The Vermont Statutes Online

Title 8 : Banking and Insurance

Chapter 107 : Health Insurance

Subchapter 001 : GENERAL PROVISIONS

• § 4011. Definitions

  As used in this chapter:

  (1) “Covered individual” means an individual who is covered by a health insurance plan, whether as the primary subscriber or policyholder or as a dependent, employee, or employee’s dependent under the plan.

  (2) “Health care services” means services for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease.

  (3) “Health insurance plan” means a policy or contract issued by a health insurer, including the health benefit plan or plans offered by the State of Vermont to its employees and any health benefit plan offered by any agency or instrumentality of the State to its employees. Unless otherwise specified, “health insurance” does not include Vermont Medicaid.

  (4) “Health insurer” means an insurance company that provides health insurance as defined in subdivision 3301(a)(2) of this title, a nonprofit hospital or medical service corporation, a managed care organization, a health maintenance organization, and, to the extent permitted under federal law, any administrator of an insured, self-insured, or publicly funded health care benefit plan offered by a public or private entity.

  (5) “Major medical insurance” means a comprehensive health insurance plan that is not specific disease, accident, hospital indemnity, dental care, vision care, disability income, long-term care, Medicare supplement insurance, or other limited-benefit coverage. The term does not include short-term, limited-duration health insurance coverage or a plan under which benefits are paid directly to a covered individual or the individual’s assigns and for which the amount of the benefit is not based on potential medical costs or on actual costs incurred. (Recodified and amended 2025, No. 11, § 2, eff. September 1, 2025.)