This bill (S.251) requires health insurance plans in Vermont to cover the medically necessary diagnosis and treatment of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) for children. It mandates coverage for specific treatments like antibiotics, mental health services, and immune-related therapies, without higher cost-sharing than for other conditions. Insurers must follow current clinical guidelines for these treatments and temporarily use "autoimmune encephalitis" as a billing code until specific PANDAS/PANS codes are created. The law takes effect January 1, 2027, applying to all new or renewed health insurance plans after that date.
This bill requires Vermont's Department of Human Resources to implement reference-based pricing for inpatient and outpatient hospital services (excluding critical access hospitals) in the state employees' health plan starting in 2026. It limits annual premium growth for the plan to no more than medical inflation in the Northeast region and allows school employers to join the plan to cover their employees. The policy directly affects current state employees, school employees whose employers participate, and the state government as the health plan administrator. The Department must report annually on the program's cost impact to the legislature.
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 430 allows Vermont health insurers to adjust individual and small group health insurance premiums based on the policyholder's age and tobacco use, while maintaining strict limits. Insurers may charge up to 3 times more for the oldest age group compared to the youngest, and up to 1.5 times more for tobacco users compared to non-users. Premium changes cannot deviate more than 20% above or below the standard community rate, and total adjustments (including age/tobacco) must stay within a 30% cap. This bill directly affects Vermont residents purchasing individual or small-group health plans, effective January 1, 2026.
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.
