§ 4088f. Prosthetic parity
(a) As used in this section:
(1) “Health insurance plan” means any health insurance policy or health benefit plan offered by a health insurer, as defined in 18 V.S.A. § 9402, as well as Medicaid and any other public health care assistance program offered or administered by the State or by any subdivision or instrumentality of the State. The term shall not include policies or plans providing coverage for a specific disease or other limited benefit coverage.
(2) “Prosthetic device” means an artificial limb device to replace, in whole or in part, an arm or a leg.
(b) A health insurance plan shall provide coverage for prosthetic devices in all health plans at least equivalent to that provided by the federal Medicare program. Coverage may be limited to the prosthetic device that is the most appropriate model that is medically necessary to meet the patient’s medical needs. Any dispute between the insured and the carrier concerning coverage and the application of this section shall be subject to independent external review under section 4089f of this title.
(c) A health insurance plan may require prior authorization for prosthetic devices in the same manner and to the same extent as prior authorization is required for any other covered benefit.
(d) A health insurance plan shall provide coverage under this section for the medically necessary repair or replacement of a prosthetic device.
(e) A health insurance plan shall not impose any annual or lifetime dollar maximum on coverage for prosthetics that is less than the annual or lifetime dollar maximum that applies generally to all terms and services covered under the plan.
(f) The coverage required may not be subject to a deductible, co-payment, or coinsurance provision that is less favorable to a covered individual than the deductible, co-payment, or coinsurance provisions that apply generally to other non-primary care items and services under the health plan. (Added 2007, No. 103 (Adj. Sess.), § 1, eff. Oct. 1, 2008; amended 2015, No. 97 (Adj. Sess.), § 16.)
Structure Vermont Statutes
Title 8 - Banking and Insurance
Chapter 107 - Health Insurance
§ 4062. Filing and approval of policy forms and premiums
§ 4062b. Medicare supplemental health insurance
§ 4062c. Compliance with federal law
§ 4062e. Compliance with Medicaid recovery provisions
§ 4062f. Discretionary clauses prohibited
§ 4063. Form and contents of policy
§ 4063a. Coverage for civil unions
§ 4063b. Coverage for employees of an employer domiciled outside Vermont
§ 4064. Provisions applying to policies delivered in another state
§ 4065. Required standard policy provisions
§ 4066. Optional standard policy provisions
§ 4067. Omission of inapplicable or inconsistent standard provisions
§ 4068. Order of standard policy provisions
§ 4070. Requirements of other jurisdictions
§ 4071. Regulations on filing policies
§ 4072. Nonconforming policies
§ 4073. Applications for insurance
§ 4077. Termination; comprehensive major medical policies; grace period
§ 4079. Group insurance policies; definitions
§ 4079a. Association health plans
§ 4080. Required policy provisions
§ 4080d. Coordination of insurance coverage with Medicaid
§ 4080e. Medicare supplemental health insurance policies; community rating; disability
§ 4081. Blanket health insurance
§ 4082. Blanket insurance; policy contents
§ 4083. Discrimination prohibited
§ 4084a. Short-term, limited-duration health insurance
§ 4085a. Rebates prohibited for group insurance policies
§ 4086. Exemption from attachment and trustee process
§ 4087. Penalties for violations
§ 4088a. Chiropractic services
§ 4088b. Clinical trials for cancer patients
§ 4088c. Chemotherapy treatment
§ 4088d. Coverage for covered services provided by naturopathic physicians
§ 4088e. Notice of preferred drug list changes
§ 4088g. Coverage for covered services provided by athletic trainers
§ 4088h. Health insurance and the Blueprint for Health
§ 4088i. Coverage for diagnosis and treatment of early childhood developmental disorders
§ 4088j. Choice of providers for vision care and medical eye care services
§ 4088k. Physical therapy co-payments for certain plans
§ 4088l. Coverage for hearing aids [Effective January 1, 2024]
§ 4089. Services for victims of sexual assault
§ 4089a. Mental health care services review
§ 4089b. Health insurance coverage, mental health, and substance use disorder
§ 4089d. Coverage; dependent children
§ 4089e. Treatment of inherited metabolic diseases
§ 4089f. Independent external review of health care service decisions
§ 4089g. Craniofacial disorders
§ 4089h. Cancellation or nonrenewal of health insurance coverage
§ 4089i. Prescription drug coverage
§ 4089j. Retail pharmacies; filling of prescriptions
§ 4090a. Continuation of group
§ 4090b. Continuation; notice; terms
§ 4090c. Termination of coverage
§ 4090e. Conversion; notice; terms
§ 4090f. Exemptions; termination
§ 4091b. Policies and contracts covered
§ 4091c. Termination for nonpayment of premium or subscription charges
§ 4091d. Notice of termination
§ 4091e. Extension of benefits
§ 4092. Newborn infants; coverage
§ 4096. Home health care; insurance
§ 4099c. Reproductive health equity in health insurance coverage
§ 4099d. Midwifery coverage; home births
§ 4100a. Mammograms; coverage required
§ 4100c. Adopted child coverage
§ 4100d. Child vaccine benefits
§ 4100e. Required coverage for off-label use
§ 4100f. Prostate screenings; coverage required
§ 4100g. Colorectal cancer screening, coverage required
§ 4100h. Orally administered anticancer medication; coverage required
§ 4100i. Anesthesia coverage for certain dental procedures
§ 4100j. Coverage for tobacco cessation programs
§ 4100l. Coverage of health care services delivered by audio-only telephone