Vermont Statutes
Chapter 107 - Health Insurance
§ 4099c. Reproductive health equity in health insurance coverage

§ 4099c. Reproductive health equity in health insurance coverage
(a) As used in this section, “health insurance plan” means any individual or group health insurance policy, any hospital or medical service corporation or health maintenance organization subscriber contract, or any other health benefit plan offered, issued, or renewed for any person in this State by a health insurer, as defined by 18 V.S.A. § 9402. The term shall not include benefit plans providing coverage for a specific disease or other limited benefit coverage.
(b) A health insurance plan shall provide coverage for outpatient contraceptive services including sterilizations, and shall provide coverage for the purchase of all prescription contraceptives and prescription contraceptive devices approved by the federal Food and Drug Administration, except that a health insurance plan that does not provide coverage of prescription drugs is not required to provide coverage of prescription contraceptives and prescription contraceptive devices. A health insurance plan providing coverage required under this section shall not establish any rate, term, or condition that places a greater financial burden on an insured or beneficiary for access to contraceptive services, prescription contraceptives, and prescription contraceptive devices than for access to treatment, prescriptions, or devices for any other health condition.
(c) A health insurance plan shall provide coverage without any deductible, coinsurance, co-payment, or other cost-sharing requirement for at least one drug, device, or other product within each method of contraception for women identified by the U.S. Food and Drug Administration (FDA) and prescribed by an insured’s health care provider.
(1) The coverage provided pursuant to this subsection shall include patient education and counseling by the patient’s health care provider regarding the appropriate use of the contraceptive method prescribed.
(2)(A) If there is a therapeutic equivalent of a drug, device, or other product for an FDA-approved contraceptive method, a health insurance plan may provide coverage for more than one drug, device, or other product and may impose cost-sharing requirements as long as at least one drug, device, or other product for that method is available without cost sharing.
(B) If an insured’s health care provider recommends a particular service or FDA-approved drug, device, or other product for the insured based on a determination of medical necessity, the health insurance plan shall defer to the provider’s determination and judgment and shall provide coverage without cost sharing for the drug, device, or product prescribed by the provider for the insured.
(d) A health insurance plan shall provide coverage for voluntary sterilization procedures for men and women without any deductible, coinsurance, co-payment, or other cost-sharing requirement, except to the extent that such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to 26 U.S.C. § 223.
(e) A health insurance plan shall provide coverage without any deductible, coinsurance, co-payment, or other cost-sharing requirement for clinical services associated with providing the drugs, devices, products, and procedures covered under this section and related follow-up services, including management of side effects, counseling for continued adherence, and device insertion and removal.
(f)(1) A health insurance plan shall provide coverage for a supply of prescribed contraceptives intended to last over a 12-month duration, which may be furnished or dispensed all at once or over the course of the 12 months at the discretion of the health care provider. The health insurance plan shall reimburse a health care provider or dispensing entity per unit for furnishing or dispensing a supply of contraceptives intended to last for 12 months.
(2) This subsection shall apply to Medicaid and any other public health care assistance program offered or administered by the State or by any subdivision or instrumentality of the State.
(g) Benefits provided to an insured under this section shall be the same for the insured’s covered spouse and other covered dependents.
(h) The coverage requirements of this section shall apply to self-administered hormonal contraceptives prescribed for an insured by a pharmacist in accordance with 26 V.S.A. § 2023. (Added 1999, No. 26, § 1; amended 2015, No. 120 (Adj. Sess.), § 1, eff. Oct. 1, 2016; 2019, No. 157 (Adj. Sess.), § 2, eff. July 1, 2021.)

Structure Vermont Statutes

Vermont Statutes

Title 8 - Banking and Insurance

Chapter 107 - Health Insurance

§ 4061. Definition

§ 4062. Filing and approval of policy forms and premiums

§ 4062a. Filing fees

§ 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

§ 4069. Third party ownership

§ 4070. Requirements of other jurisdictions

§ 4071. Regulations on filing policies

§ 4072. Nonconforming policies

§ 4073. Applications for insurance

§ 4074. Notice as waiver

§ 4075. Age limits

§ 4076. Policies not affected

§ 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

§ 4080g. Grandfathered plans

§ 4081. Blanket health insurance

§ 4082. Blanket insurance; policy contents

§ 4083. Discrimination prohibited

§ 4084. Advertising practices

§ 4084a. Short-term, limited-duration health insurance

§ 4085. Rebates and commissions prohibited for nongroup and small group policies and plans offered through the Vermont Health Benefit Exchange

§ 4085a. Rebates prohibited for group insurance policies

§ 4086. Exemption from attachment and trustee process

§ 4087. Penalties for violations

§ 4088. Appeal

§ 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

§ 4088f. Prosthetic parity

§ 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

§ 4089c. Diabetes treatment

§ 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

§ 4090d. Right of conversion

§ 4090e. Conversion; notice; terms

§ 4090f. Exemptions; termination

§ 4090g. Options required

§ 4091a. Definitions

§ 4091b. Policies and contracts covered

§ 4091c. Termination for nonpayment of premium or subscription charges

§ 4091d. Notice of termination

§ 4091e. Extension of benefits

§ 4091f. Replacement coverage

§ 4092. Newborn infants; coverage

§ 4095. Definitions

§ 4096. Home health care; insurance

§ 4099c. Reproductive health equity in health insurance coverage

§ 4099d. Midwifery coverage; home births

§ 4100a. Mammograms; coverage required

§ 4100b. Coverage of children

§ 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

§ 4100k. Coverage of health care services delivered through telemedicine and by store-and-forward means

§ 4100l. Coverage of health care services delivered by audio-only telephone