This bill requires Vermont's Agency of Human Services to seek a federal waiver by January 1, 2026, to expand eligibility for catastrophic health insurance plans to Vermont residents under age 40. Currently, these plans typically only cover people under 30, so this would allow younger adults (up to age 39) to access them. The waiver request is needed because federal law restricts catastrophic plan eligibility to those under 30, and Vermont seeks to override this limit. The bill is currently under review by the Health Care Committee after its first reading on February 28, 2025.
H.359 regulates when Vermont state agencies can replace permanent employees with private contractors. It requires agencies to provide 35 days' written notice to unions before seeking bids for privatization contracts, including details on wages (at least equal to comparable state positions) and services. Contracts must include wage standards, health insurance parity, performance metrics, and just-cause employment protections for contractor workers. The bill also mandates Attorney General certification that contracts align with merit system principles and requires annual audits to verify 10% cost savings and performance compliance before renewal. This directly affects state agencies, union-represented workers, and private contractors hired for state services.
This bill (H 55) requires all health insurance plans in Vermont - including Medicaid - to cover gender-affirming health care services that are medically necessary and clinically appropriate, such as facial procedures and hair removal, without extra cost-sharing. It also mandates coverage for fertility-related services, including diagnostic care, IVF procedures, fertility preservation (like egg freezing), and related medications, while prohibiting financial barriers or restrictions based on donor use. The bill prohibits insurers from denying coverage for these services based on factors like donor sperm or eggs, though it excludes experimental procedures and nonmedical costs (e.g., donor fees). Insurers must report compliance annually to state health committees, and the Agency of Human Services must seek federal approval for Medicaid coverage changes. The bill directly affects all Vermont health insurers, Medicaid, and individuals seeking these specific health services.
H 203 would expand the eligibility for association health plans (AHPs) in Vermont, allowing more types of organizations - such as professional or trade associations - to offer these health insurance options. Currently, AHPs are limited to specific association types, but this bill would broaden that scope, potentially giving more Vermont residents access to alternative coverage. It directly affects members of qualifying associations who may gain new health insurance choices through their group. The bill is pending review by the Health Care Committee after its initial referral.
H.207 requires health insurers in Vermont to cover all diabetes treatments (including equipment, supplies, and self-management education) without restricting providers to those under contract with the insurer. It also prohibits cost-sharing like copays or deductibles for these covered services. The bill applies to all standard health insurance plans issued on or after January 1, 2026, directly affecting Vermont residents with diabetes who have health insurance. It modifies existing law to ensure comprehensive, affordable access to diabetes care by eliminating insurer-imposed provider restrictions and cost barriers.
This bill updates Vermont's workers' compensation system by expanding wage definitions to include health insurance benefits, requiring employers to cover translation services for non-English speaking injured workers, and creating a process for requesting medical case management services. Insurers must approve or deny medical case management requests within 14 days, with injured workers able to seek Department intervention if denied. It also increases penalties for late payments, charging 5% of the benefit amount for the first late payment, escalating to 25% for fifth or subsequent late payments. The changes directly affect injured workers (especially non-English speakers), employers, and insurance carriers, aiming to improve access to care and timely compensation.
H 521 proposes to mandate that health insurance plans and the Dr. Dynasaur program provide coverage for pasteurized donated human breast milk. This coverage would be for infants under 12 months of age. The bill specifies that this coverage would apply under certain circumstances, though the full details are not included in this short-form version.
Senate Bill S 154 requires health insurance plans and Vermont's Medicaid program to provide coverage for biomarker testing. This testing analyzes a patient's samples to identify biological characteristics relevant to a disease or condition. Coverage is mandated for the diagnosis, treatment, management, and ongoing monitoring of a patient's disease. Such coverage is required when the test is supported by medical and scientific evidence, including FDA approvals, Medicare/Medicaid determinations, or nationally recognized clinical practice guidelines. The bill also specifies that coverage should be provided in a way that minimizes disruptions to patient care.
H.80 strengthens the Office of the Health Care Advocate (OHCA) by clarifying its role as an independent voice for Vermonters promoting access to affordable health care. The bill expands the OHCA's ability to advocate for consumers in health insurance rate reviews and certificate of need applications by allowing it to submit questions, comments, and provide testimony to the Green Mountain Care Board. It also updates the OHCA's duties, which include assisting Vermonters with health insurance plan selection, understanding their rights, filing complaints, and facilitating public input on health care policies.
This bill modifies Vermont's health insurance claim processing rules. It specifies that standard claim edit requirements (used to review billing accuracy) don't apply when healthcare services are provided outside Vermont, unless the insurer and out-of-state provider agree otherwise. It also updates the definition of "primary care provider" to align with Vermont Blueprint for Health standards, meaning orders from these providers generally won't require prior authorization for in-network services (except for prescriptions or out-of-network care). The changes to claim edits take effect January 1, 2026, while the primary care provider definition change applies immediately.
