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HIV Testing Information and Consent Forms (Revised)

Wednesday, September 4, 2019
Insurance Bulletin #138 (Revised)
Forms Related to Bulletin #138

Insurance Division Bulletin 138 (Revised)
HIV Testing Information & Consent Form

The purpose of this bulletin is to notify insurers that effective July 1, 2019, Title 8 V.S.A. 4724(20), regarding HIV testing requirements, was amended by Act No. 57 of the 2019 Legislative Session. 

The forms for consent, disclosure, and notification of test results must be filed with and approved by the Commissioner prior to their use.  The department has drafted revised  model forms: HIV TESTING INFORMATION STATEMENT & CONSENT FORM (VT-Bulletin138-Form 1 (Rev. 09/19)) and Vermont Notification of Test Result Letters ( VT-Bulletin138-Form 2, 3, 4, 5 (Rev. 09/19)), for insurers to consider using.  Use of these forms will result in an expedited approval.


Questions should be directed to:

Emily Brown

Director of Rates and Forms

Vermont Department of Financial Regulation

Phone: (802) 828-4871


Dated at Montpelier, Vermont on this   ______day of September, 2019.


Michael S. Pieciak, Commissioner

Contact Information

Department of Financial Regulation
Consumer Services 
89 Main Street, Montpelier, VT 05620 - 3101

833-DFR-HOTLINE (toll free)
833-337-4685 (toll free)

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