	(c)Nothinginthissectionshallbedeemedtorequirethathomehealthcare
4741		-	coveragebeprovidedtoindividualseligibleforMedicare.
4742		-	(d)Ahealthinsuranceplanshallnotimposegreatercoinsurance,co-
4743		-	payment,deductible,orothercost-sharingrequirementsforcoverageofhome
4744		-	1
4745		-	2
4746		-	3
4747		-	4
4748		-	5
4749		-	6
4750		-	7
4751		-	8
4752		-	9
4753		-	10
4754		-	11
4755		-	12
4756		-	13
4757		-	14
4758		-	15
4759		-	16
4760		-	17
4761		-	18
4762		-	19
4763		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2766	+
	2767	+
	2768	+	VT LEG #380165 v.1
	2769	+	(2) A health insurer may require evidence of insurability as a 1
	2770	+	prerequisite to coverage. 2
	2771	+	(3) The coverage shall consist of at least 40 visits by a home health 3
	2772	+	agency in any calendar year, or in any continuous period of 12 months, for 4
	2773	+	each person covered under the health insurance plan. 5
	2774	+	(4) Each visit by a member of a home health care agency, other than a 6
	2775	+	home health aide, shall be considered one home health care visit, and four 7
	2776	+	hours of home health aide service shall be considered one home health care 8
	2777	+	visit. Coverage shall be provided for maternity and childbirth. 9
	2778	+	(c) Nothing in this section shall be deemed to require that home health care 10
	2779	+	coverage be provided to individuals eligible for Medicare. 11
	2780	+	(d) A health insurance plan shall not impose greater coinsurance, co-12
	2781	+	payment, deductible, or other cost-sharing requirements for coverage of home 13
	2782	+	health care than apply to the diagnosis and treatment of any other physical or 14
	2783	+	mental condition under the plan. 15
	2784	+	§ 4077. REPRODUCTIVE HEALTH CARE SERVICES 16
	2785	+	(a)(1) A health insurance plan shall provide coverage for outpatient 17
	2786	+	contraceptive services including sterilizations, and shall provide coverage for 18
	2787	+	the purchase of all prescription contraceptives and prescription contraceptive 19
	2788	+	devices approved by the U.S. Food and Drug Administration (FDA), except 20
	2789	+	that a health insurance plan that does not provide coverage of prescription 21 BILL AS INTRODUCED S.30
4764	2790		2025 Page 115 of 181
4765		-	healthcarethanapplytothediagnosisandtreatmentofanyotherphysicalor
4766		-	mentalconditionundertheplan.
4767		-	§ 4077.REPRODUCTIVEHEALTHCARESERVICES
4768		-	(a)(1)Ahealthinsuranceplanshallprovidecoverageforoutpatient
4769		-	contraceptiveservicesincludingsterilizations,andshallprovidecoveragefor
4770		-	thepurchaseofallprescriptioncontraceptivesandprescriptioncontraceptive
4771		-	devicesapprovedbytheU.S.FoodandDrugAdministration(FDA),except
4772		-	thatahealthinsuranceplanthatdoesnotprovidecoverageofprescription
4773		-	drugsisnotrequiredtoprovidecoverageofprescriptioncontraceptivesand
4774		-	prescriptioncontraceptivedevices.
4775		-	(2)Ahealthinsuranceplanprovidingcoveragerequiredunderthis
4776		-	sectionshallnotestablishanyrate,term,orconditionthatplacesagreater
4777		-	financialburdenonacoveredindividualforaccesstocontraceptiveservices,
4778		-	prescriptioncontraceptives,andprescriptioncontraceptivedevicesthanfor
4779		-	accesstotreatment,prescriptions,ordevicesforanyotherhealthcondition.
4780		-	(b)Ahealthinsuranceplanshallprovidecoveragewithoutanydeductible,
4781		-	coinsurance,co-payment,orothercost-sharingrequirementforatleastone
4782		-	drug,device,orotherproductwithineachmethodofcontraceptionforwomen
4783		-	identifiedbytheFDAandprescribedbyacoveredindividual’shealthcare
4784		-	professional.
4785		-	1
4786		-	2
4787		-	3
4788		-	4
4789		-	5
4790		-	6
4791		-	7
4792		-	8
4793		-	9
4794		-	10
4795		-	11
4796		-	12
4797		-	13
4798		-	14
4799		-	15
4800		-	16
4801		-	17
4802		-	18
4803		-	19
4804		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2791	+
	2792	+
	2793	+	VT LEG #380165 v.1
	2794	+	drugs is not required to provide coverage of prescription contraceptives and 1
	2795	+	prescription contraceptive devices. 2
	2796	+	(2) A health insurance plan providing coverage required under this 3
	2797	+	section shall not establish any rate, term, or condition that places a greater 4
	2798	+	financial burden on a covered individual for access to contraceptive services, 5
	2799	+	prescription contraceptives, and prescription contraceptive devices than for 6
	2800	+	access to treatment, prescriptions, or devices for any other health condition. 7
	2801	+	(b) A health insurance plan shall provide coverage without any deductible, 8
	2802	+	coinsurance, co-payment, or other cost-sharing requirement for at least one 9
	2803	+	drug, device, or other product within each method of contraception for women 10
	2804	+	identified by the FDA and prescribed by a covered individual’s health care 11
	2805	+	professional. 12
	2806	+	(1) The coverage provided pursuant to this subsection shall include 13
	2807	+	patient education and counseling by the covered individual’s health care 14
	2808	+	provider regarding the appropriate use of the contraceptive method prescribed. 15
	2809	+	(2)(A) If there is a therapeutic equivalent of a drug, device, or other 16
	2810	+	product for an FDA-approved contraceptive method, a health insurance plan 17
	2811	+	may provide coverage for more than one drug, device, or other product and 18
	2812	+	may impose cost-sharing requirements as long as at least one drug, device, or 19
	2813	+	other product for that method is available without cost sharing. 20 BILL AS INTRODUCED S.30
4805	2814		2025 Page 116 of 181
4806		-	(1)Thecoverageprovidedpursuanttothissubsectionshallinclude
4807		-	patienteducationandcounselingbythecoveredindividual’shealthcare
4808		-	providerregardingtheappropriateuseofthecontraceptivemethodprescribed.
4809		-	(2)(A)Ifthereisatherapeuticequivalentofadrug,device,orother
4810		-	productforanFDA-approvedcontraceptivemethod,ahealthinsuranceplan
4811		-	mayprovidecoverageformorethanonedrug,device,orotherproductand
4812		-	mayimposecost-sharingrequirementsaslongasatleastonedrug,device,or
4813		-	otherproductforthatmethodisavailablewithoutcostsharing.
4814		-	(B)Ifacoveredindividual’shealthcareprofessionalrecommendsa
4815		-	particularserviceorFDA-approveddrug,device,orotherproductforthe
4816		-	coveredindividualbasedonadeterminationofmedicalnecessity,thehealth
4817		-	insuranceplanshalldefertothehealthcareprofessional’sdeterminationand
4818		-	judgmentandshallprovidecoveragewithoutcostsharingforthedrug,device,
4819		-	orproductprescribedbythehealthcareprofessionalforthecovered
4820		-	individual.
4821		-	(c)Ahealthinsuranceplanshallprovidecoverageforvoluntary
4822		-	sterilizationproceduresformenandwomenwithoutanydeductible,
4823		-	coinsurance,co-payment,orothercost-sharingrequirement,excepttothe
4824		-	extentthatsuchcoveragewoulddisqualifyahigh-deductiblehealthplanfrom
4825		-	eligibilityforahealthsavingsaccountpursuantto26U.S.C.§223.
4826		-	1
4827		-	2
4828		-	3
4829		-	4
4830		-	5
4831		-	6
4832		-	7
4833		-	8
4834		-	9
4835		-	10
4836		-	11
4837		-	12
4838		-	13
4839		-	14
4840		-	15
4841		-	16
4842		-	17
4843		-	18
4844		-	19
4845		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2815	+
	2816	+
	2817	+	VT LEG #380165 v.1
	2818	+	(B) If a covered individual’s health care professional recommends a 1
	2819	+	particular service or FDA-approved drug, device, or other product for the 2
	2820	+	covered individual based on a determination of medical necessity, the health 3
	2821	+	insurance plan shall defer to the health care professional’s determination and 4
	2822	+	judgment and shall provide coverage without cost sharing for the drug, device, 5
	2823	+	or product prescribed by the health care professional for the covered 6
	2824	+	individual. 7
	2825	+	(c) A health insurance plan shall provide coverage for voluntary 8
	2826	+	sterilization procedures for men and women without any deductible, 9
	2827	+	coinsurance, co-payment, or other cost-sharing requirement, except to the 10
	2828	+	extent that such coverage would disqualify a high-deductible health plan from 11
	2829	+	eligibility for a health savings account pursuant to 26 U.S.C. § 223. 12
	2830	+	(d) A health insurance plan shall provide coverage without any deductible, 13
	2831	+	coinsurance, co-payment, or other cost-sharing requirement for clinical 14
	2832	+	services associated with providing the drugs, devices, products, and procedures 15
	2833	+	covered under this section and related follow-up services, including 16
	2834	+	management of side effects, counseling for continued adherence, and device 17
	2835	+	insertion and removal. 18
	2836	+	(e)(1) A health insurance plan shall provide coverage for a supply of 19
	2837	+	prescribed contraceptives intended to last over a 12-month duration, which 20
	2838	+	may be furnished or dispensed all at once or over the course of the 12 months 21 BILL AS INTRODUCED S.30
4846	2839		2025 Page 117 of 181
4847		-	(d)Ahealthinsuranceplanshallprovidecoveragewithoutanydeductible,
4848		-	coinsurance,co-payment,orothercost-sharingrequirementforclinical
4849		-	servicesassociatedwithprovidingthedrugs,devices,products,andprocedures
4850		-	coveredunderthissectionandrelatedfollow-upservices,including
4851		-	managementofsideeffects,counselingforcontinuedadherence,anddevice
4852		-	insertionandremoval.
4853		-	(e)(1)Ahealthinsuranceplanshallprovidecoverageforasupplyof
4854		-	prescribedcontraceptivesintendedtolastovera12-monthduration,which
4855		-	maybefurnishedordispensedallatonceoroverthecourseofthe12months
4856		-	atthediscretionofthehealthcareprovider.Thehealthinsuranceplanshall
4857		-	reimburseahealthcareproviderordispensingentityperunitforfurnishingor
4858		-	dispensingasupplyofcontraceptivesintendedtolastfor12months.
4859		-	(2)ThissubsectionshallapplytoMedicaidandanyotherpublichealth
4860		-	careassistanceprogramofferedoradministeredbytheStateorbyany
4861		-	subdivisionorinstrumentalityoftheState.
4862		-	(f)Benefitsprovidedunderthissectionshallbethesameforindividuals
4863		-	coveredunderthehealthinsuranceplan.
4864		-	(g)Thecoveragerequirementsofthissectionshallapplytoself-
4865		-	administeredhormonalcontraceptivesprescribedforacoveredindividualbya
4866		-	pharmacistinaccordancewith26V.S.A.§2023.
4867		-	1
4868		-	2
4869		-	3
4870		-	4
4871		-	5
4872		-	6
4873		-	7
4874		-	8
4875		-	9
4876		-	10
4877		-	11
4878		-	12
4879		-	13
4880		-	14
4881		-	15
4882		-	16
4883		-	17
4884		-	18
4885		-	19
4886		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2840	+
	2841	+
	2842	+	VT LEG #380165 v.1
	2843	+	at the discretion of the health care provider. The health insurance plan shall 1
	2844	+	reimburse a health care provider or dispensing entity per unit for furnishing or 2
	2845	+	dispensing a supply of contraceptives intended to last for 12 months. 3
	2846	+	(2) This subsection shall apply to Medicaid and any other public health 4
	2847	+	care assistance program offered or administered by the State or by any 5
	2848	+	subdivision or instrumentality of the State. 6
	2849	+	(f) Benefits provided under this section shall be the same for individuals 7
	2850	+	covered under the health insurance plan. 8
	2851	+	(g) The coverage requirements of this section shall apply to self-9
	2852	+	administered hormonal contraceptives prescribed for a covered individual by a 10
	2853	+	pharmacist in accordance with 26 V.S.A. § 2023. 11
	2854	+	§ 4078. MIDWIFERY COVERAGE; HOME BIRTHS 12
	2855	+	(a) A health insurance plan providing maternity benefits shall also provide 13
	2856	+	coverage for services rendered by a midwife licensed pursuant to 26 V.S.A. 14
	2857	+	chapter 85 or an advanced practice registered nurse licensed pursuant to 15
	2858	+	26 V.S.A. chapter 28 who is certified as a nurse midwife for services within 16
	2859	+	the licensed midwife’s or certified nurse midwife’s scope of practice and 17
	2860	+	provided in a hospital or other health care facility or at home. 18
	2861	+	(b) Coverage for services provided by a licensed midwife or certified nurse 19
	2862	+	midwife shall not be subject to any greater co-payment, deductible, or 20 BILL AS INTRODUCED S.30
4887	2863		2025 Page 118 of 181
4888		-	§ 4078.MIDWIFERYCOVERAGE;HOMEBIRTHS
4889		-	(a)Ahealthinsuranceplanprovidingmaternitybenefitsshallalsoprovide
4890		-	coverageforservicesrenderedbyamidwifelicensedpursuantto26V.S.A.
4891		-	chapter85oranadvancedpracticeregisterednurselicensedpursuantto
4892		-	26 V.S.A.chapter28whoiscertifiedasanursemidwifeforserviceswithin
4893		-	thelicensedmidwife’sorcertifiednursemidwife’sscopeofpracticeand
4894		-	providedinahospitalorotherhealthcarefacilityorathome.
4895		-	(b)Coverageforservicesprovidedbyalicensedmidwifeorcertifiednurse
4896		-	midwifeshallnotbesubjecttoanygreaterco-payment,deductible,or
4897		-	coinsurancethanisapplicabletoanyothersimilarbenefitsprovidedbythe
4898		-	healthinsuranceplan.
4899		-	(c)ThissectionshallapplytoMedicaidandanyotherpublichealthcare
4900		-	assistanceprogramofferedoradministeredbytheStateorbyanysubdivision
4901		-	orinstrumentalityoftheState.
4902		-	§ 4079.ABORTIONANDABORTION-RELATEDSERVICES
4903		-	(a)Asusedinthissection,“abortion”meansanymedicaltreatment
4904		-	intendedtoinducetheterminationof,ortoterminate,aclinicallydiagnosable
4905		-	pregnancyexceptforthepurposeofproducingalivebirth.
4906		-	(b)(1)Ahealthinsuranceplanshallprovidecoverageforabortionand
4907		-	abortion-relatedcare.
4908		-	1
4909		-	2
4910		-	3
4911		-	4
4912		-	5
4913		-	6
4914		-	7
4915		-	8
4916		-	9
4917		-	10
4918		-	11
4919		-	12
4920		-	13
4921		-	14
4922		-	15
4923		-	16
4924		-	17
4925		-	18
4926		-	19
4927		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2864	+
	2865	+
	2866	+	VT LEG #380165 v.1
	2867	+	coinsurance than is applicable to any other similar benefits provided by the 1
	2868	+	health insurance plan. 2
	2869	+	(c) This section shall apply to Medicaid and any other public health care 3
	2870	+	assistance program offered or administered by the State or by any subdivision 4
	2871	+	or instrumentality of the State. 5
	2872	+	§ 4079. ABORTION AND ABORTION-RELATED SERVICES 6
	2873	+	(a) As used in this section, “abortion” means any medical treatment 7
	2874	+	intended to induce the termination of, or to terminate, a clinically diagnosable 8
	2875	+	pregnancy except for the purpose of producing a live birth. 9
	2876	+	(b)(1) A health insurance plan shall provide coverage for abortion and 10
	2877	+	abortion-related care. 11
	2878	+	(2) This section shall apply to Medicaid and any other public health care 12
	2879	+	assistance program offered or administered by the State or by any subdivision 13
	2880	+	or instrumentality of the State. 14
	2881	+	(c) The coverage required by this section shall not be subject to any co-15
	2882	+	payment, deductible, coinsurance, or other cost-sharing requirement or 16
	2883	+	additional charge, except: 17
	2884	+	(1) to the extent such coverage would disqualify a high-deductible 18
	2885	+	health plan from eligibility for a health savings account pursuant to 26 U.S.C. 19
	2886	+	§ 223; and 20
	2887	+	(2) for coverage provided by Medicaid. 21 BILL AS INTRODUCED S.30
4928	2888		2025 Page 119 of 181
4929		-	(2)ThissectionshallapplytoMedicaidandanyotherpublichealthcare
4930		-	assistanceprogramofferedoradministeredbytheStateorbyanysubdivision
4931		-	orinstrumentalityoftheState.
4932		-	(c)Thecoveragerequiredbythissectionshallnotbesubjecttoanyco-
4933		-	payment,deductible,coinsurance,orothercost-sharingrequirementor
4934		-	additionalcharge,except:
4935		-	(1)totheextentsuchcoveragewoulddisqualifyahigh-deductible
4936		-	healthplanfromeligibilityforahealthsavingsaccountpursuantto26U.S.C.
4937		-	§223;and
4938		-	(2)forcoverageprovidedbyMedicaid.
4939		-	§ 4080.ANESTHESIAFORCERTAINDENTALPROCEDURES
4940		-	(a)Asusedinthissection:
4941		-	(1)“Ambulatorysurgicalcenter”hasthesamemeaningasin
4942		-	18V.S.A.§ 2141.
4943		-	(2)“Anesthesiologist”meansaphysicianwhoislicensedunder
4944		-	26 V.S.A.chapter23or33andwhoeither:
4945		-	(A)hascompletedaresidencyinanesthesiologyapprovedbythe
4946		-	AmericanBoardofAnesthesiologyortheAmericanOsteopathicBoardof
4947		-	Anesthesiologyortheirpredecessorsorsuccessors;or
4948		-	(B)iscredentialedbyahospitaltopracticeanesthesiologyand
4949		-	engagesinthepracticeofanesthesiologyatthathospitalfull-time.
4950		-	1
4951		-	2
4952		-	3
4953		-	4
4954		-	5
4955		-	6
4956		-	7
4957		-	8
4958		-	9
4959		-	10
4960		-	11
4961		-	12
4962		-	13
4963		-	14
4964		-	15
4965		-	16
4966		-	17
4967		-	18
4968		-	19
4969		-	20
4970		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2889	+
	2890	+
	2891	+	VT LEG #380165 v.1
	2892	+	§ 4080. ANESTHESIA FOR CERTAIN DENTAL PROCEDURES 1
	2893	+	(a) As used in this section: 2
	2894	+	(1) “Ambulatory surgical center” has the same meaning as in 3
	2895	+	18 V.S.A. § 2141. 4
	2896	+	(2) “Anesthesiologist” means a physician who is licensed under 5
	2897	+	26 V.S.A. chapter 23 or 33 and who either: 6
	2898	+	(A) has completed a residency in anesthesiology approved by the 7
	2899	+	American Board of Anesthesiology or the American Osteopathic Board of 8
	2900	+	Anesthesiology or their predecessors or successors; or 9
	2901	+	(B) is credentialed by a hospital to practice anesthesiology and 10
	2902	+	engages in the practice of anesthesiology at that hospital full-time. 11
	2903	+	(3) “Certified registered nurse anesthetist” means an advanced practice 12
	2904	+	registered nurse licensed by the Vermont Board of Nursing to practice as a 13
	2905	+	certified registered nurse anesthetist. 14
	2906	+	(4) “Licensed mental health professional” means a licensed physician, 15
	2907	+	psychologist, psychoanalyst, social worker, marriage and family therapist, 16
	2908	+	clinical mental health counselor, or nurse with professional training, 17
	2909	+	experience, and demonstrated competence in the treatment of a mental 18
	2910	+	condition or psychiatric disability. 19
	2911	+	(b) A health insurance plan shall provide coverage for the hospital or 20
	2912	+	ambulatory surgical center charges and administration of general anesthesia 21 BILL AS INTRODUCED S.30
4971	2913		2025 Page 120 of 181
4972		-	(3)“Certifiedregisterednurseanesthetist”meansanadvancedpractice
4973		-	registerednurselicensedbytheVermontBoardofNursingtopracticeasa
4974		-	certifiedregisterednurseanesthetist.
4975		-	(4)“Licensedmentalhealthprofessional”meansalicensedphysician,
4976		-	psychologist,psychoanalyst,socialworker,marriageandfamilytherapist,
4977		-	clinicalmentalhealthcounselor,ornursewithprofessionaltraining,
4978		-	experience,anddemonstratedcompetenceinthetreatmentofamental
4979		-	conditionorpsychiatricdisability.
4980		-	(b)Ahealthinsuranceplanshallprovidecoverageforthehospitalor
4981		-	ambulatorysurgicalcenterchargesandadministrationofgeneralanesthesia
4982		-	administeredbyalicensedanesthesiologistorcertifiedregisterednurse
4983		-	anesthetistfordentalproceduresperformedonacoveredindividualwhois:
4984		-	(1)achildsevenyearsofageoryoungerwhoisdeterminedbyadentist
4985		-	licensedpursuantto26V.S.A.chapter13tobeunabletoreceiveneededdental
4986		-	treatmentinanoutpatientsetting,wheretheprovidertreatingthecovered
4987		-	individualcertifiesthatduetothecoveredindividual’sageandthecovered
4988		-	individual’sconditionorproblem,hospitalizationorgeneralanesthesiaina
4989		-	hospitalorambulatorysurgicalcenterisrequiredinordertoperform
4990		-	significantlycomplexdentalproceduressafelyandeffectively;
4991		-	(2)achild12yearsofageoryoungerwithdocumentedphobiasora
4992		-	documentedmentalconditionorpsychiatricdisability,asdeterminedbya
4993		-	1
4994		-	2
4995		-	3
4996		-	4
4997		-	5
4998		-	6
4999		-	7
5000		-	8
5001		-	9
5002		-	10
5003		-	11
5004		-	12
5005		-	13
5006		-	14
5007		-	15
5008		-	16
5009		-	17
5010		-	18
5011		-	19
5012		-	20
5013		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2914	+
	2915	+
	2916	+	VT LEG #380165 v.1
	2917	+	administered by a licensed anesthesiologist or certified registered nurse 1
	2918	+	anesthetist for dental procedures performed on a covered individual who is: 2
	2919	+	(1) a child seven years of age or younger who is determined by a dentist 3
	2920	+	licensed pursuant to 26 V.S.A. chapter 13 to be unable to receive needed dental 4
	2921	+	treatment in an outpatient setting, where the provider treating the covered 5
	2922	+	individual certifies that due to the covered individual’s age and the covered 6
	2923	+	individual’s condition or problem, hospitalization or general anesthesia in a 7
	2924	+	hospital or ambulatory surgical center is required in order to perform 8
	2925	+	significantly complex dental procedures safely and effectively; 9
	2926	+	(2) a child 12 years of age or younger with documented phobias or a 10
	2927	+	documented mental condition or psychiatric disability, as determined by a 11
	2928	+	physician licensed pursuant to 26 V.S.A. chapter 23 or 33 or by a licensed 12
	2929	+	mental health professional, whose dental needs are sufficiently complex and 13
	2930	+	urgent that delaying or deferring treatment can be expected to result in 14
	2931	+	infection, loss of teeth, or other increased oral or dental morbidity; for whom a 15
	2932	+	successful result cannot be expected from dental care provided under local 16
	2933	+	anesthesia; and for whom a superior result can be expected from dental care 17
	2934	+	provided under general anesthesia; or 18
	2935	+	(3) a person who has exceptional medical circumstances or a 19
	2936	+	developmental disability, as determined by a physician licensed pursuant to 20
	2937	+	26 V.S.A. chapter 23 or 33, that place the person at serious risk. 21 BILL AS INTRODUCED S.30
5014	2938		2025 Page 121 of 181
5015		-	physicianlicensedpursuantto26V.S.A.chapter23or33orbyalicensed
5016		-	mentalhealthprofessional,whosedentalneedsaresufficientlycomplexand
5017		-	urgentthatdelayingordeferringtreatmentcanbeexpectedtoresultin
5018		-	infection,lossofteeth,orotherincreasedoralordentalmorbidity;forwhoma
5019		-	successfulresultcannotbeexpectedfromdentalcareprovidedunderlocal
5020		-	anesthesia;andforwhomasuperiorresultcanbeexpectedfromdentalcare
5021		-	providedundergeneralanesthesia;or
5022		-	(3)apersonwhohasexceptionalmedicalcircumstancesora
5023		-	developmentaldisability,asdeterminedbyaphysicianlicensedpursuantto
5024		-	26 V.S.A.chapter23or33,thatplacethepersonatseriousrisk.
5025		-	(c)Ahealthinsuranceplanmayrequirepriorauthorizationforgeneral
5026		-	anesthesiaandassociatedhospitalorambulatorysurgicalcenterchargesfor
5027		-	dentalcareinthesamemannerthatpriorauthorizationisrequiredforthese
5028		-	benefitsinconnectionwithothercoveredmedicalcare.
5029		-	(d)Ahealthinsuranceplanmayrestrictcoverageforgeneralanesthesia
5030		-	andassociatedhospitalorambulatorysurgicalcenterchargestodentalcare
5031		-	thatisprovidedby:
5032		-	(1)afullyaccreditedspecialistinpediatricdentistry;
5033		-	(2)afullyaccreditedspecialistinoralandmaxillofacialsurgery;and
5034		-	(3)adentisttowhomhospitalprivilegeshavebeengranted.
5035		-	1
5036		-	2
5037		-	3
5038		-	4
5039		-	5
5040		-	6
5041		-	7
5042		-	8
5043		-	9
5044		-	10
5045		-	11
5046		-	12
5047		-	13
5048		-	14
5049		-	15
5050		-	16
5051		-	17
5052		-	18
5053		-	19
5054		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2939	+
	2940	+
	2941	+	VT LEG #380165 v.1
	2942	+	(c) A health insurance plan may require prior authorization for general 1
	2943	+	anesthesia and associated hospital or ambulatory surgical center charges for 2
	2944	+	dental care in the same manner that prior authorization is required for these 3
	2945	+	benefits in connection with other covered medical care. 4
	2946	+	(d) A health insurance plan may restrict coverage for general anesthesia 5
	2947	+	and associated hospital or ambulatory surgical center charges to dental care 6
	2948	+	that is provided by: 7
	2949	+	(1) a fully accredited specialist in pediatric dentistry; 8
	2950	+	(2) a fully accredited specialist in oral and maxillofacial surgery; and 9
	2951	+	(3) a dentist to whom hospital privileges have been granted. 10
	2952	+	(e) The provisions of this section shall not be construed to require a health 11
	2953	+	insurance plan to provide coverage for the dental procedure or other dental 12
	2954	+	care for which general anesthesia is provided. 13
	2955	+	(f) The provisions of this section shall not be construed to prevent or 14
	2956	+	require reimbursement by a health insurance plan for the provision of general 15
	2957	+	anesthesia and associated facility charges to a dentist holding a general 16
	2958	+	anesthesia endorsement issued by the Vermont Board of Dental Examiners if 17
	2959	+	the dentist has provided services pursuant to this section on an outpatient basis 18
	2960	+	in the dentist’s own office and the dentist is in compliance with the 19
	2961	+	endorsement’s terms and conditions. 20 BILL AS INTRODUCED S.30
5055	2962		2025 Page 122 of 181
5056		-	(e)Theprovisionsofthissectionshallnotbeconstruedtorequireahealth
5057		-	insuranceplantoprovidecoverageforthedentalprocedureorotherdental
5058		-	careforwhichgeneralanesthesiaisprovided.
5059		-	(f)Theprovisionsofthissectionshallnotbeconstruedtopreventor
5060		-	requirereimbursementbyahealthinsuranceplanfortheprovisionofgeneral
5061		-	anesthesiaandassociatedfacilitychargestoadentistholdingageneral
5062		-	anesthesiaendorsementissuedbytheVermontBoardofDentalExaminersif
5063		-	thedentisthasprovidedservicespursuanttothissectiononanoutpatientbasis
5064		-	inthedentist’sownofficeandthedentistisincompliancewiththe
5065		-	endorsement’stermsandconditions.
5066		-	§ 4081.TOBACCOCESSATION
5067		-	(a)Asusedinthissection,“tobaccocessationmedication”meansall
5068		-	therapiesapprovedbytheU.S.FoodandDrugAdministrationforusein
5069		-	tobaccocessation.
5070		-	(b)Ahealthinsuranceplanshallprovidecoverageofatleastonethree-
5071		-	monthsupplyperyearoftobaccocessationmedication,includingover-the-
5072		-	countermedication,ifprescribedbyalicensedhealthcareprofessionalforan
5073		-	individualcoveredundertheplan.Ahealthinsuranceplanmayrequirethe
5074		-	individualtopaytheplan’sapplicableprescriptiondrugco-paymentforthe
5075		-	tobaccocessationmedication.
5076		-	1
5077		-	2
5078		-	3
5079		-	4
5080		-	5
5081		-	6
5082		-	7
5083		-	8
5084		-	9
5085		-	10
5086		-	11
5087		-	12
5088		-	13
5089		-	14
5090		-	15
5091		-	16
5092		-	17
5093		-	18
5094		-	19
5095		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2963	+
	2964	+
	2965	+	VT LEG #380165 v.1
	2966	+	§ 4081. TOBACCO CESSATION 1
	2967	+	(a) As used in this section, “tobacco cessation medication” means all 2
	2968	+	therapies approved by the U.S. Food and Drug Administration for use in 3
	2969	+	tobacco cessation. 4
	2970	+	(b) A health insurance plan shall provide coverage of at least one three-5
	2971	+	month supply per year of tobacco cessation medication, including over-the-6
	2972	+	counter medication, if prescribed by a licensed health care professional for an 7
	2973	+	individual covered under the plan. A health insurance plan may require the 8
	2974	+	individual to pay the plan’s applicable prescription drug co-payment for the 9
	2975	+	tobacco cessation medication. 10
	2976	+	(c) This section shall apply to Medicaid and any other public health care 11
	2977	+	assistance program offered or administered by the State or by any subdivision 12
	2978	+	or instrumentality of the State. 13
	2979	+	§ 4082. EARLY CHILDHOOD DEVELOPMENT DISORDERS 14
	2980	+	(a) As used in this section: 15
	2981	+	(1) “Applied behavior analysis” means the design, implementation, and 16
	2982	+	evaluation of environmental modifications using behavioral stimuli and 17
	2983	+	consequences to produce socially significant improvement in human behavior. 18
	2984	+	The term includes the use of direct observation, measurement, and functional 19
	2985	+	analysis of the relationship between environment and behavior. 20 BILL AS INTRODUCED S.30
5096	2986		2025 Page 123 of 181
5097		-	(c)ThissectionshallapplytoMedicaidandanyotherpublichealthcare
5098		-	assistanceprogramofferedoradministeredbytheStateorbyanysubdivision
5099		-	orinstrumentalityoftheState.
5100		-	§ 4082.EARLYCHILDHOODDEVELOPMENT DISORDERS
5101		-	(a)Asusedinthissection:
5102		-	(1)“Appliedbehavioranalysis”meansthedesign,implementation,and
5103		-	evaluationofenvironmentalmodificationsusingbehavioralstimuliand
5104		-	consequencestoproducesociallysignificantimprovementinhumanbehavior.
5105		-	Thetermincludestheuseofdirectobservation,measurement,andfunctional
5106		-	analysisoftherelationshipbetweenenvironmentandbehavior.
5107		-	(2)“Autismspectrumdisorders”meansoneormorepervasive
5108		-	developmentaldisordersasdefinedinthemostrecenteditionoftheDiagnostic
5109		-	andStatisticalManualofMentalDisorders(DSM),includingautisticdisorder,
5110		-	pervasivedevelopmentaldisordernototherwisespecified,andAsperger’s
5111		-	disorder.
5112		-	(3)“Behavioralhealthtreatment”meansevidence-basedcounselingand
5113		-	treatmentprograms,includingappliedbehavioranalysis,thatare:
5114		-	(A)necessarytodevelopskillsandabilitiesforthemaximum
5115		-	reductionofphysicalormentaldisabilityandforrestorationofanindividual
5116		-	totheindividual’sbestfunctionallevel,ortoensurethatanindividual21
5117		-	yearsofageachievespropergrowthanddevelopment;and
5118		-	1
5119		-	2
5120		-	3
5121		-	4
5122		-	5
5123		-	6
5124		-	7
5125		-	8
5126		-	9
5127		-	10
5128		-	11
5129		-	12
5130		-	13
5131		-	14
5132		-	15
5133		-	16
5134		-	17
5135		-	18
5136		-	19
5137		-	20
5138		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	2987	+
	2988	+
	2989	+	VT LEG #380165 v.1
	2990	+	(2) “Autism spectrum disorders” means one or more pervasive 1
	2991	+	developmental disorders as defined in the most recent edition of the Diagnostic 2
	2992	+	and Statistical Manual of Mental Disorders (DSM), including autistic disorder, 3
	2993	+	pervasive developmental disorder not otherwise specified, and Asperger’s 4
	2994	+	disorder. 5
	2995	+	(3) “Behavioral health treatment” means evidence-based counseling and 6
	2996	+	treatment programs, including applied behavior analysis, that are: 7
	2997	+	(A) necessary to develop skills and abilities for the maximum 8
	2998	+	reduction of physical or mental disability and for restoration of an individual to 9
	2999	+	the individual’s best functional level, or to ensure that an individual 21 years of 10
	3000	+	age achieves proper growth and development; and 11
	3001	+	(B) provided or supervised by a nationally board-certified behavior 12
	3002	+	analyst or by a licensed health care professional, provided the services 13
	3003	+	performed are within the health care professional’s scope of practice and 14
	3004	+	certifications. 15
	3005	+	(4) “Diagnosis of early childhood developmental disorders” means 16
	3006	+	medically necessary assessments, evaluations, or tests to determine whether an 17
	3007	+	individual has an early childhood developmental delay, including an autism 18
	3008	+	spectrum disorder. 19
	3009	+	(5) “Early childhood developmental disorder” means a childhood mental 20
	3010	+	or physical impairment or combination of mental and physical impairments 21 BILL AS INTRODUCED S.30
5139	3011		2025 Page 124 of 181
5140		-	(B)providedorsupervisedbyanationallyboard-certifiedbehavior
5141		-	analystorbyalicensedhealthcareprofessional,providedtheservices
5142		-	performedarewithinthehealthcareprofessional’sscopeofpracticeand
5143		-	certifications.
5144		-	(4)“Diagnosisofearlychildhooddevelopmentaldisorders”means
5145		-	medicallynecessaryassessments,evaluations,orteststodeterminewhetheran
5146		-	individualhasanearlychildhooddevelopmentaldelay,includinganautism
5147		-	spectrumdisorder.
5148		-	(5)“Earlychildhooddevelopmentaldisorder”meansachildhood
5149		-	mentalorphysicalimpairmentorcombinationofmentalandphysical
5150		-	impairmentsthatresultsinfunctionallimitationsinmajorlifeactivities,
5151		-	accompaniedbyadiagnosisdefinedbytheDSMortheInternational
5152		-	ClassificationofDiseases(ICD),asperiodicallyrevised.Thetermincludes
5153		-	autismspectrumdisordersbutdoesnotincludealearningdisability.
5154		-	(6)“Evidence-based”hasthesamemeaningasin18V.S.A.§4621.
5155		-	(7)“Medicallynecessary”describeshealthcareservicesthatare
5156		-	appropriateintermsoftype,amount,frequency,level,setting,anddurationto
5157		-	theindividual’sdiagnosisorcondition;areinformedbygenerallyaccepted
5158		-	medicalorscientificevidence;andareconsistentwithgenerallyaccepted
5159		-	practiceparameters.Suchservicesshallbeinformedbytheuniqueneedsof
5160		-	eachindividualandeachpresentingsituationandshallincludeadetermination
5161		-	1
5162		-	2
5163		-	3
5164		-	4
5165		-	5
5166		-	6
5167		-	7
5168		-	8
5169		-	9
5170		-	10
5171		-	11
5172		-	12
5173		-	13
5174		-	14
5175		-	15
5176		-	16
5177		-	17
5178		-	18
5179		-	19
5180		-	20
5181		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3012	+
	3013	+
	3014	+	VT LEG #380165 v.1
	3015	+	that results in functional limitations in major life activities, accompanied by a 1
	3016	+	diagnosis defined by the DSM or the International Classification of Diseases 2
	3017	+	(ICD), as periodically revised. The term includes autism spectrum disorders 3
	3018	+	but does not include a learning disability. 4
	3019	+	(6) “Evidence-based” has the same meaning as in 18 V.S.A. § 4621. 5
	3020	+	(7) “Medically necessary” describes health care services that are 6
	3021	+	appropriate in terms of type, amount, frequency, level, setting, and duration to 7
	3022	+	the individual’s diagnosis or condition; are informed by generally accepted 8
	3023	+	medical or scientific evidence; and are consistent with generally accepted 9
	3024	+	practice parameters. Such services shall be informed by the unique needs of 10
	3025	+	each individual and each presenting situation and shall include a determination 11
	3026	+	that a service is needed to achieve proper growth and development or to 12
	3027	+	prevent the onset or worsening of a health condition. 13
	3028	+	(8) “Natural environment” means a home or child care setting. 14
	3029	+	(9) “Pharmacy care” means medications prescribed by a licensed health 15
	3030	+	care professional and any health-related services deemed medically necessary 16
	3031	+	to determine the need for or effectiveness of a medication. 17
	3032	+	(10) “Psychiatric care” means direct or consultative services provided 18
	3033	+	by a licensed physician certified in psychiatry by the American Board of 19
	3034	+	Medical Specialties. 20 BILL AS INTRODUCED S.30
5182	3035		2025 Page 125 of 181
5183		-	thataserviceisneededtoachievepropergrowthanddevelopmentorto
5184		-	preventtheonsetorworseningofahealthcondition.
5185		-	(8)“Naturalenvironment”meansahomeorchildcaresetting.
5186		-	(9)“Pharmacycare”meansmedicationsprescribedbyalicensedhealth
5187		-	careprofessionalandanyhealth-relatedservicesdeemedmedicallynecessary
5188		-	todeterminetheneedfororeffectivenessofamedication.
5189		-	(10)“Psychiatriccare”meansdirectorconsultativeservicesprovided
5190		-	byalicensedphysiciancertifiedinpsychiatrybytheAmericanBoardof
5191		-	MedicalSpecialties.
5192		-	(11)“Psychologicalcare”meansdirectorconsultativeservicesprovided
5193		-	byapsychologistlicensedpursuantto26V.S.A.chapter55.
5194		-	(12)“Therapeuticcare”meansservicesprovidedbylicensedorcertified
5195		-	speechlanguagepathologists,occupationaltherapists,orphysicaltherapists.
5196		-	(13)“Treatmentforearlydevelopmentaldisorders”meansevidence-
5197		-	basedcareandrelatedequipmentprescribedororderedforanindividualbya
5198		-	licensedhealthcareprofessionaloralicensedpsychologistwhodeterminesthe
5199		-	caretobemedicallynecessary,including:
5200		-	(A)behavioralhealthtreatment;
5201		-	(B)pharmacycare;
5202		-	(C)psychiatriccare;
5203		-	(D)psychologicalcare;and
5204		-	1
5205		-	2
5206		-	3
5207		-	4
5208		-	5
5209		-	6
5210		-	7
5211		-	8
5212		-	9
5213		-	10
5214		-	11
5215		-	12
5216		-	13
5217		-	14
5218		-	15
5219		-	16
5220		-	17
5221		-	18
5222		-	19
5223		-	20
5224		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3036	+
	3037	+
	3038	+	VT LEG #380165 v.1
	3039	+	(11) “Psychological care” means direct or consultative services provided 1
	3040	+	by a psychologist licensed pursuant to 26 V.S.A. chapter 55. 2
	3041	+	(12) “Therapeutic care” means services provided by licensed or certified 3
	3042	+	speech language pathologists, occupational therapists, or physical therapists. 4
	3043	+	(13) “Treatment for early developmental disorders” means evidence-5
	3044	+	based care and related equipment prescribed or ordered for an individual by a 6
	3045	+	licensed health care professional or a licensed psychologist who determines the 7
	3046	+	care to be medically necessary, including: 8
	3047	+	(A) behavioral health treatment; 9
	3048	+	(B) pharmacy care; 10
	3049	+	(C) psychiatric care; 11
	3050	+	(D) psychological care; and 12
	3051	+	(E) therapeutic care. 13
	3052	+	(b)(1) A health insurance plan shall provide coverage for the evidence-14
	3053	+	based diagnosis and treatment of early childhood developmental disorders, 15
	3054	+	including applied behavior analysis supervised by a nationally board-certified 16
	3055	+	behavior analyst, for children, beginning at birth and continuing until the child 17
	3056	+	reaches 21 years of age. 18
	3057	+	(2) This section shall apply to Medicaid and any other public health care 19
	3058	+	assistance program offered or administered by the State or by any subdivision 20
	3059	+	or instrumentality of the State. Coverage provided pursuant to this section by 21 BILL AS INTRODUCED S.30
5225	3060		2025 Page 126 of 181
5226		-	(E)therapeuticcare.
5227		-	(b)(1)Ahealthinsuranceplanshallprovidecoveragefortheevidence-
5228		-	baseddiagnosisandtreatmentofearlychildhooddevelopmentaldisorders,
5229		-	includingappliedbehavioranalysissupervisedbyanationallyboard-certified
5230		-	behavioranalyst,forchildren,beginningatbirthandcontinuinguntilthechild
5231		-	reaches21yearsofage.
5232		-	(2)ThissectionshallapplytoMedicaidandanyotherpublichealthcare
5233		-	assistanceprogramofferedoradministeredbytheStateorbyanysubdivision
5234		-	orinstrumentalityoftheState.Coverageprovidedpursuanttothissectionby
5235		-	Medicaidoranyotherpublichealthcareassistanceprogramshallcomplywith
5236		-	allfederalrequirementsimposedbytheCentersforMedicareandMedicaid
5237		-	Services.
5238		-	(3)Amajormedicalinsuranceplanisnotrequiredtoprovideany
5239		-	benefitsrequiredbythissectionthatexceedtheessentialhealthbenefits
5240		-	specifiedunderSection1302(b)ofthePatientProtectionandAffordableCare
5241		-	Act,PublicLaw111-148,asamended.
5242		-	(c)Theamount,frequency,anddurationoftreatmentdescribedinthis
5243		-	sectionshallbebasedonmedicalnecessityandmaybesubjecttoaprior
5244		-	authorizationrequirementunderthehealthinsuranceplan.
5245		-	(d)Ahealthinsuranceplanshallnotimposegreatercoinsurance,co-
5246		-	payment,deductible,orothercost-sharingrequirementsforcoverageofthe
5247		-	1
5248		-	2
5249		-	3
5250		-	4
5251		-	5
5252		-	6
5253		-	7
5254		-	8
5255		-	9
5256		-	10
5257		-	11
5258		-	12
5259		-	13
5260		-	14
5261		-	15
5262		-	16
5263		-	17
5264		-	18
5265		-	19
5266		-	20
5267		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3061	+
	3062	+
	3063	+	VT LEG #380165 v.1
	3064	+	Medicaid or any other public health care assistance program shall comply with 1
	3065	+	all federal requirements imposed by the Centers for Medicare and Medicaid 2
	3066	+	Services. 3
	3067	+	(3) A major medical insurance plan is not required to provide any 4
	3068	+	benefits required by this section that exceed the essential health benefits 5
	3069	+	specified under Section 1302(b) of the Patient Protection and Affordable Care 6
	3070	+	Act, Public Law 111-148, as amended. 7
	3071	+	(c) The amount, frequency, and duration of treatment described in this 8
	3072	+	section shall be based on medical necessity and may be subject to a prior 9
	3073	+	authorization requirement under the health insurance plan. 10
	3074	+	(d) A health insurance plan shall not impose greater coinsurance, co-11
	3075	+	payment, deductible, or other cost-sharing requirements for coverage of the 12
	3076	+	diagnosis or treatment of early childhood developmental disorders than apply 13
	3077	+	to the diagnosis and treatment of any other physical or mental condition under 14
	3078	+	the plan. 15
	3079	+	(e)(1) A health insurance plan shall provide coverage for applied behavior 16
	3080	+	analysis when the services are provided or supervised by a licensed health care 17
	3081	+	professional who is working within the scope of the health care professional’s 18
	3082	+	license or who is a nationally board-certified behavior analyst. 19
	3083	+	(2) A health insurance plan shall provide coverage for services under 20
	3084	+	this section delivered in the natural environment when the services are 21 BILL AS INTRODUCED S.30
5268	3085		2025 Page 127 of 181
5269		-	diagnosisortreatmentofearlychildhooddevelopmentaldisordersthanapply
5270		-	tothediagnosisandtreatmentofanyotherphysicalormentalconditionunder
5271		-	theplan.
5272		-	(e)(1)Ahealthinsuranceplanshallprovidecoverageforappliedbehavior
5273		-	analysiswhentheservicesareprovidedorsupervisedbyalicensedhealthcare
5274		-	professionalwhoisworkingwithinthescopeofthehealthcareprofessional’s
5275		-	licenseorwhoisanationallyboard-certifiedbehavioranalyst.
5276		-	(2)Ahealthinsuranceplanshallprovidecoverageforservicesunder
5277		-	thissectiondeliveredinthenaturalenvironmentwhentheservicesare
5278		-	furnishedbyahealthcareprofessionalworkingwithinthescopeofthehealth
5279		-	careprofessional’slicenseorunderthedirectsupervisionofalicensedhealth
5280		-	careprofessionalor,forappliedbehavioranalysis,byorunderthesupervision
5281		-	ofanationallyboard-certifiedbehavioranalyst.
5282		-	(f)Exceptforinpatientservices,ifanindividualisreceivingtreatmentfor
5283		-	anearlydevelopmentaldelay,thehealthinsuranceplanmayrequiretreatment
5284		-	planreviewsbasedontheneedsofthecoveredindividual,consistentwith
5285		-	reviewsforotherdiagnosticareasandwithrulesestablishedbythe
5286		-	DepartmentofFinancialRegulation.Ahealthinsuranceplanmayreviewthe
5287		-	treatmentplanforchildrenundereightyearsofagenotmorefrequentlythan
5288		-	onceeverysixmonths.
5289		-	1
5290		-	2
5291		-	3
5292		-	4
5293		-	5
5294		-	6
5295		-	7
5296		-	8
5297		-	9
5298		-	10
5299		-	11
5300		-	12
5301		-	13
5302		-	14
5303		-	15
5304		-	16
5305		-	17
5306		-	18
5307		-	19
5308		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3086	+
	3087	+
	3088	+	VT LEG #380165 v.1
	3089	+	furnished by a health care professional working within the scope of the health 1
	3090	+	care professional’s license or under the direct supervision of a licensed health 2
	3091	+	care professional or, for applied behavior analysis, by or under the supervision 3
	3092	+	of a nationally board-certified behavior analyst. 4
	3093	+	(f) Except for inpatient services, if an individual is receiving treatment for 5
	3094	+	an early developmental delay, the health insurance plan may require treatment 6
	3095	+	plan reviews based on the needs of the covered individual, consistent with 7
	3096	+	reviews for other diagnostic areas and with rules established by the Department 8
	3097	+	of Financial Regulation. A health insurance plan may review the treatment 9
	3098	+	plan for children under eight years of age not more frequently than once every 10
	3099	+	six months. 11
	3100	+	(g) Nothing in this section shall be construed to affect any obligation to 12
	3101	+	provide services to an individual under an individualized family service plan, 13
	3102	+	individualized education program, or individualized service plan. A health 14
	3103	+	insurance plan shall not reimburse services provided under 16 V.S.A. § 2959a. 15
	3104	+	(h) It is the intent of the General Assembly that the Department of 16
	3105	+	Financial Regulation facilitate and encourage health insurance plans to bundle 17
	3106	+	co-payments accrued by beneficiaries receiving services under this section to 18
	3107	+	the extent possible. 19 BILL AS INTRODUCED S.30
5309	3108		2025 Page 128 of 181
5310		-	(g)Nothinginthissectionshallbeconstruedtoaffectanyobligationto
5311		-	provideservicestoanindividualunderanindividualizedfamilyserviceplan,
5312		-	individualizededucationprogram,orindividualizedserviceplan.Ahealth
5313		-	insuranceplanshallnotreimburseservicesprovidedunder16V.S.A.§2959a.
5314		-	(h)ItistheintentoftheGeneralAssemblythattheDepartmentof
5315		-	FinancialRegulationfacilitateandencouragehealthinsuranceplanstobundle
5316		-	co-paymentsaccruedbybeneficiariesreceivingservicesunderthissectionto
5317		-	theextentpossible.
5318		-	§ 4083.SERVICESFORVICTIMSOFSEXUALASSAULT
5319		-	(a)Asusedinthissection,“sexualassaultexamination”meanseitheror
5320		-	bothofthefollowing:
5321		-	(1)aphysicalexaminationofthepatient,documentationofbiological
5322		-	andphysicalfindings,andcollectionofevidence;and
5323		-	(2)treatmentofthepatient’sinjuries;providingcareforsexually
5324		-	transmittedinfections;assessingpregnancyrisk;discussingtreatmentoptions,
5325		-	includingreproductivehealthservices,screeningforthehuman
5326		-	immunodeficiencyvirus,andprophylactictreatmentwhenappropriate;and
5327		-	providinginstructionsandreferralsforfollow-upcare.
5328		-	(b)Ahealthinsuranceplanshallnotimposeanyco-paymentor
5329		-	coinsuranceor,totheextentpermittedunderfederallaw,deductibleorother
5330		-	cost-sharingrequirementforthesexualassaultexaminationofavictimof
5331		-	1
5332		-	2
5333		-	3
5334		-	4
5335		-	5
5336		-	6
5337		-	7
5338		-	8
5339		-	9
5340		-	10
5341		-	11
5342		-	12
5343		-	13
5344		-	14
5345		-	15
5346		-	16
5347		-	17
5348		-	18
5349		-	19
5350		-	20
5351		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3109	+
	3110	+
	3111	+	VT LEG #380165 v.1
	3112	+	§ 4083. SERVICES FOR VICTIMS OF SEXUAL ASSAULT 1
	3113	+	(a) As used in this section, “sexual assault examination” means either or 2
	3114	+	both of the following: 3
	3115	+	(1) a physical examination of the patient, documentation of biological 4
	3116	+	and physical findings, and collection of evidence; and 5
	3117	+	(2) treatment of the patient’s injuries; providing care for sexually 6
	3118	+	transmitted infections; assessing pregnancy risk; discussing treatment options, 7
	3119	+	including reproductive health services, screening for the human 8
	3120	+	immunodeficiency virus, and prophylactic treatment when appropriate; and 9
	3121	+	providing instructions and referrals for follow-up care. 10
	3122	+	(b) A health insurance plan shall not impose any co-payment or 11
	3123	+	coinsurance or, to the extent permitted under federal law, deductible or other 12
	3124	+	cost-sharing requirement for the sexual assault examination of a victim of 13
	3125	+	alleged sexual assault for health care services associated with specific 14
	3126	+	procedure codes identified in a memorandum of understanding between the 15
	3127	+	health insurer and the Vermont Center for Crime Victim Services. 16
	3128	+	§ 4084. PHYSICAL THERAPY CO-PAYMENTS FOR CERTAIN PLANS 17
	3129	+	For silver- and bronze-level qualified health benefit plans and any reflective 18
	3130	+	health benefit plans offered at the silver or bronze level pursuant to 33 V.S.A. 19
	3131	+	chapter 18, subchapter 1, health care services provided by a licensed physical 20
	3132	+	therapist may be subject to a co-payment requirement, provided that any 21 BILL AS INTRODUCED S.30
5352	3133		2025 Page 129 of 181
5353		-	allegedsexualassaultforhealthcareservicesassociatedwithspecific
5354		-	procedurecodesidentifiedinamemorandumofunderstandingbetweenthe
5355		-	healthinsurerandtheVermontCenterforCrimeVictimServices.
5356		-	§ 4084.PHYSICALTHERAPYCO-PAYMENTSFORCERTAINPLANS
5357		-	Forsilver-andbronze-levelqualifiedhealthbenefitplansandanyreflective
5358		-	healthbenefitplansofferedatthesilverorbronzelevelpursuantto33V.S.A.
5359		-	chapter18,subchapter1,healthcareservicesprovidedbyalicensedphysical
5360		-	therapistmaybesubjecttoaco-paymentrequirement,providedthatany
5361		-	requiredco-paymentamountshallbebetween125and150percentofthe
5362		-	amountoftheco-paymentapplicabletocareandservicesprovidedbya
5363		-	primarycareproviderundertheplan.
5364		-	Subchapter10.PrescriptionDrugCoverage
5365		-	§ 4091.DEFINITIONS
5366		-	Asusedinthissubchapter:
5367		-	(1)“Directsolicitation”meansdirectcontact,includingtelephone,
5368		-	computer,email,instantmessaging,orin-personcontact,byapharmacy
5369		-	provideroritsagenttoanindividualcoveredunderahealthinsuranceplan
5370		-	withoutthecoveredindividual’sconsentforthepurposeofmarketingthe
5371		-	pharmacyprovider’sservices.
5372		-	(2)“Healthcareprofessional”meansanindividuallicensedtopractice
5373		-	medicineunder26V.S.A.chapter23or33,anindividuallicensedasa
5374		-	1
5375		-	2
5376		-	3
5377		-	4
5378		-	5
5379		-	6
5380		-	7
5381		-	8
5382		-	9
5383		-	10
5384		-	11
5385		-	12
5386		-	13
5387		-	14
5388		-	15
5389		-	16
5390		-	17
5391		-	18
5392		-	19
5393		-	20
5394		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3134	+
	3135	+
	3136	+	VT LEG #380165 v.1
	3137	+	required co-payment amount shall be between 125 and 150 percent of the 1
	3138	+	amount of the co-payment applicable to care and services provided by a 2
	3139	+	primary care provider under the plan. 3
	3140	+	Subchapter 10. Prescription Drug Coverage 4
	3141	+	§ 4091. DEFINITIONS 5
	3142	+	As used in this subchapter: 6
	3143	+	(1) “Direct solicitation” means direct contact, including telephone, 7
	3144	+	computer, email, instant messaging, or in-person contact, by a pharmacy 8
	3145	+	provider or its agent to an individual covered under a health insurance plan 9
	3146	+	without the covered individual’s consent for the purpose of marketing the 10
	3147	+	pharmacy provider’s services. 11
	3148	+	(2) “Health care professional” means an individual licensed to practice 12
	3149	+	medicine under 26 V.S.A. chapter 23 or 33, an individual licensed as a 13
	3150	+	physician assistant under 26 V.S.A. chapter 31, or an individual licensed as an 14
	3151	+	advanced practice registered nurse under 26 V.S.A. chapter 28. 15
	3152	+	(3) “Health insurance plan” has the same meaning as in section 4011 of 16
	3153	+	this chapter and includes prescription drug benefits managed by a health 17
	3154	+	insurer or by a pharmacy benefit manager on behalf of a health insurer. 18
	3155	+	(4) “Interchangeable biological products” has the same meaning as in 19
	3156	+	18 V.S.A. § 4601. 20 BILL AS INTRODUCED S.30
5395	3157		2025 Page 130 of 181
5396		-	physicianassistantunder26V.S.A.chapter31,oranindividuallicensedasan
5397		-	advancedpracticeregisterednurseunder26V.S.A.chapter28.
5398		-	(3)“Healthinsuranceplan”hasthesamemeaningasinsection4011of
5399		-	thischapterandincludesprescriptiondrugbenefitsmanagedbyahealth
5400		-	insurerorbyapharmacybenefitmanageronbehalfofahealthinsurer.
5401		-	(4)“Interchangeablebiologicalproducts”hasthesamemeaningasin
5402		-	18 V.S.A.§4601.
5403		-	(5)“Out-of-pocketexpenditure”meansaco-payment,coinsurance,
5404		-	deductible,orothercost-sharingmechanism.
5405		-	(6)“Pharmacybenefitmanager”meansanentitythatperforms
5406		-	pharmacybenefitmanagement.“Pharmacybenefitmanagement”meansan
5407		-	arrangementfortheprocurementofprescriptiondrugsatnegotiateddispensing
5408		-	rates,theadministrationormanagementofprescriptiondrugbenefitsprovided
5409		-	byahealthinsuranceplanforthebenefitofbeneficiaries,oranyofthe
5410		-	followingservicesprovidedwithregardtotheadministrationofpharmacy
5411		-	benefits:
5412		-	(A)mailservicepharmacy;
5413		-	(B)claimsprocessing,retailnetworkmanagement,andpaymentof
5414		-	claimstopharmaciesforprescriptiondrugsdispensedtobeneficiaries;
5415		-	(C)clinicalformularydevelopmentandmanagementservices;
5416		-	(D)rebatecontractingandadministration;
5417		-	1
5418		-	2
5419		-	3
5420		-	4
5421		-	5
5422		-	6
5423		-	7
5424		-	8
5425		-	9
5426		-	10
5427		-	11
5428		-	12
5429		-	13
5430		-	14
5431		-	15
5432		-	16
5433		-	17
5434		-	18
5435		-	19
5436		-	20
5437		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3158	+
	3159	+
	3160	+	VT LEG #380165 v.1
	3161	+	(5) “Out-of-pocket expenditure” means a co-payment, coinsurance, 1
	3162	+	deductible, or other cost-sharing mechanism. 2
	3163	+	(6) “Pharmacy benefit manager” means an entity that performs 3
	3164	+	pharmacy benefit management. “Pharmacy benefit management” means an 4
	3165	+	arrangement for the procurement of prescription drugs at negotiated dispensing 5
	3166	+	rates, the administration or management of prescription drug benefits provided 6
	3167	+	by a health insurance plan for the benefit of beneficiaries, or any of the 7
	3168	+	following services provided with regard to the administration of pharmacy 8
	3169	+	benefits: 9
	3170	+	(A) mail service pharmacy; 10
	3171	+	(B) claims processing, retail network management, and payment of 11
	3172	+	claims to pharmacies for prescription drugs dispensed to beneficiaries; 12
	3173	+	(C) clinical formulary development and management services; 13
	3174	+	(D) rebate contracting and administration; 14
	3175	+	(E) certain patient compliance, therapeutic intervention, and generic 15
	3176	+	substitution programs; and 16
	3177	+	(F) disease management programs. 17
	3178	+	(7) “Pharmacy benefit manager affiliate” means a pharmacy or 18
	3179	+	pharmacist that, directly or indirectly, through one or more intermediaries, is 19
	3180	+	owned or controlled by, or is under common ownership or control with, a 20
	3181	+	pharmacy benefit manager. 21 BILL AS INTRODUCED S.30
5438	3182		2025 Page 131 of 181
5439		-	(E)certainpatientcompliance,therapeuticintervention,andgeneric
5440		-	substitutionprograms;and
5441		-	(F)diseasemanagementprograms.
5442		-	(7)“Pharmacybenefitmanageraffiliate”meansapharmacyor
5443		-	pharmacistthat,directlyorindirectly,throughoneormoreintermediaries,is
5444		-	ownedorcontrolledby,orisundercommonownershiporcontrolwith,a
5445		-	pharmacybenefitmanager.
5446		-	(8)“Prescriptiondrug”or“drug”hasthesamemeaningas“prescription
5447		-	drug”in26V.S.A.§2022andincludes:
5448		-	(A)biologicalproducts,asdefinedin18V.S.A.§4601;
5449		-	(B)medicationsusedtotreatcomplex,chronicconditions,including
5450		-	medicationsthatrequireadministration,infusion,orinjectionbyahealthcare
5451		-	professional;
5452		-	(C)medicationsforwhichthemanufacturerortheU.S.Foodand
5453		-	DrugAdministrationrequiresexclusive,restricted,orlimiteddistribution;and
5454		-	(D)medicationswithspecializedhandling,storage,orinventory
5455		-	reportingrequirements.
5456		-	(9)“Prescriptioninsulinmedication”meansaprescriptiondrugthat
5457		-	containsinsulinandisusedtotreatdiabetes.
5458		-	1
5459		-	2
5460		-	3
5461		-	4
5462		-	5
5463		-	6
5464		-	7
5465		-	8
5466		-	9
5467		-	10
5468		-	11
5469		-	12
5470		-	13
5471		-	14
5472		-	15
5473		-	16
5474		-	17
5475		-	18
5476		-	19 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3183	+
	3184	+
	3185	+	VT LEG #380165 v.1
	3186	+	(8) “Prescription drug” or “drug” has the same meaning as “prescription 1
	3187	+	drug” in 26 V.S.A. § 2022 and includes: 2
	3188	+	(A) biological products, as defined in 18 V.S.A. § 4601; 3
	3189	+	(B) medications used to treat complex, chronic conditions, including 4
	3190	+	medications that require administration, infusion, or injection by a health care 5
	3191	+	professional; 6
	3192	+	(C) medications for which the manufacturer or the U.S. Food and 7
	3193	+	Drug Administration requires exclusive, restricted, or limited distribution; and 8
	3194	+	(D) medications with specialized handling, storage, or inventory 9
	3195	+	reporting requirements. 10
	3196	+	(9) “Prescription insulin medication” means a prescription drug that 11
	3197	+	contains insulin and is used to treat diabetes. 12
	3198	+	(10) “Step therapy” means protocols that establish the specific sequence 13
	3199	+	in which prescription drugs for a specific medical condition are to be 14
	3200	+	prescribed. 15
	3201	+	§ 4092. PRESCRIPTION DRUG COVERAGE 16
	3202	+	(a) A health insurance plan shall not include an annual dollar limit on 17
	3203	+	prescription drug benefits. 18
	3204	+	(b) A health insurance plan shall limit a covered individual’s out-of-pocket 19
	3205	+	expenditures for all prescription drugs to not more for self-only and family 20
	3206	+	coverage per year than the minimum dollar amounts in effect under Section 21 BILL AS INTRODUCED S.30
5477	3207		2025 Page 132 of 181
5478		-	(10)“Steptherapy”meansprotocolsthatestablishthespecificsequence
5479		-	inwhichprescriptiondrugsforaspecificmedicalconditionaretobe
5480		-	prescribed.
5481		-	§ 4092.PRESCRIPTIONDRUGCOVERAGE
5482		-	(a)Ahealthinsuranceplanshallnotincludeanannualdollarlimiton
5483		-	prescriptiondrugbenefits.
5484		-	(b)Ahealthinsuranceplanshalllimitacoveredindividual’sout-of-pocket
5485		-	expendituresforallprescriptiondrugstonotmoreforself-onlyandfamily
5486		-	coverageperyearthantheminimumdollaramountsineffectunderSection
5487		-	223(c)(2)(A)(i)oftheInternalRevenueCodeof1986forself-onlyandfamily
5488		-	coverage,respectively.
5489		-	(c)(1)Forprescriptiondrugbenefitsofferedinconjunctionwithahigh-
5490		-	deductiblehealthplan(HDHP),theplanshallnotprovideprescriptiondrug
5491		-	benefitsuntiltheexpendituresapplicabletothedeductibleundertheHDHP
5492		-	havemettheamountoftheminimumannualdeductiblesineffectforself-only
5493		-	andfamilycoverageunderSection223(c)(2)(A)(i)oftheInternalRevenue
5494		-	Codeof1986forself-onlyandfamilycoverage,respectively,exceptthata
5495		-	planmayofferfirst-dollarprescriptiondrugbenefitstotheextentpermitted
5496		-	underfederallaw.
5497		-	(2)Oncetheapplicableexpenditureamountsetforthinsubdivision(1)
5498		-	ofthissubsectionhasbeenmetundertheHDHP,coverageforprescription
5499		-	1
5500		-	2
5501		-	3
5502		-	4
5503		-	5
5504		-	6
5505		-	7
5506		-	8
5507		-	9
5508		-	10
5509		-	11
5510		-	12
5511		-	13
5512		-	14
5513		-	15
5514		-	16
5515		-	17
5516		-	18
5517		-	19
5518		-	20
5519		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3208	+
	3209	+
	3210	+	VT LEG #380165 v.1
	3211	+	223(c)(2)(A)(i) of the Internal Revenue Code of 1986 for self-only and family 1
	3212	+	coverage, respectively. 2
	3213	+	(c)(1) For prescription drug benefits offered in conjunction with a high-3
	3214	+	deductible health plan (HDHP), the plan shall not provide prescription drug 4
	3215	+	benefits until the expenditures applicable to the deductible under the HDHP 5
	3216	+	have met the amount of the minimum annual deductibles in effect for self-only 6
	3217	+	and family coverage under Section 223(c)(2)(A)(i) of the Internal Revenue 7
	3218	+	Code of 1986 for self-only and family coverage, respectively, except that a 8
	3219	+	plan may offer first-dollar prescription drug benefits to the extent permitted 9
	3220	+	under federal law. 10
	3221	+	(2) Once the applicable expenditure amount set forth in subdivision (1) 11
	3222	+	of this subsection has been met under the HDHP, coverage for prescription 12
	3223	+	drug benefits shall begin, and the limit on out-of-pocket expenditures for 13
	3224	+	prescription drug benefits shall be as specified in subsection (b) of this section. 14
	3225	+	(d)(1) A health insurance plan that uses step-therapy protocols shall: 15
	3226	+	(A) not require failure, including discontinuation due to lack of 16
	3227	+	efficacy or effectiveness, diminished effect, or an adverse event, on the same 17
	3228	+	drug on more than one occasion for covered individuals who are continuously 18
	3229	+	enrolled in a plan offered by the health insurer or its pharmacy benefit 19
	3230	+	manager; and 20 BILL AS INTRODUCED S.30
5520	3231		2025 Page 133 of 181
5521		-	drugbenefitsshallbegin,andthelimitonout-of-pocketexpendituresfor
5522		-	prescriptiondrugbenefitsshallbeasspecifiedinsubsection(b)ofthissection.
5523		-	(d)(1)Ahealthinsuranceplanthatusesstep-therapyprotocolsshall:
5524		-	(A)notrequirefailure,includingdiscontinuationduetolackof
5525		-	efficacyoreffectiveness,diminishedeffect,oranadverseevent,onthesame
5526		-	drugonmorethanoneoccasionforcoveredindividualswhoarecontinuously
5527		-	enrolledinaplanofferedbythehealthinsureroritspharmacybenefit
5528		-	manager;and
5529		-	(B)grantanexceptiontoitsstep-therapyprotocolsuponrequestofa
5530		-	coveredindividualorthecoveredindividual’streatinghealthcareprofessional
5531		-	underthesametimeparametersassetforthforpriorauthorizationrequestsin
5532		-	18V.S.A.§ 9418b(g)(4)ifanyoneormoreofthefollowingconditionsapply:
5533		-	(i)theprescriptiondrugrequiredunderthestep-therapyprotocol
5534		-	iscontraindicatedorwilllikelycauseanadversereactionorphysicalormental
5535		-	harmtothecoveredindividual;
5536		-	(ii)theprescriptiondrugrequiredunderthestep-therapyprotocol
5537		-	isexpectedtobeineffectivebasedonthecoveredindividual’sknownclinical
5538		-	history,condition,andprescriptiondrugregimen;
5539		-	(iii)thecoveredindividualhasalreadytriedtheprescriptiondrugs
5540		-	ontheprotocol,orotherprescriptiondrugsinthesamepharmacologicclassor
5541		-	withthesamemechanismofaction,whichhavebeendiscontinuedduetolack
5542		-	1
5543		-	2
5544		-	3
5545		-	4
5546		-	5
5547		-	6
5548		-	7
5549		-	8
5550		-	9
5551		-	10
5552		-	11
5553		-	12
5554		-	13
5555		-	14
5556		-	15
5557		-	16
5558		-	17
5559		-	18
5560		-	19
5561		-	20
5562		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3232	+
	3233	+
	3234	+	VT LEG #380165 v.1
	3235	+	(B) grant an exception to its step-therapy protocols upon request of a 1
	3236	+	covered individual or the covered individual’s treating health care professional 2
	3237	+	under the same time parameters as set forth for prior authorization requests in 3
	3238	+	18 V.S.A. § 9418b(g)(4) if any one or more of the following conditions apply: 4
	3239	+	(i) the prescription drug required under the step-therapy protocol 5
	3240	+	is contraindicated or will likely cause an adverse reaction or physical or mental 6
	3241	+	harm to the covered individual; 7
	3242	+	(ii) the prescription drug required under the step-therapy protocol 8
	3243	+	is expected to be ineffective based on the covered individual’s known clinical 9
	3244	+	history, condition, and prescription drug regimen; 10
	3245	+	(iii) the covered individual has already tried the prescription drugs 11
	3246	+	on the protocol, or other prescription drugs in the same pharmacologic class or 12
	3247	+	with the same mechanism of action, which have been discontinued due to lack 13
	3248	+	of efficacy or effectiveness, diminished effect, or an adverse event, regardless 14
	3249	+	of whether the covered individual was covered at the time on a plan offered by 15
	3250	+	the current insurer or its pharmacy benefit manager; 16
	3251	+	(iv) the covered individual is stable on a prescription drug selected 17
	3252	+	by the covered individual’s treating health care professional for the medical 18
	3253	+	condition under consideration; or 19
	3254	+	(v) the step-therapy protocol or a prescription drug required under 20
	3255	+	the protocol is not in the covered individual’s best interests because it will: 21 BILL AS INTRODUCED S.30
5563	3256		2025 Page 134 of 181
5564		-	ofefficacyoreffectiveness,diminishedeffect,oranadverseevent,regardless
5565		-	ofwhetherthecoveredindividualwascoveredatthetimeonaplanofferedby
5566		-	thecurrentinsureroritspharmacybenefitmanager;
5567		-	(iv)thecoveredindividualisstableonaprescriptiondrugselected
5568		-	bythecoveredindividual’streatinghealthcareprofessionalforthemedical
5569		-	conditionunderconsideration;or
5570		-	(v)thestep-therapyprotocoloraprescriptiondrugrequiredunder
5571		-	theprotocolisnotinthecoveredindividual’sbestinterestsbecauseitwill:
5572		-	(I)poseabarriertoadherence;
5573		-	(II)likelyworsenacomorbidcondition;or
5574		-	(III)likelydecreasethecoveredindividual’sabilitytoachieve
5575		-	ormaintainreasonablefunctionalability.
5576		-	(2)Nothinginthissubsectionshallbeconstruedtoprohibittheuseof
5577		-	tieredco-paymentsforcoveredindividualsnotsubjecttoastep-therapy
5578		-	protocol.
5579		-	(3)Notwithstandinganyprovisionofsubdivision(1)ofthissubsection
5580		-	tothecontrary,ahealthinsuranceshallnotutilizeastep-therapy,“failfirst,”or
5581		-	otherprotocolthatrequiresdocumentedtrialsofaprescriptiondrug,including
5582		-	atrialdocumentedthrougha“MedWatch”(FDAForm3500),before
5583		-	approvingaprescriptionforthetreatmentofsubstanceusedisorder.
5584		-	1
5585		-	2
5586		-	3
5587		-	4
5588		-	5
5589		-	6
5590		-	7
5591		-	8
5592		-	9
5593		-	10
5594		-	11
5595		-	12
5596		-	13
5597		-	14
5598		-	15
5599		-	16
5600		-	17
5601		-	18
5602		-	19
5603		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3257	+
	3258	+
	3259	+	VT LEG #380165 v.1
	3260	+	(I) pose a barrier to adherence; 1
	3261	+	(II) likely worsen a comorbid condition; or 2
	3262	+	(III) likely decrease the covered individual’s ability to achieve 3
	3263	+	or maintain reasonable functional ability. 4
	3264	+	(2) Nothing in this subsection shall be construed to prohibit the use of 5
	3265	+	tiered co-payments for covered individuals not subject to a step-therapy 6
	3266	+	protocol. 7
	3267	+	(3) Notwithstanding any provision of subdivision (1) of this subsection 8
	3268	+	to the contrary, a health insurance shall not utilize a step-therapy, “fail first,” or 9
	3269	+	other protocol that requires documented trials of a prescription drug, including 10
	3270	+	a trial documented through a “MedWatch” (FDA Form 3500), before 11
	3271	+	approving a prescription for the treatment of substance use disorder. 12
	3272	+	(e)(1) A health insurance plan shall not require, as a condition of coverage, 13
	3273	+	use of drugs not indicated by the U.S. Food and Drug Administration for the 14
	3274	+	condition diagnosed and being treated under the supervision of a health care 15
	3275	+	professional. 16
	3276	+	(2) Nothing in this subsection shall be construed to prevent a health care 17
	3277	+	professional from prescribing a prescription drug for off-label use. 18
	3278	+	(f) A health insurance plan shall apply the same cost-sharing requirements 19
	3279	+	to interchangeable biological products as apply to generic drugs under the plan. 20 BILL AS INTRODUCED S.30
5604	3280		2025 Page 135 of 181
5605		-	(e)(1)Ahealthinsuranceplanshallnotrequire,asaconditionofcoverage,
5606		-	useofdrugsnotindicatedbytheU.S.FoodandDrugAdministrationforthe
5607		-	conditiondiagnosedandbeingtreatedunderthesupervisionofahealthcare
5608		-	professional.
5609		-	(2)Nothinginthissubsectionshallbeconstruedtopreventahealthcare
5610		-	professionalfromprescribingaprescriptiondrugforoff-labeluse.
5611		-	(f)Ahealthinsuranceplanshallapplythesamecost-sharingrequirements
5612		-	tointerchangeablebiologicalproductsasapplytogenericdrugsunderthe
5613		-	plan.
5614		-	(g)(1)Ahealthinsuranceplanshalllimitacoveredindividual’stotalout-
5615		-	of-pocketresponsibilityforprescriptioninsulindrugstonotmorethan
5616		-	$100.00per30-daysupply,regardlessoftheamount,type,ornumberof
5617		-	insulindrugsprescribedforthecoveredindividual.
5618		-	(2)The$100.00monthlylimitonout-of-pocketspendingfor
5619		-	prescriptioninsulindrugssetforthinsubdivision(1)ofthissubsectionshall
5620		-	applyregardlessofwhetherthecoveredindividualhassatisfiedanyapplicable
5621		-	deductiblerequirementunderthehealthinsuranceplan.
5622		-	(h)Ahealthinsuranceplanshallcover,withoutrequiringprior
5623		-	authorization,atleastonereadilyavailableasthmacontrollerdrugfromeach
5624		-	classofdrugandmodeofadministration.Asusedinthissubsection,“readily
5625		-	available”meansthatthemedicationisnotlistedonanationaldrugshortage
5626		-	1
5627		-	2
5628		-	3
5629		-	4
5630		-	5
5631		-	6
5632		-	7
5633		-	8
5634		-	9
5635		-	10
5636		-	11
5637		-	12
5638		-	13
5639		-	14
5640		-	15
5641		-	16
5642		-	17
5643		-	18
5644		-	19
5645		-	20
5646		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3281	+
	3282	+
	3283	+	VT LEG #380165 v.1
	3284	+	(g)(1) A health insurance plan shall limit a covered individual’s total out-1
	3285	+	of-pocket responsibility for prescription insulin drugs to not more than $100.00 2
	3286	+	per 30-day supply, regardless of the amount, type, or number of insulin drugs 3
	3287	+	prescribed for the covered individual. 4
	3288	+	(2) The $100.00 monthly limit on out-of-pocket spending for 5
	3289	+	prescription insulin drugs set forth in subdivision (1) of this subsection shall 6
	3290	+	apply regardless of whether the covered individual has satisfied any applicable 7
	3291	+	deductible requirement under the health insurance plan. 8
	3292	+	(h) A health insurance plan shall cover, without requiring prior 9
	3293	+	authorization, at least one readily available asthma controller drug from each 10
	3294	+	class of drug and mode of administration. As used in this subsection, “readily 11
	3295	+	available” means that the medication is not listed on a national drug shortage 12
	3296	+	list, including lists maintained by the U.S. Food and Drug Administration and 13
	3297	+	by the American Society of Health-System Pharmacists. 14
	3298	+	(i) On a periodic basis but not less than once per calendar year, each health 15
	3299	+	insurer shall notify all individuals covered under its health insurance plans of 16
	3300	+	any changes in pharmaceutical coverage and provide access to the preferred 17
	3301	+	drug list maintained by the health insurer or its pharmacy benefit manager. 18
	3302	+	(j) The Department of Financial Regulation shall enforce this section and 19
	3303	+	may adopt rules as necessary to carry out the purposes of this section. 20 BILL AS INTRODUCED S.30
5647	3304		2025 Page 136 of 181
5648		-	list,includinglistsmaintainedbytheU.S.FoodandDrugAdministrationand
5649		-	bytheAmericanSocietyofHealth-SystemPharmacists.
5650		-	(i)Onaperiodicbasisbutnotlessthanoncepercalendaryear,eachhealth
5651		-	insurershallnotifyallindividualscoveredunderitshealthinsuranceplansof
5652		-	anychangesinpharmaceuticalcoverageandprovideaccesstothepreferred
5653		-	druglistmaintainedbythehealthinsureroritspharmacybenefitmanager.
5654		-	(j)TheDepartmentofFinancialRegulationshallenforcethissectionand
5655		-	mayadoptrulesasnecessarytocarryoutthepurposesofthissection.
5656		-	(k)Ahealthinsuranceplanshallprovidecoverageforprescriptiondrugs
5657		-	purchasedinCanadaandusedinCanadaorreimportedlegallyonthesame
5658		-	benefittermsandconditionsasprescriptiondrugspurchasedinthiscountry.
5659		-	Fordrugspurchasedbymailorthroughtheinternet,theplanmayrequire
5660		-	accreditationbytheInternetandMailorderPharmacyAccreditation
5661		-	Commission(IMPAC/tm)orsimilarorganization.
5662		-	§ 4093.RETAILPHARMACIES;FILLINGOFPRESCRIPTIONS
5663		-	(a)Ahealthinsurerorpharmacybenefitmanagerdoingbusinessin
5664		-	Vermontshallpermitaretailpharmacistlicensedunder26V.S.A.chapter36
5665		-	tofillprescriptionsforallprescriptiondrugsinthesamemannerandatthe
5666		-	samelevelofreimbursementastheyarefilledbyanyotherpharmacistor
5667		-	pharmacy,includingamail-orderpharmacyorapharmacybenefitmanager
5668		-	1
5669		-	2
5670		-	3
5671		-	4
5672		-	5
5673		-	6
5674		-	7
5675		-	8
5676		-	9
5677		-	10
5678		-	11
5679		-	12
5680		-	13
5681		-	14
5682		-	15
5683		-	16
5684		-	17
5685		-	18
5686		-	19
5687		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3305	+
	3306	+
	3307	+	VT LEG #380165 v.1
	3308	+	(k) A health insurance plan shall provide coverage for prescription drugs 1
	3309	+	purchased in Canada and used in Canada or reimported legally on the same 2
	3310	+	benefit terms and conditions as prescription drugs purchased in this country. 3
	3311	+	For drugs purchased by mail or through the internet, the plan may require 4
	3312	+	accreditation by the Internet and Mailorder Pharmacy Accreditation 5
	3313	+	Commission (IMPAC/tm) or similar organization. 6
	3314	+	§ 4093. RETAIL PHARMACIES; FILLING OF PRESCRIPTIONS 7
	3315	+	(a) A health insurer or pharmacy benefit manager doing business in 8
	3316	+	Vermont shall permit a retail pharmacist licensed under 26 V.S.A. chapter 36 9
	3317	+	to fill prescriptions for all prescription drugs in the same manner and at the 10
	3318	+	same level of reimbursement as they are filled by any other pharmacist or 11
	3319	+	pharmacy, including a mail-order pharmacy or a pharmacy benefit manager 12
	3320	+	affiliate, with respect to the quantity of drugs or days’ supply of drugs 13
	3321	+	dispensed under each prescription. 14
	3322	+	(b) Notwithstanding any provision of a health insurance plan to the 15
	3323	+	contrary, if a health insurance plan provides for payment or reimbursement that 16
	3324	+	is within the lawful scope of practice of a pharmacist, the health insurer may 17
	3325	+	provide payment or reimbursement for the service when the service is provided 18
	3326	+	by a pharmacist. 19
	3327	+	(c)(1) A health insurer or pharmacy benefit manager shall permit a 20
	3328	+	participating network pharmacy to perform all pharmacy services within the 21 BILL AS INTRODUCED S.30
5688	3329		2025 Page 137 of 181
5689		-	affiliate,withrespecttothequantityofdrugsordays’supplyofdrugs
5690		-	dispensedundereachprescription.
5691		-	(b)Notwithstandinganyprovisionofahealthinsuranceplantothe
5692		-	contrary,ifahealthinsuranceplanprovidesforpaymentorreimbursement
5693		-	thatiswithinthelawfulscopeofpracticeofapharmacist,thehealthinsurer
5694		-	mayprovidepaymentorreimbursementfortheservicewhentheserviceis
5695		-	providedbyapharmacist.
5696		-	(c)(1)Ahealthinsurerorpharmacybenefitmanagershallpermita
5697		-	participatingnetworkpharmacytoperformallpharmacyserviceswithinthe
5698		-	lawfulscopeoftheprofessionofpharmacyassetforthin26V.S.A.chapter
5699		-	36.
5700		-	(2)Ahealthinsurerorpharmacybenefitmanagershallnotdoanyof
5701		-	thefollowing:
5702		-	(A)Requireacoveredindividual,asaconditionofpaymentor
5703		-	reimbursement,topurchasepharmacistservices,includingprescriptiondrugs,
5704		-	exclusivelythroughamail-orderpharmacyorapharmacybenefitmanager
5705		-	affiliate.
5706		-	(B)Offerorimplementplandesignsthatrequireacoveredindividual
5707		-	touseamail-orderpharmacyorapharmacybenefitmanageraffiliate.
5708		-	1
5709		-	2
5710		-	3
5711		-	4
5712		-	5
5713		-	6
5714		-	7
5715		-	8
5716		-	9
5717		-	10
5718		-	11
5719		-	12
5720		-	13
5721		-	14
5722		-	15
5723		-	16
5724		-	17
5725		-	18
5726		-	19 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3330	+
	3331	+
	3332	+	VT LEG #380165 v.1
	3333	+	lawful scope of the profession of pharmacy as set forth in 26 V.S.A. chapter 1
	3334	+	36. 2
	3335	+	(2) A health insurer or pharmacy benefit manager shall not do any of the 3
	3336	+	following: 4
	3337	+	(A) Require a covered individual, as a condition of payment or 5
	3338	+	reimbursement, to purchase pharmacist services, including prescription drugs, 6
	3339	+	exclusively through a mail-order pharmacy or a pharmacy benefit manager 7
	3340	+	affiliate. 8
	3341	+	(B) Offer or implement plan designs that require a covered individual 9
	3342	+	to use a mail-order pharmacy or a pharmacy benefit manager affiliate. 10
	3343	+	(C) Order a covered individual, orally or in writing, including 11
	3344	+	through online messaging, to use a mail-order pharmacy or a pharmacy benefit 12
	3345	+	manager affiliate. 13
	3346	+	(D) Establish network requirements that are more restrictive than or 14
	3347	+	inconsistent with State or federal law, rules adopted by the Board of Pharmacy, 15
	3348	+	or guidance provided by the Board of Pharmacy or by drug manufacturers that 16
	3349	+	operate to limit or prohibit a pharmacy or pharmacist from dispensing or 17
	3350	+	prescribing drugs. 18
	3351	+	(E) Offer or implement plan designs that increase plan or patient 19
	3352	+	costs if the covered individual chooses not to use a mail-order pharmacy or a 20
	3353	+	pharmacy benefit manager affiliate. The prohibition in this subdivision (E) 21 BILL AS INTRODUCED S.30
5727	3354		2025 Page 138 of 181
5728		-	(C)Orderacoveredindividual,orallyorinwriting,including
5729		-	throughonlinemessaging,touseamail-orderpharmacyorapharmacybenefit
5730		-	manageraffiliate.
5731		-	(D)Establishnetworkrequirementsthataremorerestrictivethanor
5732		-	inconsistentwithStateorfederallaw,rulesadoptedbytheBoardofPharmacy,
5733		-	orguidanceprovidedbytheBoardofPharmacyorbydrugmanufacturersthat
5734		-	operatetolimitorprohibitapharmacyorpharmacistfromdispensingor
5735		-	prescribingdrugs.
5736		-	(E)Offerorimplementplandesignsthatincreaseplanorpatient
5737		-	costsifthecoveredindividualchoosesnottouseamail-orderpharmacyora
5738		-	pharmacybenefitmanageraffiliate.Theprohibitioninthissubdivision(E)
5739		-	includesrequiringacoveredindividualtopaythefullcostforaprescription
5740		-	drugwhenthecoveredindividualchoosesnottouseamail-orderpharmacyor
5741		-	apharmacybenefitmanageraffiliate.
5742		-	(F)(i)Excludeanyamountpaidbyoronbehalfofacovered
5743		-	individual,includinganythird-partypayment,financialassistance,discount,
5744		-	coupon,orotherreduction,whencalculatingacoveredindividual’s
5745		-	contributiontoward:
5746		-	(I)theout-of-pocketlimitsforprescriptiondrugcostsunder
5747		-	section4092ofthistitle;
5748		-	(II)thecoveredindividual’sdeductible,ifany;or
5749		-	1
5750		-	2
5751		-	3
5752		-	4
5753		-	5
5754		-	6
5755		-	7
5756		-	8
5757		-	9
5758		-	10
5759		-	11
5760		-	12
5761		-	13
5762		-	14
5763		-	15
5764		-	16
5765		-	17
5766		-	18
5767		-	19
5768		-	20
5769		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3355	+
	3356	+
	3357	+	VT LEG #380165 v.1
	3358	+	includes requiring a covered individual to pay the full cost for a prescription 1
	3359	+	drug when the covered individual chooses not to use a mail-order pharmacy or 2
	3360	+	a pharmacy benefit manager affiliate. 3
	3361	+	(F)(i) Exclude any amount paid by or on behalf of a covered 4
	3362	+	individual, including any third-party payment, financial assistance, discount, 5
	3363	+	coupon, or other reduction, when calculating a covered individual’s 6
	3364	+	contribution toward: 7
	3365	+	(I) the out-of-pocket limits for prescription drug costs under 8
	3366	+	section 4092 of this title; 9
	3367	+	(II) the covered individual’s deductible, if any; or 10
	3368	+	(III) to the extent not inconsistent with Sec. 2707 of the Public 11
	3369	+	Health Service Act, 42 U.S.C. § 300gg-6, the annual out-of-pocket maximums 12
	3370	+	applicable to the covered individual’s health benefit plan. 13
	3371	+	(ii) The provisions of subdivision (i) of this subdivision (F) 14
	3372	+	relating to a third-party payment, financial assistance, discount, coupon, or 15
	3373	+	other reduction in out-of-pocket expenses made on behalf of a covered 16
	3374	+	individual shall only apply to a prescription drug: 17
	3375	+	(I) for which there is no generic drug or interchangeable 18
	3376	+	biological product, as those terms are defined in 18 V.S.A. § 4601; or 19
	3377	+	(II) for which there is a generic drug or interchangeable 20
	3378	+	biological product, as those terms are defined in 18 V.S.A. § 4601, but for 21 BILL AS INTRODUCED S.30
5770	3379		2025 Page 139 of 181
5771		-	(III)totheextentnotinconsistentwithSec.2707ofthePublic
5772		-	HealthServiceAct,42U.S.C.§ 300gg-6,theannualout-of-pocketmaximums
5773		-	applicabletothecoveredindividual’shealthbenefitplan.
5774		-	(ii)Theprovisionsofsubdivision(i)ofthissubdivision(F)
5775		-	relatingtoathird-partypayment,financialassistance,discount,coupon,or
5776		-	otherreductioninout-of-pocketexpensesmadeonbehalfofacovered
5777		-	individualshallonlyapplytoaprescriptiondrug:
5778		-	(I)forwhichthereisnogenericdrugorinterchangeable
5779		-	biologicalproduct,asthosetermsaredefinedin18V.S.A.§4601;or
5780		-	(II)forwhichthereisagenericdrugorinterchangeable
5781		-	biologicalproduct,asthosetermsaredefinedin18V.S.A.§4601,butfor
5782		-	whichthecoveredindividualhasobtainedaccessthroughpriorauthorization,
5783		-	asteptherapyprotocol,orthepharmacybenefitmanager’sorhealthinsurer’s
5784		-	exceptionsandappealsprocess.
5785		-	(iii)Theprovisionsofsubdivision(i)ofthissubdivision(F)shall
5786		-	applytoahigh-deductiblehealthplanonlytotheextentthatitwouldnot
5787		-	disqualifytheplanfromeligibilityforahealthsavingsaccountpursuantto
5788		-	26 U.S.C.§ 223.
5789		-	(3)Ahealthinsurerorpharmacybenefitmanagershallnot,bycontract,
5790		-	writtenpolicy,orwrittenprocedure,requirethatapharmacydesignatedbythe
5791		-	healthinsurerorpharmacybenefitmanagerdispenseamedicationdirectlytoa
5792		-	1
5793		-	2
5794		-	3
5795		-	4
5796		-	5
5797		-	6
5798		-	7
5799		-	8
5800		-	9
5801		-	10
5802		-	11
5803		-	12
5804		-	13
5805		-	14
5806		-	15
5807		-	16
5808		-	17
5809		-	18
5810		-	19
5811		-	20
5812		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3380	+
	3381	+
	3382	+	VT LEG #380165 v.1
	3383	+	which the covered individual has obtained access through prior authorization, a 1
	3384	+	step therapy protocol, or the pharmacy benefit manager’s or health insurer’s 2
	3385	+	exceptions and appeals process. 3
	3386	+	(iii) The provisions of subdivision (i) of this subdivision (F) shall 4
	3387	+	apply to a high-deductible health plan only to the extent that it would not 5
	3388	+	disqualify the plan from eligibility for a health savings account pursuant to 6
	3389	+	26 U.S.C. § 223. 7
	3390	+	(3) A health insurer or pharmacy benefit manager shall not, by contract, 8
	3391	+	written policy, or written procedure, require that a pharmacy designated by the 9
	3392	+	health insurer or pharmacy benefit manager dispense a medication directly to a 10
	3393	+	covered individual with the expectation or intention that the covered individual 11
	3394	+	will transport the medication to a health care setting for administration by a 12
	3395	+	health care professional. 13
	3396	+	(4) A health insurer or pharmacy benefit manager shall not, by contract, 14
	3397	+	written policy, or written procedure, require that a pharmacy designated by the 15
	3398	+	health insurer or pharmacy benefit manager dispense a medication directly to a 16
	3399	+	health care setting for a health care professional to administer to a covered 17
	3400	+	individual. 18
	3401	+	(5) A health insurer or pharmacy benefit manager shall adhere to the 19
	3402	+	definitions of prescription drugs and the requirements and guidance regarding 20
	3403	+	the pharmacy profession established by State and federal law and the Vermont 21 BILL AS INTRODUCED S.30
5813	3404		2025 Page 140 of 181
5814		-	coveredindividualwiththeexpectationorintentionthatthecoveredindividual
5815		-	willtransportthemedicationtoahealthcaresettingforadministrationbya
5816		-	healthcareprofessional.
5817		-	(4)Ahealthinsurerorpharmacybenefitmanagershallnot,bycontract,
5818		-	writtenpolicy,orwrittenprocedure,requirethatapharmacydesignatedbythe
5819		-	healthinsurerorpharmacybenefitmanagerdispenseamedicationdirectlytoa
5820		-	healthcaresettingforahealthcareprofessionaltoadministertoacovered
5821		-	individual.
5822		-	(5)Ahealthinsurerorpharmacybenefitmanagershalladheretothe
5823		-	definitionsofprescriptiondrugsandtherequirementsandguidanceregarding
5824		-	thepharmacyprofessionestablishedbyStateandfederallawandtheVermont
5825		-	BoardofPharmacyandshallnotestablishclassificationsofordistinctions
5826		-	betweenprescriptiondrugs,imposepenaltiesonprescriptiondrugclaims,
5827		-	attempttodictatethebehaviorofpharmaciesorpharmacists,orplace
5828		-	restrictionsonpharmaciesorpharmaciststhataremorerestrictivethanor
5829		-	inconsistentwithStateorfederallaworwithrulesadoptedorguidance
5830		-	providedbytheBoardofPharmacy.
5831		-	(6)Apharmacybenefitmanagerorlicensedpharmacyshallnotmakea
5832		-	directsolicitationtoanindividualcoveredbyahealthinsuranceplanunless
5833		-	oneormoreofthefollowingapplies:
5834		-	1
5835		-	2
5836		-	3
5837		-	4
5838		-	5
5839		-	6
5840		-	7
5841		-	8
5842		-	9
5843		-	10
5844		-	11
5845		-	12
5846		-	13
5847		-	14
5848		-	15
5849		-	16
5850		-	17
5851		-	18
5852		-	19
5853		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3405	+
	3406	+
	3407	+	VT LEG #380165 v.1
	3408	+	Board of Pharmacy and shall not establish classifications of or distinctions 1
	3409	+	between prescription drugs, impose penalties on prescription drug claims, 2
	3410	+	attempt to dictate the behavior of pharmacies or pharmacists, or place 3
	3411	+	restrictions on pharmacies or pharmacists that are more restrictive than or 4
	3412	+	inconsistent with State or federal law or with rules adopted or guidance 5
	3413	+	provided by the Board of Pharmacy. 6
	3414	+	(6) A pharmacy benefit manager or licensed pharmacy shall not make a 7
	3415	+	direct solicitation to an individual covered by a health insurance plan unless 8
	3416	+	one or more of the following applies: 9
	3417	+	(A) the covered individual has given written permission to the 10
	3418	+	supplier or the ordering health care professional to contact the covered 11
	3419	+	individual regarding the furnishing of a prescription item that is to be rented or 12
	3420	+	purchased; 13
	3421	+	(B) the supplier has furnished a prescription item to the covered 14
	3422	+	individual and is contacting the covered individual to coordinate delivery of 15
	3423	+	the item; or 16
	3424	+	(C) if the contact relates to the furnishing of a prescription item other 17
	3425	+	than a prescription item already furnished to the covered individual, the 18
	3426	+	supplier has furnished at least one prescription item to the covered individual 19
	3427	+	within the 15-month period preceding the date on which the supplier attempts 20
	3428	+	to make the contact. 21 BILL AS INTRODUCED S.30
5854	3429		2025 Page 141 of 181
5855		-	(A)thecoveredindividualhasgivenwrittenpermissiontothe
5856		-	supplierortheorderinghealthcareprofessionaltocontactthecovered
5857		-	individualregardingthefurnishingofaprescriptionitemthatistoberentedor
5858		-	purchased;
5859		-	(B)thesupplierhasfurnishedaprescriptionitemtothecovered
5860		-	individualandiscontactingthecoveredindividualtocoordinatedeliveryof
5861		-	theitem;or
5862		-	(C)ifthecontactrelatestothefurnishingofaprescriptionitemother
5863		-	thanaprescriptionitemalreadyfurnishedtothecoveredindividual,the
5864		-	supplierhasfurnishedatleastoneprescriptionitemtothecoveredindividual
5865		-	withinthe15-monthperiodprecedingthedateonwhichthesupplierattempts
5866		-	tomakethecontact.
5867		-	(d)Ahealthinsurerorpharmacybenefitmanagershallnotalteracovered
5868		-	individual’sprescriptiondrugorderorthepharmacychosenbythecovered
5869		-	individualwithoutthecoveredindividual’sconsent;provided,however,that
5870		-	nothinginthissubsectionshallbeconstruedtoaffectthedutyofapharmacist
5871		-	tosubstitutealower-costdrugorbiologicalproductinaccordancewiththe
5872		-	provisionsof18V.S.A.§ 4605.
5873		-	(e)Alloftheprovisionsofthissectionexceptsubsection(c)shallapplyto
5874		-	Medicaidandanyotherpublichealthcareassistanceprogramofferedor
5875		-	administeredbytheStateorbyanysubdivisionorinstrumentalityoftheState.
5876		-	1
5877		-	2
5878		-	3
5879		-	4
5880		-	5
5881		-	6
5882		-	7
5883		-	8
5884		-	9
5885		-	10
5886		-	11
5887		-	12
5888		-	13
5889		-	14
5890		-	15
5891		-	16
5892		-	17
5893		-	18
5894		-	19
5895		-	20
5896		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3430	+
	3431	+
	3432	+	VT LEG #380165 v.1
	3433	+	(d) A health insurer or pharmacy benefit manager shall not alter a covered 1
	3434	+	individual’s prescription drug order or the pharmacy chosen by the covered 2
	3435	+	individual without the covered individual’s consent; provided, however, that 3
	3436	+	nothing in this subsection shall be construed to affect the duty of a pharmacist 4
	3437	+	to substitute a lower-cost drug or biological product in accordance with the 5
	3438	+	provisions of 18 V.S.A. § 4605. 6
	3439	+	(e) All of the provisions of this section except subsection (c) shall apply to 7
	3440	+	Medicaid and any other public health care assistance program offered or 8
	3441	+	administered by the State or by any subdivision or instrumentality of the State. 9
	3442	+	Subchapter 11. Prevention and Treatment of Cancer 10
	3443	+	§ 4095a. COLORECTAL CANCER SCREENING 11
	3444	+	(a) As used in this section, “colonoscopy” means a procedure that enables 12
	3445	+	a health care professional to examine visually the inside of a patient’s entire 13
	3446	+	colon and includes the concurrent removal of polyps or biopsy, or both. 14
	3447	+	(b) A health insurance plan shall provide coverage for colorectal cancer 15
	3448	+	screening, including: 16
	3449	+	(1) for a covered individual who is not at high risk for colorectal cancer, 17
	3450	+	colorectal cancer screening examinations and laboratory tests in accordance 18
	3451	+	with the most recently published recommendations established by the U.S. 19
	3452	+	Preventive Services Task Force for average-risk individuals; and 20 BILL AS INTRODUCED S.30
5897	3453		2025 Page 142 of 181
5898		-	Subchapter11.PreventionandTreatmentofCancer
5899		-	§ 4095a.COLORECTALCANCERSCREENING
5900		-	(a)Asusedinthissection,“colonoscopy”meansaprocedurethatenables
5901		-	ahealthcareprofessionaltoexaminevisuallytheinsideofapatient’sentire
5902		-	colonandincludestheconcurrentremovalofpolypsorbiopsy,orboth.
5903		-	(b)Ahealthinsuranceplanshallprovidecoverageforcolorectalcancer
5904		-	screening,including:
5905		-	(1)foracoveredindividualwhoisnotathighriskforcolorectalcancer,
5906		-	colorectalcancerscreeningexaminationsandlaboratorytestsinaccordance
5907		-	withthemostrecentlypublishedrecommendationsestablishedbytheU.S.
5908		-	PreventiveServicesTaskForceforaverage-riskindividuals;and
5909		-	(2)foracoveredindividualwhoisathighriskforcolorectalcancer,
5910		-	colorectalcancerscreeningexaminationsandlaboratorytestsasrecommended
5911		-	bythetreatinghealthcareprofessional.
5912		-	(c)Forthepurposesofsubdivision(b)(2)ofthissection,anindividualisat
5913		-	highriskforcolorectalcanceriftheindividualhas:
5914		-	(1)afamilymedicalhistoryofcolorectalcancerorageneticsyndrome
5915		-	predisposingtheindividualtocolorectalcancer;
5916		-	(2)aprioroccurrenceofcolorectalcancerorprecursorpolyps;
5917		-	(3)aprioroccurrenceofachronicdigestivediseaseconditionsuchas
5918		-	inflammatoryboweldisease,Crohn’sdisease,orulcerativecolitis;or
5919		-	1
5920		-	2
5921		-	3
5922		-	4
5923		-	5
5924		-	6
5925		-	7
5926		-	8
5927		-	9
5928		-	10
5929		-	11
5930		-	12
5931		-	13
5932		-	14
5933		-	15
5934		-	16
5935		-	17
5936		-	18
5937		-	19
5938		-	20
5939		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3454	+
	3455	+
	3456	+	VT LEG #380165 v.1
	3457	+	(2) for a covered individual who is at high risk for colorectal cancer, 1
	3458	+	colorectal cancer screening examinations and laboratory tests as recommended 2
	3459	+	by the treating health care professional. 3
	3460	+	(c) For the purposes of subdivision (b)(2) of this section, an individual is at 4
	3461	+	high risk for colorectal cancer if the individual has: 5
	3462	+	(1) a family medical history of colorectal cancer or a genetic syndrome 6
	3463	+	predisposing the individual to colorectal cancer; 7
	3464	+	(2) a prior occurrence of colorectal cancer or precursor polyps; 8
	3465	+	(3) a prior occurrence of a chronic digestive disease condition such as 9
	3466	+	inflammatory bowel disease, Crohn’s disease, or ulcerative colitis; or 10
	3467	+	(4) other predisposing factors as determined by the individual’s treating 11
	3468	+	health care professional. 12
	3469	+	(d) Colorectal cancer screening services performed under contract with the 13
	3470	+	insurer shall not be subject to any co-payment, deductible, coinsurance, or 14
	3471	+	other cost-sharing requirement. In addition, a covered individual shall not be 15
	3472	+	subject to any additional charge for any service associated with a procedure or 16
	3473	+	test for colorectal cancer screening, which may include one or more of the 17
	3474	+	following: 18
	3475	+	(1) removal of tissue or other matter; 19
	3476	+	(2) laboratory services; 20
	3477	+	(3) health care professional services; 21 BILL AS INTRODUCED S.30
5940	3478		2025 Page 143 of 181
5941		-	(4)otherpredisposingfactorsasdeterminedbytheindividual’streating
5942		-	healthcareprofessional.
5943		-	(d)Colorectalcancerscreeningservicesperformedundercontractwiththe
5944		-	insurershallnotbesubjecttoanyco-payment,deductible,coinsurance,or
5945		-	othercost-sharingrequirement.Inaddition,acoveredindividualshallnotbe
5946		-	subjecttoanyadditionalchargeforanyserviceassociatedwithaprocedureor
5947		-	testforcolorectalcancerscreening,whichmayincludeoneormoreofthe
5948		-	following:
5949		-	(1)removaloftissueorothermatter;
5950		-	(2)laboratoryservices;
5951		-	(3)healthcareprofessionalservices;
5952		-	(4)facilityuse;and
5953		-	(5)anesthesia.
5954		-	§ 4095b.MAMMOGRAPHY ANDOTHERBREASTIMAGING
5955		-	SERVICES
5956		-	(a)(1)Ahealthinsuranceplanshallprovidecoverageforscreening
5957		-	mammographyandforothermedicallynecessarybreastimagingservicesupon
5958		-	recommendationofahealthcareprofessionalasneededtodetectthepresence
5959		-	ofbreastcancerandotherabnormalitiesofthebreastorbreasttissue.In
5960		-	addition,ahealthinsuranceplanshallprovidecoverageforscreeningby
5961		-	ultrasoundoranotherappropriateimagingserviceforacoveredindividualfor
5962		-	1
5963		-	2
5964		-	3
5965		-	4
5966		-	5
5967		-	6
5968		-	7
5969		-	8
5970		-	9
5971		-	10
5972		-	11
5973		-	12
5974		-	13
5975		-	14
5976		-	15
5977		-	16
5978		-	17
5979		-	18
5980		-	19
5981		-	20
5982		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3479	+
	3480	+
	3481	+	VT LEG #380165 v.1
	3482	+	(4) facility use; and 1
	3483	+	(5) anesthesia. 2
	3484	+	§ 4095b. MAMMOGRAPHY AND OTHER BREAST IMAGING 3
	3485	+	SERVICES 4
	3486	+	(a)(1) A health insurance plan shall provide coverage for screening 5
	3487	+	mammography and for other medically necessary breast imaging services upon 6
	3488	+	recommendation of a health care professional as needed to detect the presence 7
	3489	+	of breast cancer and other abnormalities of the breast or breast tissue. In 8
	3490	+	addition, a health insurance plan shall provide coverage for screening by 9
	3491	+	ultrasound or another appropriate imaging service for a covered individual for 10
	3492	+	whom the results of a screening mammogram were inconclusive or who has 11
	3493	+	dense breast tissue, or both. 12
	3494	+	(2) Benefits provided shall cover the full cost of the mammography, 13
	3495	+	ultrasound, and other breast imaging services and shall not be subject to any 14
	3496	+	co-payment, deductible, coinsurance, or other cost-sharing requirement or 15
	3497	+	additional charge, except to the extent that such coverage would disqualify a 16
	3498	+	high-deductible health plan from eligibility for a health savings account 17
	3499	+	pursuant to 26 U.S.C. § 223. 18
	3500	+	(b) This section shall apply only to procedures conducted by test facilities 19
	3501	+	accredited by the American College of Radiologists. 20
	3502	+	(c) As used in this section: 21 BILL AS INTRODUCED S.30
5983	3503		2025 Page 144 of 181
5984		-	whomtheresultsofascreeningmammogramwereinconclusiveorwhohas
5985		-	densebreasttissue,orboth.
5986		-	(2)Benefitsprovidedshallcoverthefullcostofthemammography,
5987		-	ultrasound,andotherbreastimagingservicesandshallnotbesubjecttoany
5988		-	co-payment,deductible,coinsurance,orothercost-sharingrequirementor
5989		-	additionalcharge,excepttotheextentthatsuchcoveragewoulddisqualifya
5990		-	high-deductiblehealthplanfromeligibilityforahealthsavingsaccount
5991		-	pursuantto26U.S.C.§ 223.
5992		-	(b)Thissectionshallapplyonlytoproceduresconductedbytestfacilities
5993		-	accreditedbytheAmericanCollegeofRadiologists.
5994		-	(c)Asusedinthissection:
5995		-	(1)“Mammography”meansthex-rayexaminationofthebreastusing
5996		-	equipmentdedicatedspecificallyformammography,includingthex-raytube,
5997		-	filter,compressiondevice,anddigitaldetector.Thetermincludesbreast
5998		-	tomosynthesis.
5999		-	(2)“Otherbreastimagingservices”meansdiagnosticmammography,
6000		-	ultrasound,andmagneticresonanceimagingservicesthatenablehealthcare
6001		-	professionalstodetectthepresenceorabsenceofbreastcancerandother
6002		-	abnormalitiesaffectingthebreastorbreasttissue.
6003		-	1
6004		-	2
6005		-	3
6006		-	4
6007		-	5
6008		-	6
6009		-	7
6010		-	8
6011		-	9
6012		-	10
6013		-	11
6014		-	12
6015		-	13
6016		-	14
6017		-	15
6018		-	16
6019		-	17
6020		-	18
6021		-	19 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3504	+
	3505	+
	3506	+	VT LEG #380165 v.1
	3507	+	(1) “Mammography” means the x-ray examination of the breast using 1
	3508	+	equipment dedicated specifically for mammography, including the x-ray tube, 2
	3509	+	filter, compression device, and digital detector. The term includes breast 3
	3510	+	tomosynthesis. 4
	3511	+	(2) “Other breast imaging services” means diagnostic mammography, 5
	3512	+	ultrasound, and magnetic resonance imaging services that enable health care 6
	3513	+	professionals to detect the presence or absence of breast cancer and other 7
	3514	+	abnormalities affecting the breast or breast tissue. 8
	3515	+	(3) “Screening” includes the mammography or ultrasound test procedure 9
	3516	+	and a qualified health care professional’s interpretation of the results of the 10
	3517	+	procedure, including additional views and interpretation as needed. 11
	3518	+	§ 4095c. PROSTATE CANCER SCREENINGS 12
	3519	+	A health insurance plan shall provide coverage for prostate cancer 13
	3520	+	screenings consistent with the recommendations of the Centers for Disease 14
	3521	+	Control and Prevention or upon recommendation of the covered individual’s 15
	3522	+	health care professional. Benefits provided shall be at least as favorable as 16
	3523	+	coverage for other cancer screening procedures and subject to the same dollar 17
	3524	+	limits, deductibles, and coinsurance factors within the provisions of the policy. 18
	3525	+	§ 4095d. CHEMOTHERAPY TREATMENT AND ORAL ANTICANCER 19
	3526	+	MEDICATIONS 20 BILL AS INTRODUCED S.30
6022	3527		2025 Page 145 of 181
6023		-	(3)“Screening”includesthemammographyorultrasoundtest
6024		-	procedureandaqualifiedhealthcareprofessional’sinterpretationoftheresults
6025		-	oftheprocedure,includingadditionalviewsandinterpretationasneeded.
6026		-	§ 4095c.PROSTATECANCERSCREENINGS
6027		-	Ahealthinsuranceplanshallprovidecoverageforprostatecancer
6028		-	screeningsconsistentwiththerecommendationsoftheCentersforDisease
6029		-	ControlandPreventionoruponrecommendationofthecoveredindividual’s
6030		-	healthcareprofessional.Benefitsprovidedshallbeatleastasfavorableas
6031		-	coverageforothercancerscreeningproceduresandsubjecttothesamedollar
6032		-	limits,deductibles,andcoinsurancefactorswithintheprovisionsofthepolicy.
6033		-	§ 4095d.CHEMOTHERAPY TREATMENTANDORALANTICANCER
6034		-	MEDICATIONS
6035		-	(a)Ahealthinsuranceplanshallprovidecoverageformedicallynecessary
6036		-	growthcellstimulatingfactorinjectionstakenaspartofaprescribed
6037		-	chemotherapyregimen.
6038		-	(b)Ahealthinsuranceplanshallprovidecoverageforprescribed,orally
6039		-	administeredanticancermedicationsusedtokillorslowthegrowthof
6040		-	cancerouscellsthatisnotlessfavorableonafinancialbasisthanintravenously
6041		-	administeredorinjectedanticancermedicationscoveredunderthecovered
6042		-	individual’splan.
6043		-	1
6044		-	2
6045		-	3
6046		-	4
6047		-	5
6048		-	6
6049		-	7
6050		-	8
6051		-	9
6052		-	10
6053		-	11
6054		-	12
6055		-	13
6056		-	14
6057		-	15
6058		-	16
6059		-	17
6060		-	18
6061		-	19
6062		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3528	+
	3529	+
	3530	+	VT LEG #380165 v.1
	3531	+	(a) A health insurance plan shall provide coverage for medically necessary 1
	3532	+	growth cell stimulating factor injections taken as part of a prescribed 2
	3533	+	chemotherapy regimen. 3
	3534	+	(b) A health insurance plan shall provide coverage for prescribed, orally 4
	3535	+	administered anticancer medications used to kill or slow the growth of 5
	3536	+	cancerous cells that is not less favorable on a financial basis than intravenously 6
	3537	+	administered or injected anticancer medications covered under the covered 7
	3538	+	individual’s plan. 8
	3539	+	§ 4095e. CLINICAL TRIALS FOR CANCER PATIENTS 9
	3540	+	(a) The Commissioner shall, after notice and hearing, adopt rules requiring 10
	3541	+	that all health insurance plans issued in this State provide coverage for routine 11
	3542	+	costs for covered individuals who participate in cancer clinical trials. 12
	3543	+	(1) Any rules adopted under this section shall be limited to the coverage 13
	3544	+	of routine costs for covered individuals who participate in a cancer clinical 14
	3545	+	trial. 15
	3546	+	(2) Any rules adopted under this section shall be restricted to approved 16
	3547	+	cancer clinical trials conducted under the auspices of the following cancer care 17
	3548	+	providers (cancer care providers): The University of Vermont Medical Center, 18
	3549	+	the Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, and 19
	3550	+	approved clinical trials administered by a hospital and its affiliated, qualified 20
	3551	+	cancer care providers. 21 BILL AS INTRODUCED S.30
6063	3552		2025 Page 146 of 181
6064		-	§ 4095e.CLINICALTRIALSFORCANCERPATIENTS
6065		-	(a)TheCommissionershall,afternoticeandhearing,adoptrulesrequiring
6066		-	thatallhealthinsuranceplansissuedinthisStateprovidecoverageforroutine
6067		-	costsforcoveredindividualswhoparticipateincancerclinicaltrials.
6068		-	(1)Anyrulesadoptedunderthissectionshallbelimitedtothecoverage
6069		-	ofroutinecostsforcoveredindividualswhoparticipateinacancerclinical
6070		-	trial.
6071		-	(2)Anyrulesadoptedunderthissectionshallberestrictedtoapproved
6072		-	cancerclinicaltrialsconductedundertheauspicesofthefollowingcancercare
6073		-	providers(cancercareproviders):TheUniversityofVermontMedicalCenter,
6074		-	theNorrisCottonCancerCenteratDartmouth-HitchcockMedicalCenter,and
6075		-	approvedclinicaltrialsadministeredbyahospitalanditsaffiliated,qualified
6076		-	cancercareproviders.
6077		-	(3)ForparticipationinclinicaltrialslocatedoutsideVermont,coverage
6078		-	underthissectionshallberequiredonlyifthecoveredindividualprovides
6079		-	noticetothehealthinsuranceplanpriortoparticipationintheclinicaltrial,
6080		-	andoneormoreofthefollowingcircumstancesapplies:
6081		-	(A)noclinicaltrialisavailableattheVermontorNewHampshire
6082		-	cancercareprovidersdescribedinsubdivision(2)ofthissubsection(a);
6083		-	(B)thecoveredindividualalreadyhascompletedaclinicaltrialat
6084		-	oneoftheVermontorNewHampshirecancercareprovidersdescribedin
6085		-	1
6086		-	2
6087		-	3
6088		-	4
6089		-	5
6090		-	6
6091		-	7
6092		-	8
6093		-	9
6094		-	10
6095		-	11
6096		-	12
6097		-	13
6098		-	14
6099		-	15
6100		-	16
6101		-	17
6102		-	18
6103		-	19
6104		-	20
6105		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3553	+
	3554	+
	3555	+	VT LEG #380165 v.1
	3556	+	(3) For participation in clinical trials located outside Vermont, coverage 1
	3557	+	under this section shall be required only if the covered individual provides 2
	3558	+	notice to the health insurance plan prior to participation in the clinical trial, and 3
	3559	+	one or more of the following circumstances applies: 4
	3560	+	(A) no clinical trial is available at the Vermont or New Hampshire 5
	3561	+	cancer care providers described in subdivision (2) of this subsection (a); 6
	3562	+	(B) the covered individual already has completed a clinical trial at 7
	3563	+	one of the Vermont or New Hampshire cancer care providers described in 8
	3564	+	subdivision (2) of this subsection (a) and the covered individual’s cancer care 9
	3565	+	provider determines that a subsequent clinical trial related to the original 10
	3566	+	diagnosis is available outside the health benefit plan’s network and that 11
	3567	+	participation in that clinical trial would be in the best interests of the covered 12
	3568	+	individual, even if a comparable clinical trial is available at that time at one or 13
	3569	+	both of the Vermont or New Hampshire cancer care providers described in 14
	3570	+	subdivision (2) of this subsection (a); or 15
	3571	+	(C) the health insurance plan has already approved a referral of the 16
	3572	+	covered individual to an out-of-network cancer care provider and an out-of-17
	3573	+	network clinical trial becomes available and the covered individual’s cancer 18
	3574	+	care provider determines participation in that clinical trial would be in the best 19
	3575	+	interests of the covered individual, even if a comparable clinical trial is 20 BILL AS INTRODUCED S.30
6106	3576		2025 Page 147 of 181
6107		-	subdivision(2)ofthissubsection(a)andthecoveredindividual’scancercare
6108		-	providerdeterminesthatasubsequentclinicaltrialrelatedtotheoriginal
6109		-	diagnosisisavailableoutsidethehealthbenefitplan’snetworkandthat
6110		-	participationinthatclinicaltrialwouldbeinthebestinterestsofthecovered
6111		-	individual,evenifacomparableclinicaltrialisavailableatthattimeatoneor
6112		-	bothoftheVermontorNewHampshirecancercareprovidersdescribedin
6113		-	subdivision(2)ofthissubsection(a);or
6114		-	(C)thehealthinsuranceplanhasalreadyapprovedareferralofthe
6115		-	coveredindividualtoanout-of-networkcancercareproviderandanout-of-
6116		-	networkclinicaltrialbecomesavailableandthecoveredindividual’scancer
6117		-	careproviderdeterminesparticipationinthatclinicaltrialwouldbeinthebest
6118		-	interestsofthecoveredindividual,evenifacomparableclinicaltrialis
6119		-	availableatoneorbothoftheVermontorNewHampshirecancercare
6120		-	providersdescribedinsubdivision(2)ofthissubsection(a).
6121		-	(4)Ifacoveredindividualparticipatesinaclinicaltrialadministeredby
6122		-	acancercareproviderthatisnotinthehealthinsuranceplan’sprovider
6123		-	network,thehealthinsuranceplanmayrequirethatroutinefollow-upcarebe
6124		-	providedwithinthehealthinsuranceplan’snetwork,unlessthecancercare
6125		-	providerdeterminesthiswouldnotbeinthebestinterestofthecovered
6126		-	individual.
6127		-	1
6128		-	2
6129		-	3
6130		-	4
6131		-	5
6132		-	6
6133		-	7
6134		-	8
6135		-	9
6136		-	10
6137		-	11
6138		-	12
6139		-	13
6140		-	14
6141		-	15
6142		-	16
6143		-	17
6144		-	18
6145		-	19
6146		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3577	+
	3578	+
	3579	+	VT LEG #380165 v.1
	3580	+	available at one or both of the Vermont or New Hampshire cancer care 1
	3581	+	providers described in subdivision (2) of this subsection (a). 2
	3582	+	(4) If a covered individual participates in a clinical trial administered by 3
	3583	+	a cancer care provider that is not in the health insurance plan’s provider 4
	3584	+	network, the health insurance plan may require that routine follow-up care be 5
	3585	+	provided within the health insurance plan’s network, unless the cancer care 6
	3586	+	provider determines this would not be in the best interest of the covered 7
	3587	+	individual. 8
	3588	+	(b) This section shall apply to Medicaid and any other public health care 9
	3589	+	assistance program offered or administered by the State or by any subdivision 10
	3590	+	or instrumentality of the State. 11
	3591	+	§ 4095f. OFF-LABEL USE OF PRESCRIPTION DRUGS FOR CANCER 12
	3592	+	(a) As used in this section: 13
	3593	+	(1) “Medical or scientific evidence” means one or more of the following 14
	3594	+	sources: 15
	3595	+	(A) peer-reviewed scientific studies published in or accepted for 16
	3596	+	publication by medical journals that meet nationally recognized requirements 17
	3597	+	for scientific manuscripts and that submit most of their published articles for 18
	3598	+	review by experts who are not part of the editorial staff; 19
	3599	+	(B) peer-reviewed literature, biomedical compendia, and other 20
	3600	+	medical literature that meet the criteria of the National Institutes of Health’s 21 BILL AS INTRODUCED S.30
6147	3601		2025 Page 148 of 181
6148		-	(b)ThissectionshallapplytoMedicaidandanyotherpublichealthcare
6149		-	assistanceprogramofferedoradministeredbytheStateorbyanysubdivision
6150		-	orinstrumentalityoftheState.
6151		-	§ 4095f.OFF-LABELUSEOFPRESCRIPTIONDRUGSFORCANCER
6152		-	(a)Asusedinthissection:
6153		-	(1)“Medicalorscientificevidence”meansoneormoreofthefollowing
6154		-	sources:
6155		-	(A)peer-reviewedscientificstudiespublishedinoracceptedfor
6156		-	publicationbymedicaljournalsthatmeetnationallyrecognizedrequirements
6157		-	forscientificmanuscriptsandthatsubmitmostoftheirpublishedarticlesfor
6158		-	reviewbyexpertswhoarenotpartoftheeditorialstaff;
6159		-	(B)peer-reviewedliterature,biomedicalcompendia,andother
6160		-	medicalliteraturethatmeetthecriteriaoftheNationalInstitutesofHealth’s
6161		-	NationalLibraryofMedicineforindexinginIndexMedicus,Excerpta
6162		-	Medicus(EMBASE),Medline,andMEDLARSdatabaseHealthServices
6163		-	TechnologyAssessmentResearch(HSTAR);
6164		-	(C)medicaljournalsrecognizedbytheSecretaryoftheU.S.
6165		-	DepartmentofHealthandHumanServicesunderSection1861(t)(2)ofthe
6166		-	SocialSecurityAct;
6167		-	(D)thefollowingstandardreferencecompendia:theAmerican
6168		-	HospitalFormularyService-DrugInformation,theAmericanMedical
6169		-	1
6170		-	2
6171		-	3
6172		-	4
6173		-	5
6174		-	6
6175		-	7
6176		-	8
6177		-	9
6178		-	10
6179		-	11
6180		-	12
6181		-	13
6182		-	14
6183		-	15
6184		-	16
6185		-	17
6186		-	18
6187		-	19
6188		-	20
6189		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3602	+
	3603	+
	3604	+	VT LEG #380165 v.1
	3605	+	National Library of Medicine for indexing in Index Medicus, Excerpta 1
	3606	+	Medicus (EMBASE), Medline, and MEDLARS database Health Services 2
	3607	+	Technology Assessment Research (HSTAR); 3
	3608	+	(C) medical journals recognized by the Secretary of the U.S. 4
	3609	+	Department of Health and Human Services under Section 1861(t)(2) of the 5
	3610	+	Social Security Act; 6
	3611	+	(D) the following standard reference compendia: the American 7
	3612	+	Hospital Formulary Service-Drug Information, the American Medical 8
	3613	+	Association Drug Evaluation, and the United States Pharmacopoeia-Drug 9
	3614	+	Information; 10
	3615	+	(E) findings, studies, or research conducted by or under the auspices 11
	3616	+	of federal government agencies and nationally recognized federal research 12
	3617	+	institutes, including the Agency for Health Care Policy and Research, National 13
	3618	+	Institutes of Health, National Cancer Institute, National Academy of Sciences, 14
	3619	+	Centers for Medicare and Medicaid Services, and any national board 15
	3620	+	recognized by the National Institutes of Health for the purpose of evaluating 16
	3621	+	the medical value of health services; and 17
	3622	+	(F) peer-reviewed abstracts accepted for presentation at major 18
	3623	+	medical association meetings. 19
	3624	+	(2) “Medically accepted indication” includes any use of a drug that has 20
	3625	+	been approved by the U.S. Food and Drug Administration and includes another 21 BILL AS INTRODUCED S.30
6190	3626		2025 Page 149 of 181
6191		-	AssociationDrugEvaluation,andtheUnitedStatesPharmacopoeia-Drug
6192		-	Information;
6193		-	(E)findings,studies,orresearchconductedbyorundertheauspices
6194		-	offederalgovernmentagenciesandnationallyrecognizedfederalresearch
6195		-	institutes,includingtheAgencyforHealthCarePolicyandResearch,National
6196		-	InstitutesofHealth,NationalCancerInstitute,NationalAcademyofSciences,
6197		-	CentersforMedicareandMedicaidServices,andanynationalboard
6198		-	recognizedbytheNationalInstitutesofHealthforthepurposeofevaluating
6199		-	themedicalvalueofhealthservices;and
6200		-	(F)peer-reviewedabstractsacceptedforpresentationatmajor
6201		-	medicalassociationmeetings.
6202		-	(2)“Medicallyacceptedindication”includesanyuseofadrugthathas
6203		-	beenapprovedbytheU.S.FoodandDrugAdministrationandincludes
6204		-	anotheruseofthedrugifthatuseisprescribedbythecoveredindividual’s
6205		-	healthcareprofessionalandsupportedbymedicalorscientificevidence.
6206		-	(3)“Off-labeluse”meanstheprescriptionanduseofdrugsfor
6207		-	medicallyacceptedindicationsotherthanthosestatedinthelabelingapproved
6208		-	bytheU.S.FoodandDrugAdministration.
6209		-	(b)Ahealthinsuranceplanshallprovidecoverageforoff-labelusein
6210		-	cancertreatmentinaccordancewiththefollowing:
6211		-	1
6212		-	2
6213		-	3
6214		-	4
6215		-	5
6216		-	6
6217		-	7
6218		-	8
6219		-	9
6220		-	10
6221		-	11
6222		-	12
6223		-	13
6224		-	14
6225		-	15
6226		-	16
6227		-	17
6228		-	18
6229		-	19
6230		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3627	+
	3628	+
	3629	+	VT LEG #380165 v.1
	3630	+	use of the drug if that use is prescribed by the covered individual’s health care 1
	3631	+	professional and supported by medical or scientific evidence. 2
	3632	+	(3) “Off-label use” means the prescription and use of drugs for 3
	3633	+	medically accepted indications other than those stated in the labeling approved 4
	3634	+	by the U.S. Food and Drug Administration. 5
	3635	+	(b) A health insurance plan shall provide coverage for off-label use in 6
	3636	+	cancer treatment in accordance with the following: 7
	3637	+	(1) A health insurance plan contract shall not exclude coverage for any 8
	3638	+	drug used for the treatment of cancer on grounds that the drug has not been 9
	3639	+	approved by the U.S. Food and Drug Administration, provided the use of the 10
	3640	+	drug is a medically accepted indication for the treatment of cancer. 11
	3641	+	(2) Coverage of a drug required by this section also includes medically 12
	3642	+	necessary services associated with the administration of the drug. 13
	3643	+	(3) This section shall not be construed to require coverage for a drug 14
	3644	+	when the U.S. Food and Drug Administration has determined its use to be 15
	3645	+	contraindicated for treatment of the current indication. 16
	3646	+	(4) A drug use that is covered under subdivision (1) of this subsection 17
	3647	+	shall not be denied coverage based on a “medical necessity” requirement 18
	3648	+	except for a reason unrelated to the legal status of the drug use. 19
	3649	+	(5) A health insurance plan that provides coverage of a drug as required 20
	3650	+	by this section may contain provisions for maximum benefits and coinsurance 21 BILL AS INTRODUCED S.30
6231	3651		2025 Page 150 of 181
6232		-	(1)Ahealthinsuranceplancontractshallnotexcludecoverageforany
6233		-	drugusedforthetreatmentofcancerongroundsthatthedrughasnotbeen
6234		-	approvedbytheU.S.FoodandDrugAdministration,providedtheuseofthe
6235		-	drugisamedicallyacceptedindicationforthetreatmentofcancer.
6236		-	(2)Coverageofadrugrequiredbythissectionalsoincludesmedically
6237		-	necessaryservicesassociatedwiththeadministrationofthedrug.
6238		-	(3)Thissectionshallnotbeconstruedtorequirecoverageforadrug
6239		-	whentheU.S.FoodandDrugAdministrationhasdetermineditsusetobe
6240		-	contraindicatedfortreatmentofthecurrentindication.
6241		-	(4)Adrugusethatiscoveredundersubdivision(1)ofthissubsection
6242		-	shallnotbedeniedcoveragebasedona“medicalnecessity”requirement
6243		-	exceptforareasonunrelatedtothelegalstatusofthedruguse.
6244		-	(5)Ahealthinsuranceplanthatprovidescoverageofadrugasrequired
6245		-	bythissectionmaycontainprovisionsformaximumbenefitsandcoinsurance
6246		-	andreasonablelimitations,deductibles,andexclusionstothesameextentthese
6247		-	provisionsareapplicabletocoverageofallprescriptiondrugsandarenot
6248		-	inconsistentwiththerequirementsofthissection.
6249		-	(c)Adeterminationbyahealthinsurerthatanoff-labeluseofa
6250		-	prescriptiondrugunderthissectionisnotamedicallyacceptedindication
6251		-	supportedbymedicalorscientificevidenceiseligibleforreviewundersection
6252		-	4063ofthistitle.
6253		-	1
6254		-	2
6255		-	3
6256		-	4
6257		-	5
6258		-	6
6259		-	7
6260		-	8
6261		-	9
6262		-	10
6263		-	11
6264		-	12
6265		-	13
6266		-	14
6267		-	15
6268		-	16
6269		-	17
6270		-	18
6271		-	19
6272		-	20
6273		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3652	+
	3653	+
	3654	+	VT LEG #380165 v.1
	3655	+	and reasonable limitations, deductibles, and exclusions to the same extent these 1
	3656	+	provisions are applicable to coverage of all prescription drugs and are not 2
	3657	+	inconsistent with the requirements of this section. 3
	3658	+	(c) A determination by a health insurer that an off-label use of a 4
	3659	+	prescription drug under this section is not a medically accepted indication 5
	3660	+	supported by medical or scientific evidence is eligible for review under section 6
	3661	+	4063 of this title. 7
	3662	+	(d) This section shall apply to Medicaid and any other public health care 8
	3663	+	assistance program offered or administered by the State or by any subdivision 9
	3664	+	or instrumentality of the State. 10
	3665	+	Subchapter 12. Service Delivery and Treatment Modalities 11
	3666	+	§ 4098a. COVERAGE OF HEALTH CARE SERVICES DELIVERED 12
	3667	+	THROUGH TELEMEDICINE AND BY STORE -AND-FORWARD 13
	3668	+	MEANS 14
	3669	+	(a) As used in this section: 15
	3670	+	(1) “Distant site” means the location of the health care provider 16
	3671	+	delivering services through telemedicine at the time the services are provided. 17
	3672	+	(2) “Health insurance plan” has the same meaning as in section 4011 of 18
	3673	+	this title and also includes a stand-alone dental plan or policy or other dental 19
	3674	+	insurance plan offered by a dental insurer. 20
	3675	+	(3) “Health care facility” has the same meaning as in 18 V.S.A. § 9402. 21 BILL AS INTRODUCED S.30
6274	3676		2025 Page 151 of 181
6275		-	(d)ThissectionshallapplytoMedicaidandanyotherpublichealthcare
6276		-	assistanceprogramofferedoradministeredbytheStateorbyanysubdivision
6277		-	orinstrumentalityoftheState.
6278		-	Subchapter12.ServiceDeliveryandTreatmentModalities
6279		-	§ 4098a.COVERAGEOFHEALTHCARESERVICESDELIVERED
6280		-	THROUGHTELEMEDICINEANDBYSTORE-AND-FORWARD
6281		-	MEANS
6282		-	(a)Asusedinthissection:
6283		-	(1)“Distantsite”meansthelocationofthehealthcareprovider
6284		-	deliveringservicesthroughtelemedicineatthetimetheservicesareprovided.
6285		-	(2)“Healthinsuranceplan”hasthesamemeaningasinsection4011of
6286		-	thistitleandalsoincludesastand-alonedentalplanorpolicyorotherdental
6287		-	insuranceplanofferedbyadentalinsurer.
6288		-	(3)“Healthcarefacility”hasthesamemeaningasin18V.S.A.§9402.
6289		-	(4)“Healthcareprovider”meansaperson,partnership,orcorporation,
6290		-	otherthanafacilityorinstitution,thatislicensed,certified,orotherwise
6291		-	authorizedbylawtoprovideprofessionalhealthcareservices,includingdental
6292		-	services,inthisStatetoanindividualduringthatindividual’smedicalcare,
6293		-	treatment,orconfinement.
6294		-	(5)“Originatingsite”meansthelocationofthepatient,whetherornot
6295		-	accompaniedbyahealthcareprovider,atthetimeservicesareprovidedbya
6296		-	1
6297		-	2
6298		-	3
6299		-	4
6300		-	5
6301		-	6
6302		-	7
6303		-	8
6304		-	9
6305		-	10
6306		-	11
6307		-	12
6308		-	13
6309		-	14
6310		-	15
6311		-	16
6312		-	17
6313		-	18
6314		-	19
6315		-	20
6316		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3677	+
	3678	+
	3679	+	VT LEG #380165 v.1
	3680	+	(4) “Health care provider” means a person, partnership, or corporation, 1
	3681	+	other than a facility or institution, that is licensed, certified, or otherwise 2
	3682	+	authorized by law to provide professional health care services, including dental 3
	3683	+	services, in this State to an individual during that individual’s medical care, 4
	3684	+	treatment, or confinement. 5
	3685	+	(5) “Originating site” means the location of the patient, whether or not 6
	3686	+	accompanied by a health care provider, at the time services are provided by a 7
	3687	+	health care provider through telemedicine, including a health care provider’s 8
	3688	+	office, a hospital, or a health care facility, or the patient’s home or another 9
	3689	+	nonmedical environment such as a school-based health center, a university-10
	3690	+	based health center, or the patient’s workplace. 11
	3691	+	(6) “Store-and-forward” means an asynchronous transmission of 12
	3692	+	medical information, such as one or more video clips, audio clips, still images, 13
	3693	+	x-rays, magnetic resonance imaging scans, electrocardiograms, 14
	3694	+	electroencephalograms, or laboratory results, sent over a secure connection that 15
	3695	+	complies with the requirements of the Health Insurance Portability and 16
	3696	+	Accountability Act of 1996, Pub. L. No. 104-191 to be reviewed at a later date 17
	3697	+	by a health care provider at a distant site who is trained in the relevant 18
	3698	+	specialty. In store-and-forward, the health care provider at the distant site 19
	3699	+	reviews the medical information without the patient present in real time and 20 BILL AS INTRODUCED S.30
6317	3700		2025 Page 152 of 181
6318		-	healthcareproviderthroughtelemedicine,includingahealthcareprovider’s
6319		-	office,ahospital,orahealthcarefacility,orthepatient’shomeoranother
6320		-	nonmedicalenvironmentsuchasaschool-basedhealthcenter,auniversity-
6321		-	basedhealthcenter,orthepatient’sworkplace.
6322		-	(6)“Store-and-forward”meansanasynchronoustransmissionof
6323		-	medicalinformation,suchasoneormorevideoclips,audioclips,stillimages,
6324		-	x-rays,magneticresonanceimagingscans,electrocardiograms,
6325		-	electroencephalograms,orlaboratoryresults,sentoverasecureconnection
6326		-	thatcomplieswiththerequirementsoftheHealthInsurancePortabilityand
6327		-	AccountabilityActof1996,Pub.L.No.104-191tobereviewedatalaterdate
6328		-	byahealthcareprovideratadistantsitewhoistrainedintherelevant
6329		-	specialty.Instore-and-forward,thehealthcareprovideratthedistantsite
6330		-	reviewsthemedicalinformationwithoutthepatientpresentinrealtimeand
6331		-	communicatesacareplanortreatmentrecommendationbacktothepatientor
6332		-	referringprovider,orboth.
6333		-	(7)“Telemedicine”meansthedeliveryofhealthcareservices,including
6334		-	dentalservices,suchasdiagnosis,consultation,ortreatment,throughtheuse
6335		-	ofliveinteractiveaudioandvideooverasecureconnectionthatcomplieswith
6336		-	therequirementsoftheHealthInsurancePortabilityandAccountabilityActof
6337		-	1996,Pub.L.No.104-191.
6338		-	1
6339		-	2
6340		-	3
6341		-	4
6342		-	5
6343		-	6
6344		-	7
6345		-	8
6346		-	9
6347		-	10
6348		-	11
6349		-	12
6350		-	13
6351		-	14
6352		-	15
6353		-	16
6354		-	17
6355		-	18
6356		-	19
6357		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3701	+
	3702	+
	3703	+	VT LEG #380165 v.1
	3704	+	communicates a care plan or treatment recommendation back to the patient or 1
	3705	+	referring provider, or both. 2
	3706	+	(7) “Telemedicine” means the delivery of health care services, including 3
	3707	+	dental services, such as diagnosis, consultation, or treatment, through the use 4
	3708	+	of live interactive audio and video over a secure connection that complies with 5
	3709	+	the requirements of the Health Insurance Portability and Accountability Act of 6
	3710	+	1996, Pub. L. No. 104-191. 7
	3711	+	(b)(1) A health insurance plan shall provide coverage for health care 8
	3712	+	services and dental services delivered through telemedicine by a health care 9
	3713	+	provider at a distant site to a covered individual at an originating site to the 10
	3714	+	same extent that the plan would cover the services if they were provided 11
	3715	+	through in-person consultation. 12
	3716	+	(2)(A) A health insurance plan shall provide the same reimbursement 13
	3717	+	rate for services billed using equivalent procedure codes and modifiers, subject 14
	3718	+	to the terms of the health insurance plan and provider contract, regardless of 15
	3719	+	whether the service was provided through an in-person visit with the health 16
	3720	+	care provider or through telemedicine. 17
	3721	+	(B) The provisions of subdivision (A) of this subdivision (2) shall not 18
	3722	+	apply: 19 BILL AS INTRODUCED S.30
6358	3723		2025 Page 153 of 181
6359		-	(b)(1)Ahealthinsuranceplanshallprovidecoverageforhealthcare
6360		-	servicesanddentalservicesdeliveredthroughtelemedicinebyahealthcare
6361		-	provideratadistantsitetoacoveredindividualatanoriginatingsitetothe
6362		-	sameextentthattheplanwouldcovertheservicesiftheywereprovided
6363		-	throughin-personconsultation.
6364		-	(2)(A)Ahealthinsuranceplanshallprovidethesamereimbursement
6365		-	rateforservicesbilledusingequivalentprocedurecodesandmodifiers,subject
6366		-	tothetermsofthehealthinsuranceplanandprovidercontract,regardlessof
6367		-	whethertheservicewasprovidedthroughanin-personvisitwiththehealth
6368		-	careproviderorthroughtelemedicine.
6369		-	(B)Theprovisionsofsubdivision(A)ofthissubdivision(2)shall
6370		-	notapply:
6371		-	(i)toservicesprovidedpursuanttothehealthinsuranceplan’s
6372		-	contractwithathird-partytelemedicinevendortoprovidehealthcareordental
6373		-	services;or
6374		-	(ii)intheeventthatahealthinsurerandhealthcareproviderenter
6375		-	intoavalue-basedcontractforhealthcareservicesthatincludecaredelivered
6376		-	throughtelemedicineorbystore-and-forwardmeans.
6377		-	(c)Ahealthinsuranceplanmaychargeadeductible,co-payment,or
6378		-	coinsuranceforahealthcareserviceordentalserviceprovidedthrough
6379		-	1
6380		-	2
6381		-	3
6382		-	4
6383		-	5
6384		-	6
6385		-	7
6386		-	8
6387		-	9
6388		-	10
6389		-	11
6390		-	12
6391		-	13
6392		-	14
6393		-	15
6394		-	16
6395		-	17
6396		-	18
6397		-	19
6398		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3724	+
	3725	+
	3726	+	VT LEG #380165 v.1
	3727	+	(i) to services provided pursuant to the health insurance plan’s 1
	3728	+	contract with a third-party telemedicine vendor to provide health care or dental 2
	3729	+	services; or 3
	3730	+	(ii) in the event that a health insurer and health care provider enter 4
	3731	+	into a value-based contract for health care services that include care delivered 5
	3732	+	through telemedicine or by store-and-forward means. 6
	3733	+	(c) A health insurance plan may charge a deductible, co-payment, or 7
	3734	+	coinsurance for a health care service or dental service provided through 8
	3735	+	telemedicine as long as it does not exceed the deductible, co-payment, or 9
	3736	+	coinsurance applicable to an in-person consultation. 10
	3737	+	(d) A health insurance plan may limit coverage to health care providers in 11
	3738	+	the plan’s network. A health insurance plan shall not impose limitations on the 12
	3739	+	number of telemedicine consultations a covered individual may receive that 13
	3740	+	exceed limitations otherwise placed on in-person covered services. 14
	3741	+	(e) Nothing in this section shall be construed to prohibit a health insurance 15
	3742	+	plan from providing coverage for only those services that are medically 16
	3743	+	necessary and are clinically appropriate for delivery through telemedicine, 17
	3744	+	subject to the terms and conditions of the covered individual’s policy. 18
	3745	+	(f)(1) A health insurance plan shall reimburse for health care services and 19
	3746	+	dental services delivered by store-and-forward means. 20 BILL AS INTRODUCED S.30
6399	3747		2025 Page 154 of 181
6400		-	telemedicineaslongasitdoesnotexceedthedeductible,co-payment,or
6401		-	coinsuranceapplicabletoanin-personconsultation.
6402		-	(d)Ahealthinsuranceplanmaylimitcoveragetohealthcareprovidersin
6403		-	theplan’snetwork.Ahealthinsuranceplanshallnotimposelimitationson
6404		-	thenumberoftelemedicineconsultationsacoveredindividualmayreceive
6405		-	thatexceedlimitationsotherwiseplacedonin-personcoveredservices.
6406		-	(e)Nothinginthissectionshallbeconstruedtoprohibitahealthinsurance
6407		-	planfromprovidingcoverageforonlythoseservicesthataremedically
6408		-	necessaryandareclinicallyappropriatefordeliverythroughtelemedicine,
6409		-	subjecttothetermsandconditionsofthecoveredindividual’spolicy.
6410		-	(f)(1)Ahealthinsuranceplanshallreimburseforhealthcareservicesand
6411		-	dentalservicesdeliveredbystore-and-forwardmeans.
6412		-	(2)Ahealthinsuranceplanshallnotimposemorethanonecost-sharing
6413		-	requirementonacoveredindividualforreceiptofhealthcareservicesor
6414		-	dentalservicesdeliveredbystore-and-forwardmeans.Iftheserviceswould
6415		-	requirecostsharingunderthetermsofthecoveredindividual’shealth
6416		-	insuranceplan,theplanmayimposethecostsharingrequirementonthe
6417		-	servicesoftheoriginatingsitehealthcareproviderorofthedistantsitehealth
6418		-	careprovider,butnotboth.
6419		-	(g)Ahealthinsuranceplanshallnotconstrueacoveredindividual’s
6420		-	receiptofservicesdeliveredthroughtelemedicineorbystore-and-forward
6421		-	1
6422		-	2
6423		-	3
6424		-	4
6425		-	5
6426		-	6
6427		-	7
6428		-	8
6429		-	9
6430		-	10
6431		-	11
6432		-	12
6433		-	13
6434		-	14
6435		-	15
6436		-	16
6437		-	17
6438		-	18
6439		-	19
6440		-	20
6441		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3748	+
	3749	+
	3750	+	VT LEG #380165 v.1
	3751	+	(2) A health insurance plan shall not impose more than one cost-sharing 1
	3752	+	requirement on a covered individual for receipt of health care services or 2
	3753	+	dental services delivered by store-and-forward means. If the services would 3
	3754	+	require cost sharing under the terms of the covered individual’s health 4
	3755	+	insurance plan, the plan may impose the cost sharing requirement on the 5
	3756	+	services of the originating site health care provider or of the distant site health 6
	3757	+	care provider, but not both. 7
	3758	+	(g) A health insurance plan shall not construe a covered individual’s receipt 8
	3759	+	of services delivered through telemedicine or by store-and-forward means as 9
	3760	+	limiting in any way the covered individual’s ability to receive additional 10
	3761	+	covered in-person services from the same or a different health care provider for 11
	3762	+	diagnosis or treatment of the same condition. 12
	3763	+	(h) Nothing in this section shall be construed to require a health insurance 13
	3764	+	plan to reimburse the distant site health care provider if the distant site health 14
	3765	+	care provider has insufficient information to render an opinion. 15
	3766	+	(i) In order to facilitate the use of telemedicine in treating substance use 16
	3767	+	disorder, when the originating site is a health care facility, health insurers and 17
	3768	+	the Department of Vermont Health Access shall ensure that the health care 18
	3769	+	provider at the distant site and the health care facility at the originating site are 19
	3770	+	both reimbursed for the services rendered, unless the health care providers at 20
	3771	+	both the distant and originating sites are employed by the same entity. 21 BILL AS INTRODUCED S.30
6442	3772		2025 Page 155 of 181
6443		-	meansaslimitinginanywaythecoveredindividual’sabilitytoreceive
6444		-	additionalcoveredin-personservicesfromthesameoradifferenthealthcare
6445		-	providerfordiagnosisortreatmentofthesamecondition.
6446		-	(h)Nothinginthissectionshallbeconstruedtorequireahealthinsurance
6447		-	plantoreimbursethedistantsitehealthcareproviderifthedistantsitehealth
6448		-	careproviderhasinsufficientinformationtorenderanopinion.
6449		-	(i)Inordertofacilitatetheuseoftelemedicineintreatingsubstanceuse
6450		-	disorder,whentheoriginatingsiteisahealthcarefacility,healthinsurersand
6451		-	theDepartmentofVermontHealthAccessshallensurethatthehealthcare
6452		-	provideratthedistantsiteandthehealthcarefacilityattheoriginatingsiteare
6453		-	bothreimbursedfortheservicesrendered,unlessthehealthcareprovidersat
6454		-	boththedistantandoriginatingsitesareemployedbythesameentity.
6455		-	(j)ThissectionshallapplytoMedicaidandanyotherpublichealthcare
6456		-	assistanceprogramofferedoradministeredbytheStateorbyanysubdivision
6457		-	orinstrumentalityoftheState.
6458		-	§4098b.COVERAGEOFHEALTHCARESERVICESDELIVEREDBY
6459		-	AUDIO-ONLYTELEPHONE
6460		-	(a)Asusedinthissection,“healthcareprovider”meansaperson,
6461		-	partnership,orcorporation,otherthanafacilityorinstitution,thatislicensed,
6462		-	certified,orotherwiseauthorizedbylawtoprovideprofessionalhealthcare
6463		-	1
6464		-	2
6465		-	3
6466		-	4
6467		-	5
6468		-	6
6469		-	7
6470		-	8
6471		-	9
6472		-	10
6473		-	11
6474		-	12
6475		-	13
6476		-	14
6477		-	15
6478		-	16
6479		-	17
6480		-	18
6481		-	19
6482		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3773	+
	3774	+
	3775	+	VT LEG #380165 v.1
	3776	+	(j) This section shall apply to Medicaid and any other public health care 1
	3777	+	assistance program offered or administered by the State or by any subdivision 2
	3778	+	or instrumentality of the State. 3
	3779	+	§ 4098b. COVERAGE OF HEALTH CARE SERVICES DELIVERED BY 4
	3780	+	AUDIO-ONLY TELEPHONE 5
	3781	+	(a) As used in this section, “health care provider” means a person, 6
	3782	+	partnership, or corporation, other than a facility or institution, that is licensed, 7
	3783	+	certified, or otherwise authorized by law to provide professional health care 8
	3784	+	services in this State to an individual during that individual’s medical care, 9
	3785	+	treatment, or confinement. 10
	3786	+	(b)(1) A health insurance plan shall provide coverage for all medically 11
	3787	+	necessary, clinically appropriate health care services delivered remotely by 12
	3788	+	audio-only telephone to the same extent that the plan would cover the services 13
	3789	+	if they were provided through in-person consultation. Services covered under 14
	3790	+	this subdivision shall include services that are covered when provided in the 15
	3791	+	home by home health agencies. 16
	3792	+	(2)(A) A health insurance plan shall provide the same reimbursement 17
	3793	+	rate for services billed using equivalent procedure codes and modifiers, subject 18
	3794	+	to the terms of the health insurance plan and provider contract, regardless of 19
	3795	+	whether the service was provided through an in-person visit with the health 20
	3796	+	care provider or by audio-only telephone. 21 BILL AS INTRODUCED S.30
6483	3797		2025 Page 156 of 181
6484		-	servicesinthisStatetoanindividualduringthatindividual’smedicalcare,
6485		-	treatment,orconfinement.
6486		-	(b)(1)Ahealthinsuranceplanshallprovidecoverageforallmedically
6487		-	necessary,clinicallyappropriatehealthcareservicesdeliveredremotelyby
6488		-	audio-onlytelephonetothesameextentthattheplanwouldcovertheservices
6489		-	iftheywereprovidedthroughin-personconsultation.Servicescoveredunder
6490		-	thissubdivisionshallincludeservicesthatarecoveredwhenprovidedinthe
6491		-	homebyhomehealthagencies.
6492		-	(2)(A)Ahealthinsuranceplanshallprovidethesamereimbursement
6493		-	rateforservicesbilledusingequivalentprocedurecodesandmodifiers,subject
6494		-	tothetermsofthehealthinsuranceplanandprovidercontract,regardlessof
6495		-	whethertheservicewasprovidedthroughanin-personvisitwiththehealth
6496		-	careproviderorbyaudio-onlytelephone.
6497		-	(B)Theprovisionsofsubdivision(A)ofthissubdivision(2)shall
6498		-	notapplyintheeventthatahealthinsurerandhealthcareproviderenterintoa
6499		-	value-basedcontractforhealthcareservicesthatincludecaredeliveredby
6500		-	audio-onlytelephone.
6501		-	(c)Ahealthinsuranceplanmaychargeanotherwisepermissible
6502		-	deductible,co-payment,orcoinsuranceforahealthcareservicedeliveredby
6503		-	audio-onlytelephone,providedthatitdoesnotexceedthedeductible,co-
6504		-	payment,orcoinsuranceapplicabletoanin-personconsultation.
6505		-	1
6506		-	2
6507		-	3
6508		-	4
6509		-	5
6510		-	6
6511		-	7
6512		-	8
6513		-	9
6514		-	10
6515		-	11
6516		-	12
6517		-	13
6518		-	14
6519		-	15
6520		-	16
6521		-	17
6522		-	18
6523		-	19
6524		-	20
6525		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3798	+
	3799	+
	3800	+	VT LEG #380165 v.1
	3801	+	(B) The provisions of subdivision (A) of this subdivision (2) shall not 1
	3802	+	apply in the event that a health insurer and health care provider enter into a 2
	3803	+	value-based contract for health care services that include care delivered by 3
	3804	+	audio-only telephone. 4
	3805	+	(c) A health insurance plan may charge an otherwise permissible 5
	3806	+	deductible, co-payment, or coinsurance for a health care service delivered by 6
	3807	+	audio-only telephone, provided that it does not exceed the deductible, co-7
	3808	+	payment, or coinsurance applicable to an in-person consultation. 8
	3809	+	(d) A health insurance plan shall not require a health care provider to have 9
	3810	+	an existing relationship with a covered individual in order to be reimbursed for 10
	3811	+	health care services delivered by audio-only telephone. 11
	3812	+	(e) This section shall apply to Medicaid, to the extent permitted by the 12
	3813	+	Centers for Medicare and Medicaid Services, and any other public health care 13
	3814	+	assistance program offered or administered by the State or by any subdivision 14
	3815	+	or instrumentality of the State. 15
	3816	+	§ 4098c. COVERED SERVICES PROVIDED BY NATUROPATHIC 16
	3817	+	PHYSICIANS 17
	3818	+	(a) A health insurance plan shall provide coverage for medically necessary 18
	3819	+	health care services covered by the plan when provided by a naturopathic 19
	3820	+	physician licensed in this State for treatment within the scope of practice 20 BILL AS INTRODUCED S.30
6526	3821		2025 Page 157 of 181
6527		-	(d)Ahealthinsuranceplanshallnotrequireahealthcareprovidertohave
6528		-	anexistingrelationshipwithacoveredindividualinordertobereimbursedfor
6529		-	healthcareservicesdeliveredbyaudio-onlytelephone.
6530		-	(e)ThissectionshallapplytoMedicaid,totheextentpermittedbythe
6531		-	CentersforMedicareandMedicaidServices,andanyotherpublichealthcare
6532		-	assistanceprogramofferedoradministeredbytheStateorbyanysubdivision
6533		-	orinstrumentalityoftheState.
6534		-	§ 4098c.COVEREDSERVICESPROVIDEDBYNATUROPATHIC
6535		-	PHYSICIANS
6536		-	(a)Ahealthinsuranceplanshallprovidecoverageformedicallynecessary
6537		-	healthcareservicescoveredbytheplanwhenprovidedbyanaturopathic
6538		-	physicianlicensedinthisStatefortreatmentwithinthescopeofpractice
6539		-	describedin26V.S.A.chapter81andshallrecognizenaturopathicphysicians
6540		-	whopracticeprimarycaretobeprimarycarephysicians.
6541		-	(b)Healthcareservicesprovidedbynaturopathicphysiciansmaybe
6542		-	subjecttoreasonabledeductibles,co-paymentandcoinsuranceamounts,and
6543		-	feeorbenefitlimitsconsistentwiththoseapplicabletootherprimarycare
6544		-	physiciansundertheplan,aswellaspracticeparameters,cost-effectiveness
6545		-	andclinicalefficacystandards,andutilizationreviewconsistentwithany
6546		-	applicablerulespublishedbytheDepartmentofFinancialRegulation.Any
6547		-	amounts,limits,standards,andreviewshallnotfunctiontodirecttreatmentin
6548		-	1
6549		-	2
6550		-	3
6551		-	4
6552		-	5
6553		-	6
6554		-	7
6555		-	8
6556		-	9
6557		-	10
6558		-	11
6559		-	12
6560		-	13
6561		-	14
6562		-	15
6563		-	16
6564		-	17
6565		-	18
6566		-	19
6567		-	20
6568		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3822	+
	3823	+
	3824	+	VT LEG #380165 v.1
	3825	+	described in 26 V.S.A. chapter 81 and shall recognize naturopathic physicians 1
	3826	+	who practice primary care to be primary care physicians. 2
	3827	+	(b) Health care services provided by naturopathic physicians may be 3
	3828	+	subject to reasonable deductibles, co-payment and coinsurance amounts, and 4
	3829	+	fee or benefit limits consistent with those applicable to other primary care 5
	3830	+	physicians under the plan, as well as practice parameters, cost-effectiveness 6
	3831	+	and clinical efficacy standards, and utilization review consistent with any 7
	3832	+	applicable rules published by the Department of Financial Regulation. Any 8
	3833	+	amounts, limits, standards, and review shall not function to direct treatment in 9
	3834	+	a manner unfairly discriminative against naturopathic care, and collectively 10
	3835	+	shall be not more restrictive than those applicable under the same plan to care 11
	3836	+	or services provided by other primary care physicians, but may allow for the 12
	3837	+	management of the benefit consistent with variations in practice patterns and 13
	3838	+	treatment modalities among different types of health care professionals. 14
	3839	+	(c) A health insurance plan may require that the naturopathic physician’s 15
	3840	+	services be provided by a licensed naturopathic physician under contract with 16
	3841	+	the insurer or shall be covered in a manner consistent with out-of-network 17
	3842	+	provider reimbursement practices for primary care physicians; however, this 18
	3843	+	shall not relieve a health insurance plan from compliance with the applicable 19
	3844	+	network adequacy requirements adopted by the Commissioner by rule. 20 BILL AS INTRODUCED S.30
6569	3845		2025 Page 158 of 181
6570		-	amannerunfairlydiscriminativeagainstnaturopathiccare,andcollectively
6571		-	shallbenotmorerestrictivethanthoseapplicableunderthesameplantocare
6572		-	orservicesprovidedbyotherprimarycarephysicians,butmayallowforthe
6573		-	managementofthebenefitconsistentwithvariationsinpracticepatternsand
6574		-	treatmentmodalitiesamongdifferenttypesofhealthcareprofessionals.
6575		-	(c)Ahealthinsuranceplanmayrequirethatthenaturopathicphysician’s
6576		-	servicesbeprovidedbyalicensednaturopathicphysicianundercontractwith
6577		-	theinsurerorshallbecoveredinamannerconsistentwithout-of-network
6578		-	providerreimbursementpracticesforprimarycarephysicians;however,this
6579		-	shallnotrelieveahealthinsuranceplanfromcompliancewiththeapplicable
6580		-	networkadequacyrequirementsadoptedbytheCommissionerbyrule.
6581		-	(d)Nothingcontainedinthissectionshallbeconstruedasimpedingor
6582		-	preventingeithertheprovisionorthecoverageofhealthcareservicesby
6583		-	licensednaturopathicphysicians,withinthelawfulscopeofnaturopathic
6584		-	practice,inhospitalfacilitiesonastafforemployeebasis.
6585		-	(e)ThissectionshallapplytoMedicaidandanyotherpublichealthcare
6586		-	assistanceprogramofferedoradministeredbytheStateorbyanysubdivision
6587		-	orinstrumentalityoftheState.
6588		-	§ 4098d.COVEREDSERVICESPROVIDEDBYATHLETICTRAINERS
6589		-	(a)Totheextentahealthinsuranceplanprovidescoverageforaparticular
6590		-	typeofhealthcareserviceorforanyparticularmedicalconditionthatis
6591		-	1
6592		-	2
6593		-	3
6594		-	4
6595		-	5
6596		-	6
6597		-	7
6598		-	8
6599		-	9
6600		-	10
6601		-	11
6602		-	12
6603		-	13
6604		-	14
6605		-	15
6606		-	16
6607		-	17
6608		-	18
6609		-	19
6610		-	20
6611		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3846	+
	3847	+
	3848	+	VT LEG #380165 v.1
	3849	+	(d) Nothing contained in this section shall be construed as impeding or 1
	3850	+	preventing either the provision or the coverage of health care services by 2
	3851	+	licensed naturopathic physicians, within the lawful scope of naturopathic 3
	3852	+	practice, in hospital facilities on a staff or employee basis. 4
	3853	+	(e) This section shall apply to Medicaid and any other public health care 5
	3854	+	assistance program offered or administered by the State or by any subdivision 6
	3855	+	or instrumentality of the State. 7
	3856	+	§ 4098d. COVERED SERVICES PROVIDED BY ATHLETIC TRAINERS 8
	3857	+	(a) To the extent a health insurance plan provides coverage for a particular 9
	3858	+	type of health care service or for any particular medical condition that is within 10
	3859	+	the scope of practice of athletic trainers, a licensed athletic trainer who acts 11
	3860	+	within the scope of practice authorized by 26 V.S.A. chapter 83 shall not be 12
	3861	+	denied reimbursement by the health insurance plan for those covered services 13
	3862	+	if the health insurance plan would reimburse another health care professional 14
	3863	+	for those services. 15
	3864	+	(b) Health care services provided by athletic trainers may be subject to 16
	3865	+	reasonable deductibles, co-payment and co-insurance amounts, fee or benefit 17
	3866	+	limits, practice parameters, and utilization review consistent with applicable 18
	3867	+	rules adopted by the Department of Financial Regulation, provided that the 19
	3868	+	amounts, limits, and review shall not function to direct treatment in a manner 20
	3869	+	unfairly discriminative against athletic trainer care, and collectively shall be 21 BILL AS INTRODUCED S.30
6612	3870		2025 Page 159 of 181
6613		-	withinthescopeofpracticeofathletictrainers,alicensedathletictrainerwho
6614		-	actswithinthescopeofpracticeauthorizedby26V.S.A.chapter83shallnot
6615		-	bedeniedreimbursementbythehealthinsuranceplanforthosecovered
6616		-	servicesifthehealthinsuranceplanwouldreimburseanotherhealthcare
6617		-	professionalforthoseservices.
6618		-	(b)Healthcareservicesprovidedbyathletictrainersmaybesubjectto
6619		-	reasonabledeductibles,co-paymentandco-insuranceamounts,feeorbenefit
6620		-	limits,practiceparameters,andutilizationreviewconsistentwithapplicable
6621		-	rulesadoptedbytheDepartmentofFinancialRegulation,providedthatthe
6622		-	amounts,limits,andreviewshallnotfunctiontodirecttreatmentinamanner
6623		-	unfairlydiscriminativeagainstathletictrainercare,andcollectivelyshallbe
6624		-	notmorerestrictivethanthoseapplicableunderthesamepolicyforcareor
6625		-	servicesprovidedbyotherhealthcareprofessionalsbutallowingforthe
6626		-	managementofthebenefitconsistentwithvariationsinpracticepatternsand
6627		-	treatmentmodalitiesamongdifferenttypesofhealthcareprofessionals.
6628		-	(c)Ahealthinsurermayrequirethattheathletictrainerservicesbe
6629		-	providedbyalicensedathletictrainerundercontractwiththeinsurer.
6630		-	(d)Nothinginthissectionshallbeconstruedasimpedingorpreventing
6631		-	eithertheprovisionorcoverageofhealthcareservicesbylicensedathletic
6632		-	trainerswithinthelawfulscopeofathletictrainerpractice.
6633		-	1
6634		-	2
6635		-	3
6636		-	4
6637		-	5
6638		-	6
6639		-	7
6640		-	8
6641		-	9
6642		-	10
6643		-	11
6644		-	12
6645		-	13
6646		-	14
6647		-	15
6648		-	16
6649		-	17
6650		-	18
6651		-	19
6652		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3871	+
	3872	+
	3873	+	VT LEG #380165 v.1
	3874	+	not more restrictive than those applicable under the same policy for care or 1
	3875	+	services provided by other health care professionals but allowing for the 2
	3876	+	management of the benefit consistent with variations in practice patterns and 3
	3877	+	treatment modalities among different types of health care professionals. 4
	3878	+	(c) A health insurer may require that the athletic trainer services be 5
	3879	+	provided by a licensed athletic trainer under contract with the insurer. 6
	3880	+	(d) Nothing in this section shall be construed as impeding or preventing 7
	3881	+	either the provision or coverage of health care services by licensed athletic 8
	3882	+	trainers within the lawful scope of athletic trainer practice. 9
	3883	+	§ 4098e. CHOICE OF PROVIDERS FOR VISION CARE AND MEDICAL 10
	3884	+	EYE CARE SERVICES 11
	3885	+	(a) As used in this section: 12
	3886	+	(1) “Covered services” means services and materials for which 13
	3887	+	reimbursement from a vision care plan or other health insurance plan is 14
	3888	+	provided by a member’s or subscriber’s plan contract, or for which a 15
	3889	+	reimbursement would be available but for application of the deductible, co-16
	3890	+	payment, or coinsurance requirements under the member’s or subscriber’s 17
	3891	+	health insurance plan. 18
	3892	+	(2) “Health insurance plan” has the same meaning as in section 4011 of 19
	3893	+	this chapter and also includes vision care plans. 20 BILL AS INTRODUCED S.30
6653	3894		2025 Page 160 of 181
6654		-	§ 4098e.CHOICEOFPROVIDERSFORVISIONCAREANDMEDICAL
6655		-	EYECARESERVICES
6656		-	(a)Asusedinthissection:
6657		-	(1)“Coveredservices”meansservicesandmaterialsforwhich
6658		-	reimbursementfromavisioncareplanorotherhealthinsuranceplanis
6659		-	providedbyamember’sorsubscriber’splancontract,orforwhicha
6660		-	reimbursementwouldbeavailablebutforapplicationofthedeductible,co-
6661		-	payment,orcoinsurancerequirementsunderthemember’sorsubscriber’s
6662		-	healthinsuranceplan.
6663		-	(2)“Healthinsuranceplan”hasthesamemeaningasinsection4011of
6664		-	thischapterandalsoincludesvisioncareplans.
6665		-	(3)“Materials”includeslenses,devicescontaininglenses,prisms,lens
6666		-	treatmentsandcoatings,contactlenses,andprostheticdevicestocorrect,
6667		-	relieve,ortreatdefectsorabnormalconditionsofthehumaneyeoritsadnexa.
6668		-	(4)“Ophthalmologist”meansaphysicianlicensedpursuantto26V.S.A.
6669		-	chapter23oranosteopathicphysicianlicensedpursuantto26V.S.A.chapter
6670		-	33whohashadspecialtraininginthefieldofophthalmology.
6671		-	(5)“Optician”meansapersonlicensedpursuantto26V.S.A.chapter
6672		-	47.
6673		-	(6)“Optometrist”meansapersonlicensedpursuantto26V.S.A.
6674		-	chapter30.
6675		-	1
6676		-	2
6677		-	3
6678		-	4
6679		-	5
6680		-	6
6681		-	7
6682		-	8
6683		-	9
6684		-	10
6685		-	11
6686		-	12
6687		-	13
6688		-	14
6689		-	15
6690		-	16
6691		-	17
6692		-	18
6693		-	19
6694		-	20
6695		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3895	+
	3896	+
	3897	+	VT LEG #380165 v.1
	3898	+	(3) “Materials” includes lenses, devices containing lenses, prisms, lens 1
	3899	+	treatments and coatings, contact lenses, and prosthetic devices to correct, 2
	3900	+	relieve, or treat defects or abnormal conditions of the human eye or its adnexa. 3
	3901	+	(4) “Ophthalmologist” means a physician licensed pursuant to 26 V.S.A. 4
	3902	+	chapter 23 or an osteopathic physician licensed pursuant to 26 V.S.A. chapter 5
	3903	+	33 who has had special training in the field of ophthalmology. 6
	3904	+	(5) “Optician” means a person licensed pursuant to 26 V.S.A. chapter 7
	3905	+	47. 8
	3906	+	(6) “Optometrist” means a person licensed pursuant to 26 V.S.A. 9
	3907	+	chapter 30. 10
	3908	+	(7) “Vision care plan” means an integrated or stand-alone plan, policy, 11
	3909	+	or contract providing vision benefits to enrollees with respect to covered 12
	3910	+	services or covered materials, or both. 13
	3911	+	(b) To the extent a health insurance plan provides coverage for vision care 14
	3912	+	or medical eye care services, it shall cover those services whether provided by 15
	3913	+	a licensed optometrist or by a licensed ophthalmologist, provided the health 16
	3914	+	care professional is acting within the health care professional’s authorized 17
	3915	+	scope of practice and participates in the plan’s network. 18
	3916	+	(c) A health insurance plan shall impose no greater co-payment, 19
	3917	+	coinsurance, or other cost-sharing amount for services when provided by an 20
	3918	+	optometrist than for the same service when provided by an ophthalmologist. 21 BILL AS INTRODUCED S.30
6696	3919		2025 Page 161 of 181
6697		-	(7)“Visioncareplan”meansanintegratedorstand-aloneplan,policy,
6698		-	orcontractprovidingvisionbenefitstoenrolleeswithrespecttocovered
6699		-	servicesorcoveredmaterials,orboth.
6700		-	(b)Totheextentahealthinsuranceplanprovidescoverageforvisioncare
6701		-	ormedicaleyecareservices,itshallcoverthoseserviceswhetherprovidedby
6702		-	alicensedoptometristorbyalicensedophthalmologist,providedthehealth
6703		-	careprofessionalisactingwithinthehealthcareprofessional’sauthorized
6704		-	scopeofpracticeandparticipatesintheplan’snetwork.
6705		-	(c)Ahealthinsuranceplanshallimposenogreaterco-payment,
6706		-	coinsurance,orothercost-sharingamountforserviceswhenprovidedbyan
6707		-	optometristthanforthesameservicewhenprovidedbyanophthalmologist.
6708		-	(d)Ahealthinsuranceplanshallprovidetoalicensedhealthcare
6709		-	professionalactingwithinthehealthcareprofessional’sscopeofpracticethe
6710		-	samelevelofreimbursementorothercompensationforprovidingvisioncare
6711		-	andmedicaleyecareservicesthatarewithinthelawfulscopeofpracticeof
6712		-	theprofessionsofmedicine,optometry,andosteopathy,regardlessofwhether
6713		-	thehealthcareprofessionalisanoptometristoranophthalmologist.
6714		-	(e)(1)Ahealthinsurershallpermitalicensedoptometristtoparticipatein
6715		-	plansorcontractsprovidingforvisioncareormedicaleyecaretothesame
6716		-	extentasitdoesanophthalmologist.
6717		-	1
6718		-	2
6719		-	3
6720		-	4
6721		-	5
6722		-	6
6723		-	7
6724		-	8
6725		-	9
6726		-	10
6727		-	11
6728		-	12
6729		-	13
6730		-	14
6731		-	15
6732		-	16
6733		-	17
6734		-	18
6735		-	19
6736		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3920	+
	3921	+
	3922	+	VT LEG #380165 v.1
	3923	+	(d) A health insurance plan shall provide to a licensed health care 1
	3924	+	professional acting within the health care professional’s scope of practice the 2
	3925	+	same level of reimbursement or other compensation for providing vision care 3
	3926	+	and medical eye care services that are within the lawful scope of practice of the 4
	3927	+	professions of medicine, optometry, and osteopathy, regardless of whether the 5
	3928	+	health care professional is an optometrist or an ophthalmologist. 6
	3929	+	(e)(1) A health insurer shall permit a licensed optometrist to participate in 7
	3930	+	plans or contracts providing for vision care or medical eye care to the same 8
	3931	+	extent as it does an ophthalmologist. 9
	3932	+	(2) A health insurer shall not require a licensed optometrist or 10
	3933	+	ophthalmologist to provide discounted materials benefits or to participate as a 11
	3934	+	provider in another health insurance or vision care plan or contract as a 12
	3935	+	condition or requirement for the optometrist’s or ophthalmologist’s 13
	3936	+	participation as a provider in any health insurance or vision care plan or 14
	3937	+	contract. 15
	3938	+	(f)(1) An agreement between a health insurer and an optometrist or 16
	3939	+	ophthalmologist for the provision of vision services to plan members or 17
	3940	+	subscribers in connection with coverage under a stand-alone vision care plan or 18
	3941	+	other health insurance plan shall not require that an optometrist or 19
	3942	+	ophthalmologist provide services or materials at a fee limited or set by the plan 20 BILL AS INTRODUCED S.30
6737	3943		2025 Page 162 of 181
6738		-	(2)Ahealthinsurershallnotrequirealicensedoptometristor
6739		-	ophthalmologisttoprovidediscountedmaterialsbenefitsortoparticipateasa
6740		-	providerinanotherhealthinsuranceorvisioncareplanorcontractasa
6741		-	conditionorrequirementfortheoptometrist’sorophthalmologist’s
6742		-	participationasaproviderinanyhealthinsuranceorvisioncareplanor
6743		-	contract.
6744		-	(f)(1)Anagreementbetweenahealthinsurerandanoptometristor
6745		-	ophthalmologistfortheprovisionofvisionservicestoplanmembersor
6746		-	subscribersinconnectionwithcoverageunderastand-alonevisioncareplan
6747		-	orotherhealthinsuranceplanshallnotrequirethatanoptometristor
6748		-	ophthalmologistprovideservicesormaterialsatafeelimitedorsetbytheplan
6749		-	orinsurerunlesstheservicesormaterialsarereimbursedascoveredservices
6750		-	underthecontract.
6751		-	(2)Anoptometristorophthalmologistshallnotchargemoreforservices
6752		-	andmaterialsthatarenoncoveredservicesunderavisioncareplanorother
6753		-	healthinsuranceplanthantheoptometrist’sorophthalmologist’susualand
6754		-	customaryrateforthoseservicesandmaterials.
6755		-	(3)Reimbursementpaidbyavisioncareplanorotherhealthinsurance
6756		-	planforcoveredservicesandmaterialsshallbereasonableandshallnot
6757		-	providenominalreimbursementinordertoclaimthatservicesandmaterials
6758		-	arecoveredservices.
6759		-	1
6760		-	2
6761		-	3
6762		-	4
6763		-	5
6764		-	6
6765		-	7
6766		-	8
6767		-	9
6768		-	10
6769		-	11
6770		-	12
6771		-	13
6772		-	14
6773		-	15
6774		-	16
6775		-	17
6776		-	18
6777		-	19
6778		-	20
6779		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3944	+
	3945	+
	3946	+	VT LEG #380165 v.1
	3947	+	or insurer unless the services or materials are reimbursed as covered services 1
	3948	+	under the contract. 2
	3949	+	(2) An optometrist or ophthalmologist shall not charge more for services 3
	3950	+	and materials that are noncovered services under a vision care plan or other 4
	3951	+	health insurance plan than the optometrist’s or ophthalmologist’s usual and 5
	3952	+	customary rate for those services and materials. 6
	3953	+	(3) Reimbursement paid by a vision care plan or other health insurance 7
	3954	+	plan for covered services and materials shall be reasonable and shall not 8
	3955	+	provide nominal reimbursement in order to claim that services and materials 9
	3956	+	are covered services. 10
	3957	+	(4)(A) A vision care plan or other health insurance plan shall not restrict 11
	3958	+	or otherwise limit, directly or indirectly, an optometrist’s, ophthalmologist’s, 12
	3959	+	or independent optician’s choice of or relationship with sources and suppliers 13
	3960	+	of products, services, or materials or use of optical laboratories if the 14
	3961	+	optometrist, ophthalmologist, or optician determines that the source, supplier, 15
	3962	+	or laboratory that the optometrist, ophthalmologist, or optician has selected 16
	3963	+	offers the products, services, or materials in a manner that is more beneficial to 17
	3964	+	the consumer, including with respect to cost, quality, timing, or selection, than 18
	3965	+	the source, supplier, or laboratory selected by the vision care plan or other 19
	3966	+	health insurance plan. The plan shall not impose any penalty or fee on an 20 BILL AS INTRODUCED S.30
6780	3967		2025 Page 163 of 181
6781		-	(4)(A)Avisioncareplanorotherhealthinsuranceplanshallnotrestrict
6782		-	orotherwiselimit,directlyorindirectly,anoptometrist’s,ophthalmologist’s,
6783		-	orindependentoptician’schoiceoforrelationshipwithsourcesandsuppliers
6784		-	ofproducts,services,ormaterialsoruseofopticallaboratoriesifthe
6785		-	optometrist,ophthalmologist,oropticiandeterminesthatthesource,supplier,
6786		-	orlaboratorythattheoptometrist,ophthalmologist,oropticianhasselected
6787		-	offerstheproducts,services,ormaterialsinamannerthatismorebeneficialto
6788		-	theconsumer,includingwithrespecttocost,quality,timing,orselection,than
6789		-	thesource,supplier,orlaboratoryselectedbythevisioncareplanorother
6790		-	healthinsuranceplan.Theplanshallnotimposeanypenaltyorfeeonan
6791		-	optometrist,ophthalmologist,orindependentopticianforusinganysupplier,
6792		-	opticallaboratory,product,service,ormaterial.
6793		-	(B)Theoptometrist,ophthalmologist,oropticianshallnotifythe
6794		-	consumerofanyadditionalcoststheconsumermayincurastheresultof
6795		-	procuringtheproducts,services,ormaterialsfromthesource,supplier,or
6796		-	laboratoryselectedbytheoptometrist,ophthalmologist,oropticianinsteadof
6797		-	fromthesource,supplier,orlaboratoryselectedbythevisioncareplanor
6798		-	otherhealthinsuranceplan.
6799		-	(C)Nothinginthissubdivision(4)shallbeconstruedtopreventa
6800		-	visioncareplanorotherhealthinsuranceplanfrominformingits
6801		-	policyholdersofthebenefitsavailableundertheplanorfromconductingan
6802		-	1
6803		-	2
6804		-	3
6805		-	4
6806		-	5
6807		-	6
6808		-	7
6809		-	8
6810		-	9
6811		-	10
6812		-	11
6813		-	12
6814		-	13
6815		-	14
6816		-	15
6817		-	16
6818		-	17
6819		-	18
6820		-	19
6821		-	20
6822		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3968	+
	3969	+
	3970	+	VT LEG #380165 v.1
	3971	+	optometrist, ophthalmologist, or independent optician for using any supplier, 1
	3972	+	optical laboratory, product, service, or material. 2
	3973	+	(B) The optometrist, ophthalmologist, or optician shall notify the 3
	3974	+	consumer of any additional costs the consumer may incur as the result of 4
	3975	+	procuring the products, services, or materials from the source, supplier, or 5
	3976	+	laboratory selected by the optometrist, ophthalmologist, or optician instead of 6
	3977	+	from the source, supplier, or laboratory selected by the vision care plan or 7
	3978	+	other health insurance plan. 8
	3979	+	(C) Nothing in this subdivision (4) shall be construed to prevent a 9
	3980	+	vision care plan or other health insurance plan from informing its policyholders 10
	3981	+	of the benefits available under the plan or from conducting an audit of an 11
	3982	+	optometrist’s, ophthalmologist’s, or optician’s use of alternative sources, 12
	3983	+	suppliers, or laboratories. 13
	3984	+	(D) The provisions of this subdivision (4) shall not apply to 14
	3985	+	Medicaid. 15
	3986	+	(g)(1) Except as otherwise specified in subdivision (f)(4), this section shall 16
	3987	+	apply to Medicaid and any other public health care assistance program offered 17
	3988	+	or administered by the State or by any subdivision or instrumentality of the 18
	3989	+	State. 19 BILL AS INTRODUCED S.30
6823	3990		2025 Page 164 of 181
6824		-	auditofanoptometrist’s,ophthalmologist’s,oroptician’suseofalternative
6825		-	sources,suppliers,orlaboratories.
6826		-	(D)Theprovisionsofthissubdivision(4)shallnotapplyto
6827		-	Medicaid.
6828		-	(g)(1)Exceptasotherwisespecifiedinsubdivision(f)(4),thissectionshall
6829		-	applytoMedicaidandanyotherpublichealthcareassistanceprogramoffered
6830		-	oradministeredbytheStateorbyanysubdivisionorinstrumentalityofthe
6831		-	State.
6832		-	(2)TheDepartmentofFinancialRegulationshallenforcetheprovisions
6833		-	ofthissectionastheyrelatetohealthinsuranceplansandvisioncareplans
6834		-	otherthanMedicaid.
6835		-	*ConformingRevisions*
6836		-	Sec.3.1V.S.A.§ 317(c)isamendedtoread:
6837		-	(c)Thefollowingpublicrecordsareexemptfrompublicinspectionand
6838		-	copying:
6839		-	***
6840		-	(28)Recordsof,andinternalmaterialspreparedfor,independent
6841		-	externalreviewsofhealthcareservicedecisionspursuantto8V.S.A.§4089f
6842		-	8V.S.A.§ 4063andofmentalhealthcareservicedecisionspursuantto
6843		-	8V.S.A.§4089a8V.S.A.§ 4064.
6844		-	***
6845		-	1
6846		-	2
6847		-	3
6848		-	4
6849		-	5
6850		-	6
6851		-	7
6852		-	8
6853		-	9
6854		-	10
6855		-	11
6856		-	12
6857		-	13
6858		-	14
6859		-	15
6860		-	16
6861		-	17
6862		-	18
6863		-	19
6864		-	20
6865		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	3991	+
	3992	+
	3993	+	VT LEG #380165 v.1
	3994	+	(2) The Department of Financial Regulation shall enforce the provisions 1
	3995	+	of this section as they relate to health insurance plans and vision care plans 2
	3996	+	other than Medicaid. 3
	3997	+	* * * Conforming Revisions * * * 4
	3998	+	Sec. 3. 1 V.S.A. § 317(c) is amended to read: 5
	3999	+	(c) The following public records are exempt from public inspection and 6
	4000	+	copying: 7
	4001	+	* * * 8
	4002	+	(28) Records of, and internal materials prepared for, independent 9
	4003	+	external reviews of health care service decisions pursuant to 8 V.S.A. § 4089f 10
	4004	+	8 V.S.A. § 4063 and of mental health care service decisions pursuant to 11
	4005	+	8 V.S.A. § 4089a 8 V.S.A. § 4064. 12
	4006	+	* * * 13
	4007	+	Sec. 4. 8 V.S.A. § 4512(b) is amended to read: 14
	4008	+	(b) Subject to the approval of the Commissioner or the Green Mountain 15
	4009	+	Care Board established in 18 V.S.A. chapter 220, as appropriate, a hospital 16
	4010	+	service corporation may establish, maintain, and operate a medical service plan 17
	4011	+	as defined in section 4583 of this title. The Commissioner or the Board may 18
	4012	+	refuse approval if the Commissioner or the Board finds that the rates submitted 19
	4013	+	are excessive, inadequate, or unfairly discriminatory, fail to protect the hospital 20
	4014	+	service corporation’s solvency, or fail to meet the standards of affordability, 21 BILL AS INTRODUCED S.30
6866	4015		2025 Page 165 of 181
6867		-	Sec.4.8V.S.A.§ 4512(b)isamendedtoread:
6868		-	(b)SubjecttotheapprovaloftheCommissionerortheGreenMountain
6869		-	CareBoardestablishedin18V.S.A.chapter220,asappropriate,ahospital
6870		-	servicecorporationmayestablish,maintain,andoperateamedicalserviceplan
6871		-	asdefinedinsection4583ofthistitle.TheCommissionerortheBoardmay
6872		-	refuseapprovaliftheCommissionerortheBoardfindsthattheratessubmitted
6873		-	areexcessive,inadequate,orunfairlydiscriminatory,failtoprotectthehospital
6874		-	servicecorporation’ssolvency,orfailtomeetthestandardsofaffordability,
6875		-	promotionofqualitycare,andpromotionofaccesspursuanttosection4062
6876		-	4026ofthistitle.Thecontractsofahospitalservicecorporationthatoperates
6877		-	amedicalserviceplanunderthissubsectionshallbegovernedbychapter125
6878		-	ofthistitletotheextentthattheyprovideformedicalservicebenefits,andby
6879		-	thischaptertotheextentthatthecontractsprovideforhospitalservice
6880		-	benefits.
6881		-	Sec.5.8V.S.A.§ 4515aisamendedtoread:
6882		-	§4515a.FORMANDRATEFILING;FILINGFEES
6883		-	Everycontractorcertificateform,oramendmentthereof,includingthe
6884		-	ratesproposedtobechargedbythecorporation,shallbefiledwiththe
6885		-	CommissionerortheGreenMountainCareBoardestablishedin18V.S.A.
6886		-	chapter220,asappropriate,fortheCommissioner’sortheBoard’sapproval
6887		-	priortoissuanceoruse.Priortoapproval,thereshallbeapubliccomment
6888		-	1
6889		-	2
6890		-	3
6891		-	4
6892		-	5
6893		-	6
6894		-	7
6895		-	8
6896		-	9
6897		-	10
6898		-	11
6899		-	12
6900		-	13
6901		-	14
6902		-	15
6903		-	16
6904		-	17
6905		-	18
6906		-	19
6907		-	20
6908		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	4016	+
	4017	+
	4018	+	VT LEG #380165 v.1
	4019	+	promotion of quality care, and promotion of access pursuant to section 4062 1
	4020	+	4026 of this title. The contracts of a hospital service corporation that operates 2
	4021	+	a medical service plan under this subsection shall be governed by chapter 125 3
	4022	+	of this title to the extent that they provide for medical service benefits, and by 4
	4023	+	this chapter to the extent that the contracts provide for hospital service benefits. 5
	4024	+	Sec. 5. 8 V.S.A. § 4515a is amended to read: 6
	4025	+	§ 4515a. FORM AND RATE FILING; FILING FEES 7
	4026	+	Every contract or certificate form, or amendment thereof, including the rates 8
	4027	+	proposed to be charged by the corporation, shall be filed with the 9
	4028	+	Commissioner or the Green Mountain Care Board established in 18 V.S.A. 10
	4029	+	chapter 220, as appropriate, for the Commissioner’s or the Board’s approval 11
	4030	+	prior to issuance or use. Prior to approval, there shall be a public comment 12
	4031	+	period pursuant to section 4062 4026 of this title. In addition, each such filing 13
	4032	+	shall be accompanied by payment to the Commissioner or the Board, as 14
	4033	+	appropriate, of a nonrefundable fee of $150.00 and the plain language 15
	4034	+	summary of rate increases pursuant to section 4062 4026 of this title. 16
	4035	+	Sec. 6. 8 V.S.A. § 4516 is amended to read: 17
	4036	+	§ 4516. ANNUAL REPORT TO COMMISSIONER 18
	4037	+	Annually, on or before March 1, a hospital service corporation shall file 19
	4038	+	with the Commissioner of Financial Regulation a statement sworn to by the 20
	4039	+	president and treasurer of the corporation showing its condition on December 21 BILL AS INTRODUCED S.30
6909	4040		2025 Page 166 of 181
6910		-	periodpursuanttosection40624026ofthistitle.Inaddition,eachsuchfiling
6911		-	shallbeaccompaniedbypaymenttotheCommissionerortheBoard,as
6912		-	appropriate,ofanonrefundablefeeof$150.00andtheplainlanguage
6913		-	summaryofrateincreasespursuanttosection40624026ofthistitle.
6914		-	Sec.6.8V.S.A.§ 4516isamendedtoread:
6915		-	§4516.ANNUALREPORTTOCOMMISSIONER
6916		-	Annually,onorbeforeMarch1,ahospitalservicecorporationshallfile
6917		-	withtheCommissionerofFinancialRegulationastatementsworntobythe
6918		-	presidentandtreasurerofthecorporationshowingitsconditiononDecember
6919		-	31.Thestatementshallbeinsuchformandcontainsuchmattersasthe
6920		-	Commissionershallprescribe.Toqualifyforthetaxexemptionsetforthin
6921		-	section4518ofthistitle,thestatementshallincludeacertificationthatthe
6922		-	hospitalservicecorporationoperatesonanonprofitbasisforthepurposeof
6923		-	providinganadequatehospitalserviceplantoindividualsoftheState,both
6924		-	groupsandnongroups,withoutdiscriminationbasedonage,gender,
6925		-	geographicarea,industry,andmedicalhistory,exceptasallowedby
6926		-	subdivisions4080g(b)(7)(B)(ii)and4080g(c)(8)(B)(ii)ofthistitleandby33
6927		-	V.S.A.§1811(f)(2)(B).
6928		-	Sec.7.8V.S.A.§ 4587isamendedtoread:
6929		-	§4587.FILINGANDAPPROVALOFCONTRACTS
6930		-	1
6931		-	2
6932		-	3
6933		-	4
6934		-	5
6935		-	6
6936		-	7
6937		-	8
6938		-	9
6939		-	10
6940		-	11
6941		-	12
6942		-	13
6943		-	14
6944		-	15
6945		-	16
6946		-	17
6947		-	18
6948		-	19
6949		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	4041	+
	4042	+
	4043	+	VT LEG #380165 v.1
	4044	+	31. The statement shall be in such form and contain such matters as the 1
	4045	+	Commissioner shall prescribe. To qualify for the tax exemption set forth in 2
	4046	+	section 4518 of this title, the statement shall include a certification that the 3
	4047	+	hospital service corporation operates on a nonprofit basis for the purpose of 4
	4048	+	providing an adequate hospital service plan to individuals of the State, both 5
	4049	+	groups and nongroups, without discrimination based on age, gender, 6
	4050	+	geographic area, industry, and medical history, except as allowed by 7
	4051	+	subdivisions 4080g(b)(7)(B)(ii) and 4080g(c)(8)(B)(ii) of this title and by 33 8
	4052	+	V.S.A. § 1811(f)(2)(B). 9
	4053	+	Sec. 7. 8 V.S.A. § 4587 is amended to read: 10
	4054	+	§ 4587. FILING AND APPROVAL OF CONTRACTS 11
	4055	+	A medical service corporation that has received a permit from the 12
	4056	+	Commissioner of Financial Regulation under section 4584 of this title shall not 13
	4057	+	thereafter issue a contract to a subscriber or charge a rate that is different from 14
	4058	+	copies of the contracts and rates originally filed with and approved by the 15
	4059	+	Commissioner at the time the permit was issued to the medical service 16
	4060	+	corporation, until the medical service corporation has filed copies of its 17
	4061	+	proposed contracts and rates and they have been approved by the 18
	4062	+	Commissioner or the Green Mountain Care Board established in 18 V.S.A. 19
	4063	+	chapter 220, as appropriate. Prior to approval, there shall be a public comment 20
	4064	+	period pursuant to section 4062 4026 of this title. Each such filing of a 21 BILL AS INTRODUCED S.30
6950	4065		2025 Page 167 of 181
6951		-	Amedicalservicecorporationthathasreceivedapermitfromthe
6952		-	CommissionerofFinancialRegulationundersection4584ofthistitleshallnot
6953		-	thereafterissueacontracttoasubscriberorchargearatethatisdifferentfrom
6954		-	copiesofthecontractsandratesoriginallyfiledwithandapprovedbythe
6955		-	Commissioneratthetimethepermitwasissuedtothemedicalservice
6956		-	corporation,untilthemedicalservicecorporationhasfiledcopiesofits
6957		-	proposedcontractsandratesandtheyhavebeenapprovedbythe
6958		-	CommissionerortheGreenMountainCareBoardestablishedin18V.S.A.
6959		-	chapter220,asappropriate.Priortoapproval,thereshallbeapubliccomment
6960		-	periodpursuanttosection40624026ofthistitle.Eachsuchfilingofa
6961		-	contractortheratethereforshallbeaccompaniedbypaymenttothe
6962		-	CommissionerortheBoard,asappropriate,ofanonrefundablefeeof$150.00.
6963		-	Amedicalservicecorporationshallfileaplainlanguagesummaryofrate
6964		-	increasespursuanttosection40624026ofthistitle.
6965		-	Sec.8.8V.S.A.§ 4588isamendedtoread:
6966		-	§4588.ANNUALREPORTTOCOMMISSIONER
6967		-	Annually,onorbeforeMarch1,amedicalservicecorporationshallfile
6968		-	withtheCommissionerofFinancialRegulationastatementsworntobythe
6969		-	presidentandtreasurerofthecorporationshowingitsconditiononDecember
6970		-	31,whichshallbeinsuchformandcontainsuchmattersastheCommissioner
6971		-	shallprescribe.Toqualifyforthetaxexemptionsetforthinsection4590of
6972		-	1
6973		-	2
6974		-	3
6975		-	4
6976		-	5
6977		-	6
6978		-	7
6979		-	8
6980		-	9
6981		-	10
6982		-	11
6983		-	12
6984		-	13
6985		-	14
6986		-	15
6987		-	16
6988		-	17
6989		-	18
6990		-	19
6991		-	20
6992		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	4066	+
	4067	+
	4068	+	VT LEG #380165 v.1
	4069	+	contract or the rate therefor shall be accompanied by payment to the 1
	4070	+	Commissioner or the Board, as appropriate, of a nonrefundable fee of $150.00. 2
	4071	+	A medical service corporation shall file a plain language summary of rate 3
	4072	+	increases pursuant to section 4062 4026 of this title. 4
	4073	+	Sec. 8. 8 V.S.A. § 4588 is amended to read: 5
	4074	+	§ 4588. ANNUAL REPORT TO COMMISSIONER 6
	4075	+	Annually, on or before March 1, a medical service corporation shall file 7
	4076	+	with the Commissioner of Financial Regulation a statement sworn to by the 8
	4077	+	president and treasurer of the corporation showing its condition on December 9
	4078	+	31, which shall be in such form and contain such matters as the Commissioner 10
	4079	+	shall prescribe. To qualify for the tax exemption set forth in section 4590 of 11
	4080	+	this title, the statement shall include a certification that the medical service 12
	4081	+	corporation operates on a nonprofit basis for the purpose of providing an 13
	4082	+	adequate medical service plan to individuals of the State, both groups and 14
	4083	+	nongroups, without discrimination based on age, gender, geographic area, 15
	4084	+	industry, and medical history, except as allowed by subdivisions 16
	4085	+	4080g(b)(7)(B)(ii) and 4080g(c)(8)(B)(ii) of this title and by 33 V.S.A. § 17
	4086	+	1811(f)(2)(B). 18
	4087	+	Sec. 9. 8 V.S.A. § 4724(7)(E) is amended to read: 19
	4088	+	(E) Making or permitting unfair discrimination between married 20
	4089	+	couples and parties to a civil union as defined under 15 V.S.A. § 1201, with 21 BILL AS INTRODUCED S.30
6993	4090		2025 Page 168 of 181
6994		-	thistitle,thestatementshallincludeacertificationthatthemedicalservice
6995		-	corporationoperatesonanonprofitbasisforthepurposeofprovidingan
6996		-	adequatemedicalserviceplantoindividualsoftheState,bothgroupsand
6997		-	nongroups,withoutdiscriminationbasedonage,gender,geographicarea,
6998		-	industry,andmedicalhistory,exceptasallowedbysubdivisions
6999		-	4080g(b)(7)(B)(ii)and4080g(c)(8)(B)(ii)ofthistitleandby33V.S.A.§
7000		-	1811(f)(2)(B).
7001		-	Sec.9.8V.S.A.§ 4724(7)(E)isamendedtoread:
7002		-	(E)Makingorpermittingunfairdiscriminationbetweenmarried
7003		-	couplesandpartiestoacivilunionasdefinedunder15V.S.A.§1201,with
7004		-	regardtotheofferingofinsurancebenefitstoacouple,aspouse,apartytoa
7005		-	civilunion,ortheirfamily.TheCommissionershalladoptrulesnecessaryto
7006		-	carryoutthepurposesofthissubdivision.Therulesshallensurethat
7007		-	insurancecontractsandpoliciesofferedtomarriedcouples,spouses,and
7008		-	familiesarealsomadeavailabletopartiestoacivilunionandtheirfamilies.
7009		-	TheCommissionermayadoptbyorderstandardsandaprocesstobringthe
7010		-	formscurrentlyonfileandapprovedbytheDepartmentintocompliancewith
7011		-	Vermontlaw.Thestandardsandprocessmaydifferfromtheprovisions
7012		-	containedinchapter101,subchapter6,andsections40624026,4201,4515a,
7013		-	4587,4685,4687,4688,4985,5104,and8005ofthistitlewhere,inthe
7014		-	1
7015		-	2
7016		-	3
7017		-	4
7018		-	5
7019		-	6
7020		-	7
7021		-	8
7022		-	9
7023		-	10
7024		-	11
7025		-	12
7026		-	13
7027		-	14
7028		-	15
7029		-	16
7030		-	17
7031		-	18
7032		-	19
7033		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	4091	+
	4092	+
	4093	+	VT LEG #380165 v.1
	4094	+	regard to the offering of insurance benefits to a couple, a spouse, a party to a 1
	4095	+	civil union, or their family. The Commissioner shall adopt rules necessary to 2
	4096	+	carry out the purposes of this subdivision. The rules shall ensure that 3
	4097	+	insurance contracts and policies offered to married couples, spouses, and 4
	4098	+	families are also made available to parties to a civil union and their families. 5
	4099	+	The Commissioner may adopt by order standards and a process to bring the 6
	4100	+	forms currently on file and approved by the Department into compliance with 7
	4101	+	Vermont law. The standards and process may differ from the provisions 8
	4102	+	contained in chapter 101, subchapter 6, and sections 4062 4026, 4201, 4515a, 9
	4103	+	4587, 4685, 4687, 4688, 4985, 5104, and 8005 of this title where, in the 10
	4104	+	Commissioner’s opinion, the provisions regarding filing and approval of forms 11
	4105	+	are not desirable or necessary to effectuate the purposes of this section. 12
	4106	+	Sec. 10. 8 V.S.A. § 5104(a) is amended to read: 13
	4107	+	(a)(1) A health maintenance organization that has received a certificate of 14
	4108	+	authority under section 5102 of this title shall file and obtain approval of all 15
	4109	+	policy forms and rates as provided in sections 4062 and 4062a 4026 and 4027 16
	4110	+	of this title. This requirement shall include the filing of administrative 17
	4111	+	retentions for any business in which the organization acts as a third party 18
	4112	+	administrator or in any other administrative processing capacity. The 19
	4113	+	Commissioner or the Green Mountain Care Board, as appropriate, may request 20
	4114	+	and shall receive any information that the Commissioner or the Board deems 21 BILL AS INTRODUCED S.30
7034	4115		2025 Page 169 of 181
7035		-	Commissioner’sopinion,theprovisionsregardingfilingandapprovalofforms
7036		-	arenotdesirableornecessarytoeffectuatethepurposesofthissection.
7037		-	Sec.10.8V.S.A.§ 5104(a)isamendedtoread:
7038		-	(a)(1)Ahealthmaintenanceorganizationthathasreceivedacertificateof
7039		-	authorityundersection5102ofthistitleshallfileandobtainapprovalofall
7040		-	policyformsandratesasprovidedinsections4062and4062a4026and4027
7041		-	ofthistitle.Thisrequirementshallincludethefilingofadministrative
7042		-	retentionsforanybusinessinwhichtheorganizationactsasathirdparty
7043		-	administratororinanyotheradministrativeprocessingcapacity.The
7044		-	CommissionerortheGreenMountainCareBoard,asappropriate,mayrequest
7045		-	andshallreceiveanyinformationthattheCommissionerortheBoarddeems
7046		-	necessarytoevaluatethefiling.Inadditiontoanyotherinformation
7047		-	requested,theCommissionerortheBoardshallrequirethefilingof
7048		-	informationoncostsforprovidingservicestotheorganization’sVermont
7049		-	membersaffectedbythepolicyformorrate,includingVermontclaims
7050		-	experience,andadministrativeandoverheadcostsallocatedtotheserviceof
7051		-	Vermontmembers.Priortoapproval,thereshallbeapubliccommentperiod
7052		-	pursuanttosection40624026ofthistitle.Ahealthmaintenanceorganization
7053		-	shallfileasummaryofratefilingspursuanttosection40624026ofthistitle.
7054		-	(2)TheCommissionerortheBoardshallrefusetoapprovetheformof
7055		-	evidenceofcoverage,filing,orrateifitcontainsanyprovisionthatisunjust,
7056		-	1
7057		-	2
7058		-	3
7059		-	4
7060		-	5
7061		-	6
7062		-	7
7063		-	8
7064		-	9
7065		-	10
7066		-	11
7067		-	12
7068		-	13
7069		-	14
7070		-	15
7071		-	16
7072		-	17
7073		-	18
7074		-	19
7075		-	20
7076		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	4116	+
	4117	+
	4118	+	VT LEG #380165 v.1
	4119	+	necessary to evaluate the filing. In addition to any other information 1
	4120	+	requested, the Commissioner or the Board shall require the filing of 2
	4121	+	information on costs for providing services to the organization’s Vermont 3
	4122	+	members affected by the policy form or rate, including Vermont claims 4
	4123	+	experience, and administrative and overhead costs allocated to the service of 5
	4124	+	Vermont members. Prior to approval, there shall be a public comment period 6
	4125	+	pursuant to section 4062 4026 of this title. A health maintenance organization 7
	4126	+	shall file a summary of rate filings pursuant to section 4062 4026 of this title. 8
	4127	+	(2) The Commissioner or the Board shall refuse to approve the form of 9
	4128	+	evidence of coverage, filing, or rate if it contains any provision that is unjust, 10
	4129	+	unfair, inequitable, misleading, or contrary to the law of the State or plan of 11
	4130	+	operation, or if the rates are excessive, inadequate, or unfairly discriminatory, 12
	4131	+	fail to protect the organization’s solvency, or fail to meet the standards of 13
	4132	+	affordability, promotion of quality care, and promotion of access pursuant to 14
	4133	+	section 4062 4026 of this title. No evidence of coverage shall be offered to 15
	4134	+	any potential member unless the person making the offer has first been 16
	4135	+	licensed as an insurance agent in accordance with chapter 131 of this title. 17
	4136	+	Sec. 11. 8 V.S.A. § 5115 is amended to read: 18
	4137	+	§ 5115. DUTY OF NONPROFIT HEALTH MAINTENANCE 19
	4138	+	ORGANIZATIONS 20 BILL AS INTRODUCED S.30
7077	4139		2025 Page 170 of 181
7078		-	unfair,inequitable,misleading,orcontrarytothelawoftheStateorplanof
7079		-	operation,oriftheratesareexcessive,inadequate,orunfairlydiscriminatory,
7080		-	failtoprotecttheorganization’ssolvency,orfailtomeetthestandardsof
7081		-	affordability,promotionofqualitycare,andpromotionofaccesspursuantto
7082		-	section40624026ofthistitle.Noevidenceofcoverageshallbeofferedto
7083		-	anypotentialmemberunlessthepersonmakingtheofferhasfirstbeen
7084		-	licensedasaninsuranceagentinaccordancewithchapter131ofthistitle.
7085		-	Sec.11.8V.S.A.§ 5115isamendedtoread:
7086		-	§5115.DUTYOFNONPROFITHEALTHMAINTENANCE
7087		-	ORGANIZATIONS
7088		-	Anynonprofithealthmaintenanceorganizationsubjecttothischaptershall
7089		-	offernongroupplanstoindividualsinaccordancewith33V.S.A.§1811
7090		-	withoutdiscriminationbasedonage,gender,industry,andmedicalhistory,
7091		-	exceptasallowedbysubdivisions4080g(b)(7)(B)(ii)and4080g(c)(8)(B)(ii)of
7092		-	thistitleandby33V.S.A.§1811(f)(2)(B).
7093		-	Sec.12.8V.S.A.§ 8083isamendedtoread:
7094		-	§8083.EXTRATERRITORIAL JURISDICTION
7095		-	Nogrouplong-termcareinsurancecoveragemaybeofferedtoaresidentof
7096		-	thisStateunderagrouppolicyissuedinanotherstatetoagroupdescribedin
7097		-	subdivision8082(4)(D)ofthistitle,unlessthisStateoranotherstatehaving
7098		-	statutoryandregulatorylong-termcareinsurancerequirementssubstantially
7099		-	1
7100		-	2
7101		-	3
7102		-	4
7103		-	5
7104		-	6
7105		-	7
7106		-	8
7107		-	9
7108		-	10
7109		-	11
7110		-	12
7111		-	13
7112		-	14
7113		-	15
7114		-	16
7115		-	17
7116		-	18
7117		-	19
7118		-	20
7119		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	4140	+
	4141	+
	4142	+	VT LEG #380165 v.1
	4143	+	Any nonprofit health maintenance organization subject to this chapter shall 1
	4144	+	offer nongroup plans to individuals in accordance with 33 V.S.A. § 1811 2
	4145	+	without discrimination based on age, gender, industry, and medical history, 3
	4146	+	except as allowed by subdivisions 4080g(b)(7)(B)(ii) and 4080g(c)(8)(B)(ii) of 4
	4147	+	this title and by 33 V.S.A. § 1811(f)(2)(B). 5
	4148	+	Sec. 12. 8 V.S.A. § 8083 is amended to read: 6
	4149	+	§ 8083. EXTRATERRITORIAL JURISDICTION 7
	4150	+	No group long-term care insurance coverage may be offered to a resident of 8
	4151	+	this State under a group policy issued in another state to a group described in 9
	4152	+	subdivision 8082(4)(D) of this title, unless this State or another state having 10
	4153	+	statutory and regulatory long-term care insurance requirements substantially 11
	4154	+	similar to those adopted in this State has made a determination that such 12
	4155	+	requirements have been met. All other jurisdiction shall be pursuant to section 13
	4156	+	4062 4026 of this title. 14
	4157	+	Sec. 13. 8 V.S.A. § 8094(e) is amended to read: 15
	4158	+	(e) In the event of the death of the insured, this section shall not apply to 16
	4159	+	the remaining death benefit of a life insurance policy that accelerates benefits 17
	4160	+	for long-term care. In this situation, the remaining death benefits under these 18
	4161	+	policies shall be governed by sections 3731 and 4065 4029 of this title. In all 19
	4162	+	other situations, this section shall apply to life insurance policies that 20
	4163	+	accelerate benefits for long-term care. 21 BILL AS INTRODUCED S.30
7120	4164		2025 Page 171 of 181
7121		-	similartothoseadoptedinthisStatehasmadeadeterminationthatsuch
7122		-	requirementshavebeenmet.Allotherjurisdictionshallbepursuanttosection
7123		-	40624026ofthistitle.
7124		-	Sec.13.8V.S.A.§ 8094(e)isamendedtoread:
7125		-	(e)Intheeventofthedeathoftheinsured,thissectionshallnotapplyto
7126		-	theremainingdeathbenefitofalifeinsurancepolicythatacceleratesbenefits
7127		-	forlong-termcare.Inthissituation,theremainingdeathbenefitsunderthese
7128		-	policiesshallbegovernedbysections3731and40654029ofthistitle.Inall
7129		-	othersituations,thissectionshallapplytolifeinsurancepoliciesthat
7130		-	acceleratebenefitsforlong-termcare.
7131		-	Sec.14.18V.S.A.§ 701isamendedtoread:
7132		-	§701.DEFINITIONS
7133		-	Asusedinthischapter:
7134		-	***
7135		-	(8)“Healthbenefitinsuranceplan”shallhavehasthesamemeaningas
7136		-	healthmajormedicalinsuranceplanin8V.S.A.§4088h8V.S.A.§ 4011.
7137		-	***
7138		-	Sec.15.18V.S.A.§ 706isamendedtoread:
7139		-	§706.HEALTHINSURERPARTICIPATION
7140		-	1
7141		-	2
7142		-	3
7143		-	4
7144		-	5
7145		-	6
7146		-	7
7147		-	8
7148		-	9
7149		-	10
7150		-	11
7151		-	12
7152		-	13
7153		-	14
7154		-	15
7155		-	16
7156		-	17
7157		-	18
7158		-	19 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	4165	+
	4166	+
	4167	+	VT LEG #380165 v.1
	4168	+	Sec. 14. 18 V.S.A. § 701 is amended to read: 1
	4169	+	§ 701. DEFINITIONS 2
	4170	+	As used in this chapter: 3
	4171	+	* * * 4
	4172	+	(8) “Health benefit insurance plan” shall have has the same meaning as 5
	4173	+	health major medical insurance plan in 8 V.S.A. § 4088h 8 V.S.A. § 4011. 6
	4174	+	* * * 7
	4175	+	Sec. 15. 18 V.S.A. § 706 is amended to read: 8
	4176	+	§ 706. HEALTH INSURER PARTICIPATION 9
	4177	+	(a) As provided for in 8 V.S.A. § 4088h set forth in 8 V.S.A. § 4025, health 10
	4178	+	insurance plans shall be consistent with the Blueprint for Health as determined 11
	4179	+	by the Commissioner of Financial Regulation. 12
	4180	+	(b) Health insurers shall participate in the Blueprint for Health as a 13
	4181	+	condition of doing business in this State as provided for in this section and in 14
	4182	+	8 V.S.A. § 4088h 8 V.S.A. § 4025. Under 8 V.S.A. § 4088h, the 15
	4183	+	Commissioner of Financial Regulation may exclude or limit the participation 16
	4184	+	of health insurers offering a stand-alone dental plan or specific disease or other 17
	4185	+	limited benefit coverage in the Blueprint for Health. Health insurers shall be 18
	4186	+	exempt from participation if the insurer only offers benefit plans that are paid 19
	4187	+	directly to the individual insured or the insured’s assigned beneficiaries and for 20 BILL AS INTRODUCED S.30
7159	4188		2025 Page 172 of 181
7160		-	(a)Asprovidedforin8V.S.A.§4088hsetforthin8V.S.A.§ 4025,health
7161		-	insuranceplansshallbeconsistentwiththeBlueprintforHealthasdetermined
7162		-	bytheCommissionerofFinancialRegulation.
7163		-	(b)HealthinsurersshallparticipateintheBlueprintforHealthasa
7164		-	conditionofdoingbusinessinthisStateasprovidedforinthissectionandin
7165		-	8V.S.A.§4088h8V.S.A.§ 4025.Under8V.S.A.§4088h,the
7166		-	CommissionerofFinancialRegulationmayexcludeorlimittheparticipation
7167		-	ofhealthinsurersofferingastand-alonedentalplanorspecificdiseaseorother
7168		-	limitedbenefitcoverageintheBlueprintforHealth.Healthinsurersshallbe
7169		-	exemptfromparticipationiftheinsureronlyoffersbenefitplansthatarepaid
7170		-	directlytotheindividualinsuredortheinsured’sassignedbeneficiariesandfor
7171		-	whichtheamountofthebenefitisnotbaseduponpotentialmedicalcostsor
7172		-	actualcostsincurred.
7173		-	***
7174		-	Sec.16.18V.S.A.§ 4750isamendedtoread:
7175		-	§4750.DEFINITIONS
7176		-	Asusedinthischapter:
7177		-	(1)“Healthinsuranceplan”hasthesamemeaningasin8V.S.A.§
7178		-	4089b8V.S.A.§ 4011.
7179		-	***
7180		-	Sec.17.18V.S.A.§ 9361(a)isamendedtoread:
7181		-	1
7182		-	2
7183		-	3
7184		-	4
7185		-	5
7186		-	6
7187		-	7
7188		-	8
7189		-	9
7190		-	10
7191		-	11
7192		-	12
7193		-	13
7194		-	14
7195		-	15
7196		-	16
7197		-	17
7198		-	18
7199		-	19
7200		-	20
7201		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	4189	+
	4190	+
	4191	+	VT LEG #380165 v.1
	4192	+	which the amount of the benefit is not based upon potential medical costs or 1
	4193	+	actual costs incurred. 2
	4194	+	* * * 3
	4195	+	Sec. 16. 18 V.S.A. § 4750 is amended to read: 4
	4196	+	§ 4750. DEFINITIONS 5
	4197	+	As used in this chapter: 6
	4198	+	(1) “Health insurance plan” has the same meaning as in 8 V.S.A. § 7
	4199	+	4089b 8 V.S.A. § 4011. 8
	4200	+	* * * 9
	4201	+	Sec. 17. 18 V.S.A. § 9361(a) is amended to read: 10
	4202	+	(a) As used in this section, “distant site,” “health care provider,” 11
	4203	+	“originating site,” “store and forward,” “store-and-forward,” and 12
	4204	+	“telemedicine” shall have the same meanings as in 8 V.S.A. § 4100k 8 V.S.A. 13
	4205	+	§ 4089a. 14
	4206	+	Sec. 18. 18 V.S.A. § 9362(a) is amended to read: 15
	4207	+	(a) As used in this section, “health: 16
	4208	+	(1) “Health insurance plan” and “health has the same meaning as in 17
	4209	+	8 V.S.A. § 4011. 18
	4210	+	(2) “Health care provider” have has the same meaning as in 8 V.S.A. 19
	4211	+	§ 4100l and “telemedicine” 8 V.S.A. § 4098b. 20 BILL AS INTRODUCED S.30
7202	4212		2025 Page 173 of 181
7203		-	(a)Asusedinthissection,“distantsite,”“healthcareprovider,”
7204		-	“originatingsite,”“storeandforward,”“store-and-forward,”and
7205		-	“telemedicine”shallhavethesamemeaningsasin8V.S.A.§4100k8V.S.A.
7206		-	§ 4089a.
7207		-	Sec.18.18V.S.A.§ 9362(a)isamendedtoread:
7208		-	(a)Asusedinthissection,“health:
7209		-	(1)“Healthinsuranceplan”and“healthhasthesamemeaningasin
7210		-	8 V.S.A.§ 4011.
7211		-	(2)“Healthcareprovider”havehasthesamemeaningasin8V.S.A.
7212		-	§ 4100land“telemedicine”8V.S.A.§ 4098b.
7213		-	(3)“Telemedicine”hasthesamemeaningasin8V.S.A.§4100k
7214		-	8 V.S.A.§ 4098a.
7215		-	Sec.19.18V.S.A.§ 9375(b)isamendedtoread:
7216		-	(b)TheBoardshallhavethefollowingduties:
7217		-	***
7218		-	(6)Approve,modify,ordisapproverequestsforhealthinsurancerates
7219		-	pursuantto8V.S.A.§40628V.S.A.§ 4026,takingintoconsiderationthe
7220		-	requirementsintheunderlyingstatutes,changesinhealthcaredelivery,
7221		-	changesinpaymentmethodsandamounts,protectinginsurersolvency,and
7222		-	otherissuesatthediscretionoftheBoard.
7223		-	***
7224		-	1
7225		-	2
7226		-	3
7227		-	4
7228		-	5
7229		-	6
7230		-	7
7231		-	8
7232		-	9
7233		-	10
7234		-	11
7235		-	12
7236		-	13
7237		-	14
7238		-	15
7239		-	16
7240		-	17
7241		-	18
7242		-	19
7243		-	20
7244		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	4213	+
	4214	+
	4215	+	VT LEG #380165 v.1
	4216	+	(3) “Telemedicine” has the same meaning as in 8 V.S.A. § 4100k 1
	4217	+	8 V.S.A. § 4098a. 2
	4218	+	Sec. 19. 18 V.S.A. § 9375(b) is amended to read: 3
	4219	+	(b) The Board shall have the following duties: 4
	4220	+	* * * 5
	4221	+	(6) Approve, modify, or disapprove requests for health insurance rates 6
	4222	+	pursuant to 8 V.S.A. § 4062 8 V.S.A. § 4026, taking into consideration the 7
	4223	+	requirements in the underlying statutes, changes in health care delivery, 8
	4224	+	changes in payment methods and amounts, protecting insurer solvency, and 9
	4225	+	other issues at the discretion of the Board. 10
	4226	+	* * * 11
	4227	+	(12) Review data regarding mental health and substance abuse treatment 12
	4228	+	reported to the Department of Financial Regulation pursuant to 8 V.S.A. § 13
	4229	+	4089b(g)(1)(G) and discuss such information, as appropriate, with the Mental 14
	4230	+	Health Technical Advisory Group established pursuant to subdivision 15
	4231	+	9374(e)(2) of this title. [Repealed.] 16
	4232	+	* * * 17
	4233	+	Sec. 20. 18 V.S.A. § 9377(g)(1) is amended to read: 18
	4234	+	(g)(1) Health insurers shall participate in the development of the payment 19
	4235	+	reform strategic plan for the pilot projects and in the implementation of the 20
	4236	+	pilot projects, including providing incentives, fees, or payment methods, as 21 BILL AS INTRODUCED S.30
7245	4237		2025 Page 174 of 181
7246		-	(12)Reviewdataregardingmentalhealthandsubstanceabusetreatment
7247		-	reportedtotheDepartmentofFinancialRegulationpursuantto8V.S.A.§
7248		-	4089b(g)(1)(G)anddiscusssuchinformation,asappropriate,withtheMental
7249		-	HealthTechnicalAdvisoryGroupestablishedpursuanttosubdivision
7250		-	9374(e)(2)ofthistitle.[Repealed.]
7251		-	***
7252		-	Sec.20.18V.S.A.§ 9377(g)(1)isamendedtoread:
7253		-	(g)(1)Healthinsurersshallparticipateinthedevelopmentofthepayment
7254		-	reformstrategicplanforthepilotprojectsandintheimplementationofthe
7255		-	pilotprojects,includingprovidingincentives,fees,orpaymentmethods,as
7256		-	requiredinthissection.ThisrequirementmaybeenforcedbytheDepartment
7257		-	ofFinancialRegulationtothesameextentastherequirementtoparticipatein
7258		-	theBlueprintforHealthpursuantto8V.S.A.§4088h8V.S.A.§ 4025.
7259		-	Sec.21.18V.S.A.§ 9381(d)isamendedtoread:
7260		-	(d)AdecisionoftheBoard’sapproving,modifying,ordisapprovinga
7261		-	healthinsurer’sproposedratepursuantto8V.S.A.§40628V.S.A.§ 4026
7262		-	shallbeconsideredafinalactionoftheBoardandmaybeappealedtothe
7263		-	SupremeCourtpursuanttosubsection(b)ofthissection.
7264		-	Sec.22.18V.S.A.§ 9404(d)isamendedtoread:
7265		-	(d)ThereisherebycreatedaspecialfundtobeknownastheGreen
7266		-	MountainCareBoardRegulatoryandAdministrativeFundpursuantto
7267		-	1
7268		-	2
7269		-	3
7270		-	4
7271		-	5
7272		-	6
7273		-	7
7274		-	8
7275		-	9
7276		-	10
7277		-	11
7278		-	12
7279		-	13
7280		-	14
7281		-	15
7282		-	16
7283		-	17
7284		-	18
7285		-	19
7286		-	20
7287		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	4238	+
	4239	+
	4240	+	VT LEG #380165 v.1
	4241	+	required in this section. This requirement may be enforced by the Department 1
	4242	+	of Financial Regulation to the same extent as the requirement to participate in 2
	4243	+	the Blueprint for Health pursuant to 8 V.S.A. § 4088h 8 V.S.A. § 4025. 3
	4244	+	Sec. 21. 18 V.S.A. § 9381(d) is amended to read: 4
	4245	+	(d) A decision of the Board’s approving, modifying, or disapproving a 5
	4246	+	health insurer’s proposed rate pursuant to 8 V.S.A. § 4062 8 V.S.A. § 4026 6
	4247	+	shall be considered a final action of the Board and may be appealed to the 7
	4248	+	Supreme Court pursuant to subsection (b) of this section. 8
	4249	+	Sec. 22. 18 V.S.A. § 9404(d) is amended to read: 9
	4250	+	(d) There is hereby created a special fund to be known as the Green 10
	4251	+	Mountain Care Board Regulatory and Administrative Fund pursuant to 11
	4252	+	32 V.S.A. chapter 7, subchapter 5, for the purpose of providing the financial 12
	4253	+	means for the Green Mountain Care Board to administer its obligations, 13
	4254	+	responsibilities, and duties as required by law, including pursuant to 8 V.S.A. 14
	4255	+	§ 4062 8 V.S.A. § 4026, chapters 220 and 221 of this title, and 33 V.S.A. 15
	4256	+	chapter 18. All fees, fines, penalties, and similar assessments received by the 16
	4257	+	Board in the administration of its obligations, responsibilities, and duties shall 17
	4258	+	be credited to the Fund. The Fund may also be used by the Department of 18
	4259	+	Health to administer its obligations, responsibilities, and duties as required by 19
	4260	+	chapter 221 of this title. 20 BILL AS INTRODUCED S.30
7288	4261		2025 Page 175 of 181
7289		-	32 V.S.A.chapter7,subchapter5,forthepurposeofprovidingthefinancial
7290		-	meansfortheGreenMountainCareBoardtoadministeritsobligations,
7291		-	responsibilities,anddutiesasrequiredbylaw,includingpursuantto8V.S.A.
7292		-	§ 40628V.S.A.§ 4026,chapters220and221ofthistitle,and33V.S.A.
7293		-	chapter18.Allfees,fines,penalties,andsimilarassessmentsreceivedbythe
7294		-	Boardintheadministrationofitsobligations,responsibilities,anddutiesshall
7295		-	becreditedtotheFund.TheFundmayalsobeusedbytheDepartmentof
7296		-	Healthtoadministeritsobligations,responsibilities,anddutiesasrequiredby
7297		-	chapter221ofthistitle.
7298		-	Sec.23.18V.S.A.§ 9414a(a)isamendedtoread:
7299		-	(a)Asusedinthissection:
7300		-	***
7301		-	(5)“Independentexternalreview”meansareviewofahealthcare
7302		-	decisionbyanindependentrevieworganizationpursuantto8V.S.A.§4089f8
7303		-	V.S.A.§ 4063.
7304		-	***
7305		-	Sec.24.18V.S.A.§ 9462isamendedtoread:
7306		-	§9462.QUALITYIMPROVEMENT PROJECTS
7307		-	Inadditiontoreviewingmentalhealthandsubstanceabusetreatmentdata
7308		-	pursuanttosubdivision9375(b)(12)ofthistitle,theTheGreenMountainCare
7309		-	Boardshallconsidertheresultsofanyqualityimprovementprojectsnot
7310		-	1
7311		-	2
7312		-	3
7313		-	4
7314		-	5
7315		-	6
7316		-	7
7317		-	8
7318		-	9
7319		-	10
7320		-	11
7321		-	12
7322		-	13
7323		-	14
7324		-	15
7325		-	16
7326		-	17
7327		-	18
7328		-	19
7329		-	20
7330		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	4262	+
	4263	+
	4264	+	VT LEG #380165 v.1
	4265	+	Sec. 23. 18 V.S.A. § 9414a(a) is amended to read: 1
	4266	+	(a) As used in this section: 2
	4267	+	* * * 3
	4268	+	(5) “Independent external review” means a review of a health care 4
	4269	+	decision by an independent review organization pursuant to 8 V.S.A. § 4089f 8 5
	4270	+	V.S.A. § 4063. 6
	4271	+	* * * 7
	4272	+	Sec. 24. 18 V.S.A. § 9462 is amended to read: 8
	4273	+	§ 9462. QUALITY IMPROVEMENT PROJECTS 9
	4274	+	In addition to reviewing mental health and substance abuse treatment data 10
	4275	+	pursuant to subdivision 9375(b)(12) of this title, the The Green Mountain Care 11
	4276	+	Board shall consider the results of any quality improvement projects not 12
	4277	+	otherwise confidential or privileged undertaken by managed care organizations 13
	4278	+	for mental health and substance abuse care and treatment pursuant to 8 V.S.A. 14
	4279	+	§ 4089b(d)(1)(B)(vii) and subsection 9414(i) of this title. 15
	4280	+	Sec. 25. 18 V.S.A. § 9573(a) is amended to read: 16
	4281	+	(a) On or before December 31 of each year, the Green Mountain Care 17
	4282	+	Board shall review any all-inclusive population-based payment arrangement 18
	4283	+	between the Department of Vermont Health Access and an accountable care 19
	4284	+	organization for the following calendar year. The Board’s review shall include 20
	4285	+	the number of attributed lives, eligibility groups, covered services, elements of 21 BILL AS INTRODUCED S.30
7331	4286		2025 Page 176 of 181
7332		-	otherwiseconfidentialorprivilegedundertakenbymanagedcareorganizations
7333		-	formentalhealthandsubstanceabusecareandtreatmentpursuantto8V.S.A.
7334		-	§4089b(d)(1)(B)(vii)andsubsection9414(i)ofthistitle.
7335		-	Sec.25.18V.S.A.§ 9573(a)isamendedtoread:
7336		-	(a)OnorbeforeDecember31ofeachyear,theGreenMountainCare
7337		-	Boardshallreviewanyall-inclusivepopulation-basedpaymentarrangement
7338		-	betweentheDepartmentofVermontHealthAccessandanaccountablecare
7339		-	organizationforthefollowingcalendaryear.TheBoard’sreviewshallinclude
7340		-	thenumberofattributedlives,eligibilitygroups,coveredservices,elementsof
7341		-	thepermember,permonthpayment,andanyothernonclaimspayments.The
7342		-	Board’sreviewmayincludedeliberativesessionstothesameextentpermitted
7343		-	forinsuranceratereviewunder8V.S.A.§40628V.S.A.§ 4026.
7344		-	Sec.26.32V.S.A.§ 1407(b)isamendedtoread:
7345		-	(b)TheStateshallbearthecostsofforensicmedicalandpsychological
7346		-	examinationsadministeredtovictimsofcrimecommittedinthisState,in
7347		-	instanceswherethatexaminationisrequestedbyalawenforcementofficeror
7348		-	aprosecutingauthorityoftheStateoranyofitssubdivisionsandthevictim
7349		-	doesnothavehealthcoverageorthevictim’shealthcoveragedoesnotcover
7350		-	theentirecostoftheexamination.TheStateshallalsobearthecostsofsexual
7351		-	assaultexaminations,asdefinedin8V.S.A.§40898V.S.A.§ 4083,
7352		-	administeredtovictimsincasesofallegedsexualassaultwherethevictim
7353		-	1
7354		-	2
7355		-	3
7356		-	4
7357		-	5
7358		-	6
7359		-	7
7360		-	8
7361		-	9
7362		-	10
7363		-	11
7364		-	12
7365		-	13
7366		-	14
7367		-	15
7368		-	16
7369		-	17
7370		-	18
7371		-	19
7372		-	20
7373		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	4287	+
	4288	+
	4289	+	VT LEG #380165 v.1
	4290	+	the per member, per month payment, and any other nonclaims payments. The 1
	4291	+	Board’s review may include deliberative sessions to the same extent permitted 2
	4292	+	for insurance rate review under 8 V.S.A. § 4062 8 V.S.A. § 4026. 3
	4293	+	Sec. 26. 32 V.S.A. § 1407(b) is amended to read: 4
	4294	+	(b) The State shall bear the costs of forensic medical and psychological 5
	4295	+	examinations administered to victims of crime committed in this State, in 6
	4296	+	instances where that examination is requested by a law enforcement officer or 7
	4297	+	a prosecuting authority of the State or any of its subdivisions and the victim 8
	4298	+	does not have health coverage or the victim’s health coverage does not cover 9
	4299	+	the entire cost of the examination. The State shall also bear the costs of sexual 10
	4300	+	assault examinations, as defined in 8 V.S.A. § 4089 8 V.S.A. § 4083, 11
	4301	+	administered to victims in cases of alleged sexual assault where the victim 12
	4302	+	obtains such an examination prior to receiving such a request if the victim does 13
	4303	+	not have health coverage or the victim’s health coverage does not cover the 14
	4304	+	entire cost of the examination. If, as a result of a sexual assault examination, 15
	4305	+	the alleged victim has been referred for mental health counseling, the State 16
	4306	+	shall bear any costs of such examination not covered by the victim’s health 17
	4307	+	coverage. These costs may be paid from the Victims’ Compensation Fund 18
	4308	+	from funds appropriated for that purpose. 19 BILL AS INTRODUCED S.30
7374	4309		2025 Page 177 of 181
7375		-	obtainssuchanexaminationpriortoreceivingsucharequestifthevictimdoes
7376		-	nothavehealthcoverageorthevictim’shealthcoveragedoesnotcoverthe
7377		-	entirecostoftheexamination.If,asaresultofasexualassaultexamination,
7378		-	theallegedvictimhasbeenreferredformentalhealthcounseling,theState
7379		-	shallbearanycostsofsuchexaminationnotcoveredbythevictim’shealth
7380		-	coverage.ThesecostsmaybepaidfromtheVictims’CompensationFund
7381		-	fromfundsappropriatedforthatpurpose.
7382		-	Sec.27.32V.S.A.§ 10401isamendedtoread:
7383		-	§ 10401.DEFINITIONS
7384		-	Asusedinthischapter:
7385		-	(1)“Healthinsurance”meansanygrouporindividualhealthcare
7386		-	benefitpolicy,contract,orotherhealthbenefitplanoffered,issued,renewed,
7387		-	oradministeredbyanyhealthinsurer,includinganyhealthcarebenefitplan
7388		-	offered,issued,renewed,oradministeredbyanyhealthinsurancecompany,
7389		-	anynonprofithospitalandmedicalservicecorporation,anydentalservice
7390		-	corporation,oranymanagedcareorganizationasdefinedin18V.S.A.§9402.
7391		-	Thetermincludescomprehensivemajormedicalpolicies,contracts,orplans;
7392		-	short-term,limited-durationhealthinsurancepoliciesandcontractsasdefined
7393		-	in8V.S.A.§4084a8V.S.A.§ 4053;studenthealthinsurancepolicies;and
7394		-	Medicaresupplementalsupplementinsurancepolicies,contracts,orplans,but
7395		-	doesnotincludeMedicaidoranyotherStatehealthcareassistanceprogramin
7396		-	1
7397		-	2
7398		-	3
7399		-	4
7400		-	5
7401		-	6
7402		-	7
7403		-	8
7404		-	9
7405		-	10
7406		-	11
7407		-	12
7408		-	13
7409		-	14
7410		-	15
7411		-	16
7412		-	17
7413		-	18
7414		-	19
7415		-	20
7416		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	4310	+
	4311	+
	4312	+	VT LEG #380165 v.1
	4313	+	Sec. 27. 32 V.S.A. § 10401 is amended to read: 1
	4314	+	§ 10401. DEFINITIONS 2
	4315	+	As used in this chapter: 3
	4316	+	(1) “Health insurance” means any group or individual health care 4
	4317	+	benefit policy, contract, or other health benefit plan offered, issued, renewed, 5
	4318	+	or administered by any health insurer, including any health care benefit plan 6
	4319	+	offered, issued, renewed, or administered by any health insurance company, 7
	4320	+	any nonprofit hospital and medical service corporation, any dental service 8
	4321	+	corporation, or any managed care organization as defined in 18 V.S.A. § 9402. 9
	4322	+	The term includes comprehensive major medical policies, contracts, or plans; 10
	4323	+	short-term, limited-duration health insurance policies and contracts as defined 11
	4324	+	in 8 V.S.A. § 4084a 8 V.S.A. § 4053; student health insurance policies; and 12
	4325	+	Medicare supplemental supplement insurance policies, contracts, or plans, but 13
	4326	+	does not include Medicaid or any other State health care assistance program in 14
	4327	+	which claims are financed in whole or in part through a federal program unless 15
	4328	+	authorized by federal law and approved by the General Assembly. The term 16
	4329	+	does not include policies issued for specified disease, accident, injury, hospital 17
	4330	+	indemnity, long-term care, disability income, or other limited benefit health 18
	4331	+	insurance policies, except that any policy providing coverage for dental 19
	4332	+	services shall be included. 20
	4333	+	* * * 21 BILL AS INTRODUCED S.30
7417	4334		2025 Page 178 of 181
7418		-	whichclaimsarefinancedinwholeorinpartthroughafederalprogramunless
7419		-	authorizedbyfederallawandapprovedbytheGeneralAssembly.Theterm
7420		-	doesnotincludepoliciesissuedforspecifieddisease,accident,injury,hospital
7421		-	indemnity,long-termcare,disabilityincome,orotherlimitedbenefithealth
7422		-	insurancepolicies,exceptthatanypolicyprovidingcoveragefordental
7423		-	servicesshallbeincluded.
7424		-	***
7425		-	Sec.28.33V.S.A.§ 1813(a)(2)isamendedtoread:
7426		-	(2)Initsreviewandapprovalofpremiumratespursuantto8V.S.A.
7427		-	§ 40628V.S.A.§ 4026,theGreenMountainCareBoardshallensurethat:
7428		-	***
7429		-	Sec.29.33V.S.A.§ 1814isamendedtoread:
7430		-	§1814.MAXIMUMOUT-OF-POCKETLIMITFORPRESCRIPTION
7431		-	DRUGSINBRONZEPLANS
7432		-	(a)(1)Notwithstandinganyprovisionof8V.S.A.§4089i8V.S.A.§ 4092
7433		-	tothecontrary,theGreenMountainCareBoardmayapprovemodificationsto
7434		-	theout-of-pocketprescriptiondruglimitestablishedin8V.S.A.§4089i
7435		-	8 V.S.A.§ 4092foroneormorebronze-levelplans,aslongastheBoardfinds
7436		-	thattheofferingofsuchplanswillnotadverselyimpacttheplanoptions
7437		-	availabletoconsumerswithhighprescriptiondrugneedswhobenefitfromthe
7438		-	1
7439		-	2
7440		-	3
7441		-	4
7442		-	5
7443		-	6
7444		-	7
7445		-	8
7446		-	9
7447		-	10
7448		-	11
7449		-	12
7450		-	13
7451		-	14
7452		-	15
7453		-	16
7454		-	17
7455		-	18
7456		-	19
7457		-	20 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	4335	+
	4336	+
	4337	+	VT LEG #380165 v.1
	4338	+	Sec. 28. 33 V.S.A. § 1813(a)(2) is amended to read: 1
	4339	+	(2) In its review and approval of premium rates pursuant to 8 V.S.A. 2
	4340	+	§ 4062 8 V.S.A. § 4026, the Green Mountain Care Board shall ensure that: 3
	4341	+	* * * 4
	4342	+	Sec. 29. 33 V.S.A. § 1814 is amended to read: 5
	4343	+	§ 1814. MAXIMUM OUT-OF-POCKET LIMIT FOR PRESCRIPTION 6
	4344	+	DRUGS IN BRONZE PLANS 7
	4345	+	(a)(1) Notwithstanding any provision of 8 V.S.A. § 4089i 8 V.S.A. § 4092 8
	4346	+	to the contrary, the Green Mountain Care Board may approve modifications to 9
	4347	+	the out-of-pocket prescription drug limit established in 8 V.S.A. § 4089i 10
	4348	+	8 V.S.A. § 4092 for one or more bronze-level plans, as long as the Board finds 11
	4349	+	that the offering of such plans will not adversely impact the plan options 12
	4350	+	available to consumers with high prescription drug needs who benefit from the 13
	4351	+	out-of-pocket prescription drug limit established in 8 V.S.A. § 4089i 8 V.S.A. 14
	4352	+	§ 4092. 15
	4353	+	(2) The Department of Vermont Health Access shall certify at least two 16
	4354	+	standard bronze-level plans that include the out-of-pocket prescription drug 17
	4355	+	limit established in 8 V.S.A. § 4089i 8 V.S.A. § 4092, as long as the plans 18
	4356	+	comply with federal requirements. Notwithstanding any provision of 8 V.S.A. 19
	4357	+	§ 4089i 8 V.S.A. § 4092 to the contrary, the Department may certify one or 20
	4358	+	more bronze-level qualified health benefit plans with modifications to the out-21 BILL AS INTRODUCED S.30
7458	4359		2025 Page 179 of 181
7459		-	out-of-pocketprescriptiondruglimitestablishedin8V.S.A.§4089i8V.S.A.
7460		-	§ 4092.
7461		-	(2)TheDepartmentofVermontHealthAccessshallcertifyatleasttwo
7462		-	standardbronze-levelplansthatincludetheout-of-pocketprescriptiondrug
7463		-	limitestablishedin8V.S.A.§4089i8V.S.A.§ 4092,aslongastheplans
7464		-	complywithfederalrequirements.Notwithstandinganyprovisionof8V.S.A.
7465		-	§4089i8V.S.A.§ 4092tothecontrary,theDepartmentmaycertifyoneor
7466		-	morebronze-levelqualifiedhealthbenefitplanswithmodificationstotheout-
7467		-	of-pocketprescriptiondruglimitestablishedin8V.S.A.§4089i8V.S.A.
7468		-	§ 4092.
7469		-	(b)(1)Foreachindividualenrolledinabronze-levelqualifiedhealth
7470		-	benefitplanfortheprevioustwoplanyearswhohadout-of-pocket
7471		-	prescriptiondrugexpendituresthatmettheout-of-pocketprescriptiondrug
7472		-	limitestablishedin8V.S.A.§4089i8V.S.A.§ 4092forthemostrecentplan
7473		-	yearforwhichinformationisavailable,thehealthinsurershall,absentan
7474		-	alternativeplanselectionorplancancellationbytheindividual,automatically
7475		-	reenrolltheindividualinabronze-levelqualifiedhealthplanforthe
7476		-	forthcomingplanyearwithanout-of-pocketprescriptiondruglimitator
7477		-	belowthelimitestablishedin8V.S.A.§4089i8V.S.A.§ 4092.
7478		-	(2)Priortoreenrollinganindividualinaplanpursuanttosubdivision
7479		-	(1)ofthissubsection,thehealthinsurershallnotifytheindividualofthe
7480		-	1
7481		-	2
7482		-	3
7483		-	4
7484		-	5
7485		-	6
7486		-	7
7487		-	8
7488		-	9
7489		-	10
7490		-	11
7491		-	12
7492		-	13
7493		-	14
7494		-	15
7495		-	16
7496		-	17
7497		-	18
7498		-	19
7499		-	20
7500		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	4360	+
	4361	+
	4362	+	VT LEG #380165 v.1
	4363	+	of-pocket prescription drug limit established in 8 V.S.A. § 4089i 8 V.S.A. 1
	4364	+	§ 4092. 2
	4365	+	(b)(1) For each individual enrolled in a bronze-level qualified health 3
	4366	+	benefit plan for the previous two plan years who had out-of-pocket prescription 4
	4367	+	drug expenditures that met the out-of-pocket prescription drug limit established 5
	4368	+	in 8 V.S.A. § 4089i 8 V.S.A. § 4092 for the most recent plan year for which 6
	4369	+	information is available, the health insurer shall, absent an alternative plan 7
	4370	+	selection or plan cancellation by the individual, automatically reenroll the 8
	4371	+	individual in a bronze-level qualified health plan for the forthcoming plan year 9
	4372	+	with an out-of-pocket prescription drug limit at or below the limit established 10
	4373	+	in 8 V.S.A. § 4089i 8 V.S.A. § 4092. 11
	4374	+	(2) Prior to reenrolling an individual in a plan pursuant to subdivision 12
	4375	+	(1) of this subsection, the health insurer shall notify the individual of the 13
	4376	+	insurer’s intent to reenroll the individual automatically in a bronze-level 14
	4377	+	qualified health plan for the forthcoming plan year with an out-of-pocket 15
	4378	+	prescription drug limit at or below the limit established in 8 V.S.A. § 4089i 16
	4379	+	8 V.S.A. § 4092 unless the individual contacts the insurer to select a different 17
	4380	+	plan and of the availability of bronze-level plans with higher out-of-pocket 18
	4381	+	prescription drug limits. The health insurer shall collaborate with the 19
	4382	+	Department of Vermont Health Access and the Office of the Health Care 20
	4383	+	Advocate as to the notification’s form and content. 21 BILL AS INTRODUCED S.30
7501	4384		2025 Page 180 of 181
7502		-	insurer’sintenttoreenrolltheindividualautomaticallyinabronze-level
7503		-	qualifiedhealthplanfortheforthcomingplanyearwithanout-of-pocket
7504		-	prescriptiondruglimitatorbelowthelimitestablishedin8V.S.A.§4089i
7505		-	8 V.S.A.§ 4092unlesstheindividualcontactstheinsurertoselectadifferent
7506		-	planandoftheavailabilityofbronze-levelplanswithhigherout-of-pocket
7507		-	prescriptiondruglimits.Thehealthinsurershallcollaboratewiththe
7508		-	DepartmentofVermontHealthAccessandtheOfficeoftheHealthCare
7509		-	Advocateastothenotification’sformandcontent.
7510		-	Sec.30.33V.S.A.§ 4110(a)(6)isamendedtoread:
7511		-	(6)ForpurposesofAsusedinthissection,“dependentcoverage”shall
7512		-	havehasthesamemeaningasin8V.S.A.§4100b(a)(3)8V.S.A.§ 4058.
7513		-	Sec.31.ADDITIONALCONFORMINGREVISIONS
7514		-	WhenpreparingtheVermontStatutesAnnotatedforpublication,theOffice
7515		-	ofLegislativeCounselshallupdateanyadditionalcross-referencestostatutes
7516		-	in8V.S.A.chapter107thatusethenumberingschemeineffectpriortothe
7517		-	effectivedateofthisacttoconformtothenewnumberingschemeenactedby
7518		-	thisact.
7519		-	*InterpretationandRuleAlignment*
7520		-	Sec.32.INTERPRETATION;RULEALIGNMENT
7521		-	(a)Thepurposeofthisbillistoupdateandreorganizethehealthinsurance
7522		-	statutes.ItistheintentoftheGeneralAssemblythatthetechnical
7523		-	1
7524		-	2
7525		-	3
7526		-	4
7527		-	5
7528		-	6
7529		-	7
7530		-	8
7531		-	9
7532		-	10
7533		-	11
7534		-	12
7535		-	13
7536		-	14
7537		-	15
7538		-	16
7539		-	17
7540		-	18
7541		-	19
7542		-	20
7543		-	21 BILLASINTRODUCEDANDPASSEDBYSENATE S.30
	4385	+
	4386	+
	4387	+	VT LEG #380165 v.1
	4388	+	Sec. 30. 33 V.S.A. § 4110(a)(6) is amended to read: 1
	4389	+	(6) For purposes of As used in this section, “dependent coverage” shall 2
	4390	+	have has the same meaning as in 8 V.S.A. § 4100b(a)(3) 8 V.S.A. § 4058. 3
	4391	+	Sec. 31. ADDITIONAL CONFORMING REVISIONS 4
	4392	+	When preparing the Vermont Statutes Annotated for publication, the Office 5
	4393	+	of Legislative Counsel shall update any additional cross-references to statutes 6
	4394	+	in 8 V.S.A. chapter 107 that use the numbering scheme in effect prior to the 7
	4395	+	effective date of this act to conform to the new numbering scheme enacted by 8
	4396	+	this act. 9
	4397	+	* * * Interpretation and Rule Alignment * * * 10
	4398	+	Sec. 32. INTERPRETATION; RULE ALIGNMENT 11
	4399	+	(a) The purpose of this bill is to update and reorganize the health insurance 12
	4400	+	statutes. It is the intent of the General Assembly that the technical 13
	4401	+	amendments in this act shall not supersede substantive changes contained in 14
	4402	+	other bills enacted by the General Assembly during the current biennium. 15
	4403	+	Where possible, the amendments in this act shall be interpreted to be 16
	4404	+	supplemental to other amendments made to the sections of 8 V.S.A. chapter 17
	4405	+	107 using the numbering scheme in effect prior to the effective date of this act; 18
	4406	+	to the extent the provisions conflict, the substantive changes in other acts shall 19
	4407	+	take precedence over the technical changes in this act. Statutes added to or 20
	4408	+	amended in 8 V.S.A. chapter 107 that are enacted during the 2025–2026 21 BILL AS INTRODUCED S.30
7544	4409		2025 Page 181 of 181
7545		-	amendmentsinthisactshallnotsupersedesubstantivechangescontainedin
7546		-	otherbillsenactedbytheGeneralAssemblyduringthecurrentbiennium.
7547		-	Wherepossible,theamendmentsinthisactshallbeinterpretedtobe
7548		-	supplementaltootheramendmentsmadetothesectionsof8V.S.A.chapter
7549		-	107usingthenumberingschemeineffectpriortotheeffectivedateofthisact;
7550		-	totheextenttheprovisionsconflict,thesubstantivechangesinotheractsshall
7551		-	takeprecedenceoverthetechnicalchangesinthisact.Statutesaddedtoor
7552		-	amendedin8V.S.A.chapter107thatareenactedduringthe2025–2026
7553		-	bienniumusingthenumberingschemethatexistedpriortotheeffectivedate
7554		-	ofthisactshallbecodifiedinthecorrespondingstatutesasrenumberedbythis
7555		-	act.
7556		-	(b)Rulesadoptedandorders,bulletins,forms,andguidancedocuments
7557		-	issuedbytheDepartmentofFinancialRegulation,theGreenMountainCare
7558		-	Board,andotherStateagenciesthatrefertostatutesin8V.S.A.chapter107
7559		-	usingthenumberingthatexistedpriortotheeffectivedateofthisactshall
7560		-	continuetobevalidfollowingtheeffectivedateofthisactuntilsuchtimeas
7561		-	therelevantdocumentscanbeamendedorupdatedtoalignwiththe
7562		-	renumberingofthatchapterbythisact.
7563		-	*EffectiveDate*
7564		-	Sec.33.EFFECTIVEDATE
7565		-	ThisactshalltakeeffectonJanuary1,2026.
7566		-	1
7567		-	2
7568		-	3
7569		-	4
7570		-	5
7571		-	6
7572		-	7
7573		-	8
7574		-	9
7575		-	10
7576		-	11
7577		-	12
7578		-	13
7579		-	14
7580		-	15
7581		-	16
7582		-	17
7583		-	18
7584		-	19
7585		-	20
7586		-	21
	4410	+
	4411	+
	4412	+	VT LEG #380165 v.1
	4413	+	biennium using the numbering scheme that existed prior to the effective date of 1
	4414	+	this act shall be codified in the corresponding statutes as renumbered by this 2
	4415	+	act. 3
	4416	+	(b) Rules adopted and orders, bulletins, forms, and guidance documents 4
	4417	+	issued by the Department of Financial Regulation, the Green Mountain Care 5
	4418	+	Board, and other State agencies that refer to statutes in 8 V.S.A. chapter 107 6
	4419	+	using the numbering that existed prior to the effective date of this act shall 7
	4420	+	continue to be valid following the effective date of this act until such time as 8
	4421	+	the relevant documents can be amended or updated to align with the 9
	4422	+	renumbering of that chapter by this act. 10
	4423	+	* * * Effective Date * * * 11
	4424	+	Sec. 33. EFFECTIVE DATE 12
	4425	+	This act shall take effect on January 1, 2026. 13