The Vermont Statutes Online

Title 8 : Banking and Insurance

Chapter 107 : Health Insurance

Subchapter 002 : Continuation and Conversion of Group Health Insurance Policies

• § 4090a. Continuation of group

  (a) All group health insurance policies, including dental policies, issued by an insurance company or a nonprofit hospital or medical service corporation; self-insured group plans; and prepaid health insurance plans, delivered or issued for delivery in this State, which insure employees or members for dental insurance or hospital and medical insurance on an expense incurred, service basis, or prepaid basis, other than policies covering specific diseases or accidental injuries only, shall provide that any person whose insurance under the group policy would terminate because of the occurrence of a qualifying event as defined in subsection (b) of this section shall be entitled to continue his or her health insurance under that group policy.

  (b) For purposes of this subchapter, “qualifying event” means:

  (1) loss of employment, including a reduction in hours that results in ineligibility for employer-sponsored coverage;

  (2) divorce, dissolution, or legal separation of the covered employee from the employee’s spouse or civil union partner;

  (3) a dependent child ceasing to qualify as a dependent child under the generally applicable requirements of the policy; or

  (4) death of the covered employee or member.

  (c) The provisions of this section shall not apply if:

  (1) The deceased person or employee was not insured under the group policy on the date of the qualifying event.

  (2) The person is covered by Medicare.

  (3) The person is covered by any other group insured or uninsured arrangement which provides dental coverage or hospital and medical coverage for individuals in a group and under which the person was not covered immediately prior to such qualifying event, and no preexisting condition exclusion applies; provided, however, that the person shall remain eligible for continuation coverages which are not available under the insured or uninsured arrangement.

  (4) The person has a loss of employment due to misconduct as defined in 21 V.S.A. § 1344.

  (d) The continuation required by this section only applies to dental, hospital, and medical benefits.

  (e) Notice of the continuation privilege shall be included in each certificate of coverage and shall be provided by the employer to the employee within 30 days following the occurrence of any qualifying event. (Added 1983, No. 165 (Adj. Sess.), § 1; amended 1985, No. 184 (Adj. Sess.), § 1; 2001, No. 121 (Adj. Sess.), § 3, eff. June 5, 2002; 2009, No. 61, § 14, eff. June 2, 2009.)