Health Insurance section under the Insurance Division
Section 1. Purpose and Goals.
(a) The purpose of this Rule is to establish a process for the creation of uniform standards, including electronic transaction standards, for health insurance claims administration and adjudication, including but not limited to standards relating to claims forms, patient invoices and explanation of benefits forms, the use of payment codes, claims submission and processing procedures, and the prior authorization process.
Section 1. Policy.
(a) Authority
This Rule is promulgated pursuant to Titles 8 and 18 of the Vermont Statutes Annotated, The Health Care Affordability Act of 2006 (Act 191, 2005, Adj. Sess.), An Act Relating to Health Care Reform (Act 203, 2007, Adj. Sess.) and other applicable law.
(b) Policy
Section 1. Purpose.
The purpose of this Rule is to set forth the requirements for Catamount Health insurance, as provided in 8 V.S.A. § 4080f and An Act Relating to Health Care Affordability for Vermonters, 2005 Vt. Acts & Resolves No. 191 (Adj. Sess. 2006). Catamount Health insurance shall be sold and administered in accordance with the Act and the policies and purposes of Title 8.
Section 2. Authority.
Section 1. Purpose and Authority
This regulation is issued pursuant to the authority of the Commissioner of the Department of Banking, Insurance, Securities and Health Care Administration under 8 V.S.A. § 15 and 8 V.S.A. § 4088b to issue rules and regulations requiring that health benefit plans provide coverage for routine costs for patients who participate in approved cancer clinical trials.
Section 2. Applicability and Scope
Section 1. General Provisions.
DEPARTMENT OF FINANCIAL REGULATION
MEDICARE SUPPLEMENT
INSURANCE MINIMUM STANDARDS RULE
REGULATION H-2009-04 (Revised)
Table of Contents
Section 1. Purpose
Section 2. Authority
Section 3. Applicability and Scope
Section 4. Definitions
New Rule | Proposed Revised Rule: 12/02/2022
Final Proposed Rule: 03/03/2023
Adopted Rule: 04/17/2023
Revised Rule Effective: 15 days after adoption
Date New Rule Takes Effect: 05/02/2023
PART 1 GENERAL PROVISIONS
Section 1.1 Purpose.
The purpose of this rule is to set forth the consumer protection and quality requirements that managed care organizations shall meet in order to further the purposes of its enabling statutes.
Section 1.2 Authority.
This rule is issued pursuant to the authority vested in the Commissioner of the Department of Financial Regulation by 18 V.S.A. § 9414 and 8 V.S.A. §§ 15, 4089a, 4089b, and 4724.
STATE OF VERMONT
DEPARTMENT OF FINANCIAL REGULATION
Regulation H-2009-02 (Revised)
HEALTH CARE STOP LOSS INSURANCE
Table of Contents
Section 1. Authority and Purpose
Section 2. Scope
Section 3. Definitions
Section 4. Health Care Stop Loss Insurance Coverage Standards
Section 5. Required Disclosure Provisions
