Vermont H 95: An act relating to updating and reorganizing the health insurance statutes in 8 V.S.A. chapter 107

Bill Text

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H.95 1
Introduced by Representative Black of Essex 2
Referred to Committee on 3
Date: 4
Subject: Health; health insurance; Vermont Statutes Annotated 5
Statement of purpose of bill as introduced: This bill proposes to update and 6
reorganize the health insurance chapter, 8 V.S.A. chapter 107, including using 7
consistent language and terminology throughout the chapter. The bill would 8
also update cross-references in other statutes as needed. 9
An act relating to updating and reorganizing the health insurance statutes in 10
8 V.S.A. chapter 107 11
It is hereby enacted by the General Assembly of the State of Vermont: 12
* * * Repeal of Existing 8 V.S.A. Chapter 107 * * * 13
Sec. 1. REPEAL OF EXISTING 8 V.S.A. CHAPTER 107 14
8 V.S.A. chapter 107 (health insurance) is repealed. 15
* * * Enactment of Updated and Reorganized 8 V.S.A. Chapter 107 * * * 16
Sec. 2. 8 V.S.A. chapter 107 is added to read: 17
CHAPTER 107. HEALTH INSURANCE 18
Subchapter 1. General Provisions 19

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§ 4011. DEFINITIONS 1
As used in this chapter: 2
(1) “Covered individual” means an individual who is covered by a 3
health insurance plan, whether as the primary subscriber or policyholder or as a 4
dependent, employee, or employee’s dependent under the plan. 5
(2) “Health care services” means services for the diagnosis, prevention, 6
treatment, cure, or relief of a health condition, illness, injury, or disease. 7
(3) “Health insurance plan” means a policy or contract issued by a 8
health insurer, including the health benefit plan or plans offered by the State of 9
Vermont to its employees and any health benefit plan offered by any agency or 10
instrumentality of the State to its employees. Unless otherwise specified, 11
“health insurance” does not include Vermont Medicaid. 12
(4) “Health insurer” means an insurance company that provides health 13
insurance as defined in subdivision 3301(a)(2) of this title, a nonprofit hospital 14
or medical service corporation, a managed care organization, a health 15
maintenance organization, and, to the extent permitted under federal law, any 16
administrator of an insured, self-insured, or publicly funded health care benefit 17
plan offered by a public or private entity. 18
(5) “Major medical insurance” means a comprehensive health insurance 19
plan that is not specific disease, accident, hospital indemnity, dental care, 20
vision care, disability income, long-term care, Medicare supplement insurance, 21

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or other limited-benefit coverage. The term does not include short-term, 1
limited-duration health insurance coverage or a plan under which benefits are 2
paid directly to a covered individual or the individual’s assigns and for which 3
the amount of the benefit is not based on potential medical costs or on actual 4
costs incurred. 5
§ 4012. COMPLIANCE WITH FEDERAL LAW 6
(a) Except as otherwise provided in this title, health insurers, hospital and 7
medical service corporations, and health maintenance organizations that issue, 8
sell, renew, or offer health insurance plans in Vermont shall comply with the 9
requirements of the Health Insurance Portability and Accountability Act of 10
1996, as amended from time to time (42 U.S.C. Chapter 6A, Subchapter 11
XXV), and the Patient Protection and Affordable Care Act of 2010, Pub. L. 12
No. 111-148, as amended by the Health Care and Education Reconciliation Act 13
of 2010, Pub. L. No. 111-152. The Commissioner shall enforce such 14
requirements pursuant to the Commissioner’s authority under this title. 15
(b)(1) Health insurers, hospital and medical service corporations, health 16
maintenance organizations, and health care providers, as that term is defined in 17
18 V.S.A. § 9432, shall comply with the requirements of the No Surprises Act, 18
Pub. L. No. 116-260, Division BB, Title I, as amended from time to time. 19
(2) The Commissioner shall enforce the requirements of the No 20
Surprises Act as they apply to health insurers, hospital and medical service 21

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corporations, health maintenance organizations, and health care providers, to 1
the extent permitted under federal law, pursuant to the Commissioner’s 2
authority under this title. The Commissioner may also refer cases of 3
noncompliance to the U.S. Department of Health and Human Services under 4
the terms of a collaborative enforcement agreement, or to the Office of the 5
Vermont Attorney General. 6
§ 4013. DISCRIMINATION PROHIBITED 7
No health insurer shall make or permit any unfair discrimination between 8
individuals of substantially the same hazard in the amount of premium rates 9
charged for any health insurance plan or in the benefits payable under the plan; 10
provided, however, that this section shall not be construed to prohibit different 11
premium