§ 4089j. Retail pharmacies; filling of prescriptions
§ 4089j. Retail pharmacies; filling of prescriptions (a) As used in this section: (1) “Health insurer” shall have the same meaning as in 18 V.S.A. § 9402 and shall also include Medicaid and any other public health care assistance program. (2) “Pharmacy benefit manager” means an entity that performs pharmacy benefit management. “Pharmacy benefit management” […]
§ 4089a. Mental health care services review
§ 4089a. Mental health care services review (a) The purposes of this section are to: (1) promote the delivery of quality mental health care in a cost-effective manner; (2) foster the practice of mental health services review as a professional collaborative process, the primary objective of which is to enhance the effectiveness of clinical treatment; […]
§ 4089b. Health insurance coverage, mental health, and substance use disorder
§ 4089b. Health insurance coverage, mental health, and substance use disorder (a) It is the goal of the General Assembly that treatment for mental conditions be recognized as an integral component of health care, that health insurance plans cover all necessary and appropriate medical services without imposing practices that create barriers to receiving appropriate care, […]
§ 4089c. Diabetes treatment
§ 4089c. Diabetes treatment (a)(1) A health insurer shall provide coverage for the equipment, supplies, and outpatient self-management training and education, including medical nutrition therapy, for the treatment of insulin dependent diabetes, insulin using diabetes, gestational diabetes, and noninsulin using diabetes if prescribed by a health care professional legally authorized to prescribe such items under […]
§ 4089d. Coverage; dependent children
§ 4089d. Coverage; dependent children (a) As used in this section, “health insurance plan” has the same meaning as “group health plan” and shall be subject to the same excepted benefits, in each case, as set forth in 45 C.F.R. § 146.145, as in effect as of December 31, 2017. (b) A health insurance plan […]
§ 4089e. Treatment of inherited metabolic diseases
§ 4089e. Treatment of inherited metabolic diseases (a) For the purposes of this section: (1) “Inherited metabolic disease” means a disease caused by an inherited abnormality of body chemistry for which the State screens newborn infants. (2) “Insurer” means any health insurance company, nonprofit hospital and medical service corporation, managed care organization, and health maintenance […]
§ 4089f. Independent external review of health care service decisions
§ 4089f. Independent external review of health care service decisions (a) As used in this section: (1) “Health benefit plan” means a policy, contract, certificate, or agreement entered into, offered, or issued by a health insurer, as defined in 18 V.S.A. § 9402, to provide, deliver, arrange for, pay for, or reimburse any of the […]
§ 4089g. Craniofacial disorders
§ 4089g. Craniofacial disorders (a) A health insurance plan shall provide coverage for diagnosis and medically necessary treatment, including surgical and nonsurgical procedures, for a musculoskeletal disorder that affects any bone or joint in the face, neck, or head and is the result of accident, trauma, congenital defect, developmental defect, or pathology. Subject to subsection […]
§ 4089h. Cancellation or nonrenewal of health insurance coverage
§ 4089h. Cancellation or nonrenewal of health insurance coverage (a) Except as otherwise provided for comprehensive major medical insurance coverage in section 4077 of this chapter, a health insurer shall notify a policyholder of any premium payment due on a policy at least 21 days before the due date. If an insurer does not receive […]
§ 4089i. Prescription drug coverage
§ 4089i. Prescription drug coverage (a) A health insurance or other health benefit plan offered by a health insurer shall provide coverage for prescription drugs purchased in Canada, and used in Canada or reimported legally or purchased through the I-SaveRx program on the same benefit terms and conditions as prescription drugs purchased in this country. […]