§4091f. Replacement coverage

Link to law: http://legislature.vermont.gov/statutes/section/08/107/04091f
Published: 2015

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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.)
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