Vermont Health Insurance Guide
Vermont Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
As a Vermont resident you can choose from a variety of private health insurance plans including plans for individuals and group plans provided by an employer. Depending on your income or employment status, you may also be eligible for Vermont State-funded affordable health insurance for individuals and families, and federal programs such as Medicaid and COBRA.
Vermont is a guarantee issue state for individual health insurance policies. That means that any company licensed to sell health insurance in Vermont must offer you a policy if you apply and if you do not have access to a group plan. In addition, civil unions must recognized on all family health plans sold in Vermont. However, insurers are permitted a 12-month exclusionary period and a 12-month look-back period for pre-existing conditions, if you cannot provide required proof of prior creditable coverage. The look-back period can only be applied if you are subject to the exclusionary period. Elimination Riders that exclude coverage for specific health conditions are not permitted in Vermont. Premiums are regulated by the state, which requires that all health insurers assess the same premium to everyone, regardless of their age, sex, lifestyle, regional demographics and health history. not regulated by the state, can be based on your health, your age and lifestyle factors. Vermont does not require insurers to offer standardized policies for individuals.
Vermont is a guarantee issue state for group health plans issued to small businesses that have a minimum of 75% participation and meet other requirements regarding employment records. If your Vermont health insurance is provided through your employer, your coverage cannot be denied because of age, sex, lifestyle, regional demographics or health history. can impose a 12-month exclusionary period and a six-month look-back period for pre-existing medical conditions, but must give credit for prior creditable coverage. Your employer may impose a waiting period for eligibility for new hires, but it must be applied equally to all new hires. Premiums for small group health insurance are community rated and cannot be increased because of the group’s health history. Vermont law requires insurers to offer two standardized health plans to groups, although while benefits must be identical costs may vary depending on the carrier. If you are self-employed, you qualify for small group health insurance under Vermont law.
Vermont is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. However, your premiums can be increased to reflect your current health status, but not by more than 20% in a policy year. Your policy can be canceled if your insurer discontinues a plan or no longer sells insurance in the state.
Vermont Mandated Health Benefits
Vermont laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Alcoholism and Drug Abuse Treatment
- Breast Reconstruction
- Clinical Trials
- Contraceptives
- Diabetic Supplies
- Emergency Services
- Home Health Care
- Mammography
- Matenrity and Maternity Stays
- General and Parity Mental Health
- Off Label Drug Use
- PKU/Formula
- TMJ Disorders
- Coverage for newborns under their parent’s policy
- Coverage for adopted under their parent’s policy
- Coverage for non-custodial children under their guardian’s policy
- Coverage for handicapped dependents under their guardian’s policy
- Coverage for continuation/dependents under their guardian’s policy
- Coverage for dependent students under their parent’s policy
- Coverage for domestic partners
- Coverage for conversion to non-group
- Coverage for continuation/employees
Types Health Insurance Plans Available in Vermont
The following major medical health insurance plans are generally available in Vermont. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Vermont
Vermont Economic Services Division
VESD manages the Medicaid programs that provide health insurance for eligible Vermont seniors, the blind, disabled, pregnant women, low-income parents and uninsured children.
Dr. Dynasaur
This program provides comprehensive free or low-cost health care for resident pregnant women and children under 18, whose families meet income requirements and other eligibility requirements. One plan is available. Modest quarterly premiums are charged. There is a 30-day waiting period for children whose families voluntarily cancelled previous health care coverage. Enrollment is open but is subject to review and renewal at least every 12 months.
Regulating Agency
The Vermont Department of Banking, Insurance and Securities and Health Care Administration is responsible for regulating Vermont’s health insurance industry.
Get access to Vermont health insurance quotes from http://www.esurance.com/health-insurance.
Vermont Department of Banking, Insurance, Securities & Health Care Administration
89 Main St
Montpelier, VT 05620-3101
(802) 828-3301
http://www/bishca.state.vt.us
Vermont Economic Services Division
20 Houghton Street
St Albans, VT 05478-2227
(802) 524-7900
Dr. Dynasaur
Office of Vermont Health Access
Agency of Human Services
http://ovha.vermont.gov/for-consumers/dr-dynasaur
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/