The Vermont Statutes Online

Title 8 : Banking and Insurance

Chapter 107 : Health Insurance

Subchapter 003 : GROUP HEALTH INSURANCE TERMINATION AND REPLACEMENT

• § 4091f. Replacement coverage

  (a) General. When the group health insurance policy or subscriber contract of a carrier replaces a policy or contract providing similar benefits of another carrier, the liability of both carriers shall be as provided in this section and rules adopted pursuant to this section.

  (b) Liability of prior carrier. A prior carrier remains liable after termination of its policy or contract only to the extent of its accrued liabilities and extensions of benefits.

  (c) Liability of succeeding carrier.

  (1) A succeeding carrier shall offer a group health insurance policy or subscriber contract to replace a prior carrier’s policy or contract in accordance with the provisions of this subsection.

  (2) A succeeding carrier shall offer a policy or contract to cover all persons who:

  (A) are covered or are a member of a class eligible for coverage under the prior carrier’s policy or contract on the date of termination of the prior carrier’s policy or contract; or

  (B) are a member of a class eligible for coverage under the succeeding carrier’s policy or contract on the date of termination of the prior carrier’s policy or contract.

  (3) The succeeding carrier is not liable under this subsection for benefits required to be paid by the prior carrier.

  (4) When replacing a prior carrier’s plan that is not subject to section 4091e of this title, the succeeding carrier shall, in addition to the coverage required to be offered under subdivision (2) of this subsection, offer a policy or contract that provides a level of benefit equal to the lesser of:

  (A) the extension of benefits that would have been required if the prior carrier’s policy or contract was subject to section 4091e of this title; or

  (B) the extension of benefits required for the succeeding carrier’s policy or contract, except that any such benefits may be reduced by benefits actually payable under the prior carrier’s plan.

  (5) The preexisting condition limitation of a succeeding carrier’s policy or contract shall provide a level of benefits equal to the lesser of:

  (A) the benefits of the succeeding carrier’s policy or contract determined without application of the preexisting conditions limitation; or

  (B) the benefits of the prior carrier’s policy or contract.

  (6) The succeeding carrier, in applying a deductible or waiting-period provision in its policy or contract, shall give credit for the satisfaction of the same or similar provisions under the prior carrier’s policy or contract.

  (7) At the succeeding carrier’s request the prior carrier shall furnish all information needed to determine the benefits available under the prior carrier’s policy or contract.

  (d) Rules. The Commissioner shall adopt rules necessary to carry out the purposes of this section. (Added 1989, No. 113, § 2; amended 2019, No. 14, § 10, eff. April 30, 2019.)