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The Vermont Statutes Online
Title
08
:
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 subdivision for benefits required
to be paid by the prior carrier.
(4) When
replacing a prior carrier's plan which 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
which provides a level of benefit equal to the lesser of:
(A) the
extension of benefits which 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.)