The Vermont Statutes Online
The Vermont Statutes Online have been updated to include the actions of the 2023 session of the General Assembly.
NOTE: The Vermont Statutes Online is an unofficial copy of the Vermont Statutes Annotated that is provided as a convenience.
Title 8 : Banking and Insurance
Chapter 107 : Health Insurance
Subchapter 001 : Generally
(Cite as: 8 V.S.A. § 4088m)-
[Effective January 1, 2024.]
§ 4088m. Coverage for gender-affirming health care services [Effective January 1, 2024]
(a) Definitions. As used in this section:
(1) “Gender-affirming health care services” has the same meaning as in 1 V.S.A. § 150.
(2) “Health insurance plan” means Medicaid and any other public health care assistance program, 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. For purposes of this section, health insurance plan includes any health benefit plan offered or administered by the State or any subdivision or instrumentality of the State. The term does not include benefit plans providing coverage for a specific disease or other limited benefit coverage, except that it includes any accident and sickness health plan.
(b) Coverage.
(1) A health insurance plan shall provide coverage for gender-affirming health care services that:
(A) are medically necessary and clinically appropriate for the individual’s diagnosis or health condition; and
(B) are included in the State’s essential health benefits benchmark plan.
(2) Coverage provided pursuant to this section by Medicaid or any other public health care assistance program shall comply with all federal requirements imposed by the Centers for Medicare and Medicaid Services.
(3) Nothing in this section shall prohibit a health insurance plan from providing greater coverage for gender-affirming health care services than is required under this section.
(c) Cost sharing. A health insurance plan shall not impose greater coinsurance, co-payment, deductible, or other cost-sharing requirements for coverage of gender-affirming health care services than apply to the diagnosis and treatment of any other physical or mental condition under the plan. (Added 2023, No. 15, § 3, eff. January 1, 2024.)
