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 110: Dental Insurance
§§ 4121-4126. Repealed. 1995, No. 180 (Adj. Sess.), § 37.
§ 4121. Definitions
As used in this chapter:
(1) “Covered individual” means an individual covered under a dental insurance plan or a health insurance plan.
(2) “Covered service” means a dental service for which reimbursement is available under a covered individual’s dental insurance plan or health insurance plan or for which reimbursement would be available but for the application of contractual limitations such as deductibles, co-payments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or other limitations.
(3) “Dental insurance plan” means a stand-alone dental plan or policy that provides coverage for dental services separately from a health insurance plan.
(4) “Dental insurer” means any health or dental insurance company, including a nonprofit dental service corporation, that offers a dental insurance plan for sale.
(5) “Dentist” means an individual licensed to practice dentistry under 26 V.S.A. chapter 12.
(6) “Health insurance plan” means 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. The term does not include benefit plans providing coverage for a specific disease or other limited benefit coverage.
(7) “Health insurer” has the same meaning as in 18 V.S.A. § 9402. (Added 2021, No. 25, § 31, eff. Jan. 1, 2022.)
§ 4122. Fees for covered dental services
(a) No dental insurer, health insurer, or other similar entity that covers dental services and is subject to regulation by the Department of Financial Regulation, and no contract or participating provider agreement with a dentist, shall require, directly or indirectly, that a dentist who is a participating provider provide dental services to a covered individual at a fee set by, or subject to the approval of, the insurer or other regulated entity unless the dental services are covered services.
(b) No person providing third-party administrator services shall make available to any customers a plan that sets dental fees for providers in its provider network for any dental services other than covered services.
(c) Fees for covered services shall be set in good faith and shall not be nominal.
(d) The Commissioner of Financial Regulation shall enforce the provisions of this section pursuant to the Commissioner’s authority under this title. (Added 2021, No. 25, § 31, eff. Jan. 1, 2022.)
