H.580 would create a unified public employees' health plan covering current and retired State, school, municipal, and university workers in Vermont. It establishes an independent commission to design the plan and set cost-sharing between employers and employees, while removing health care from collective bargaining. The bill requires all public employee health insurance costs to be tracked in a single budget line item, mandating annual transparency reports on total costs, cost per covered person, and year-over-year trends. It also directs the Governor’s budget to present public employee health benefits and Medicaid costs together, along with detailed breakdowns of expenditures for other state health programs.
This Vermont bill (H.776) requires health insurance companies using artificial intelligence to make coverage decisions to base those decisions on individual patient medical records - not group data - and prohibits AI from denying coverage. Final coverage decisions must be made by licensed human health care providers after reviewing patient-specific clinical information. The bill also mandates quarterly AI performance reviews, transparency about AI use in policies, and ensures tools are applied fairly across all patients with similar needs. It takes effect July 1, 2026.
H.691 requires health insurance plans to cover breastfeeding equipment, education, and counseling (including lactation support) without cost-sharing like deductibles or copays. It also mandates hospitals with maternity units to adopt infant-feeding policies promoting breastfeeding, aligned with the Baby-Friendly Hospital Initiative, and to communicate these policies to staff and patients. The bill directly affects mothers and newborns by improving access to breastfeeding support through insurance and hospital practices. Key provisions include eliminating out-of-pocket costs for breastfeeding services and requiring hospitals to implement evidence-based feeding policies. The law takes effect January 1, 2027.
This bill (S.164) makes members of Vermont's General Assembly eligible for the same health insurance benefits as state employees. It amends state law to include legislators under the definition of "employees" for health coverage, requiring them to pay the same cost-sharing portion (premium) as Executive Branch employees. The change applies to group hospital-surgical-medical expense insurance, employee assistance programs, and flexible spending accounts already offered to state workers. The policy takes effect January 1, 2027, extending existing benefits to legislators without creating new coverage or altering benefit levels.
This bill requires health insurance plans in Vermont to cover scalp cooling systems used during cancer chemotherapy treatment. It directly affects cancer patients undergoing chemotherapy who might otherwise face out-of-pocket costs for these devices, which help prevent hair loss. The law defines scalp cooling systems as reusable medical devices designed specifically to cool the scalp during treatment. Coverage becomes mandatory for all health insurance plans issued or renewed on or after January 1, 2027.
H.815 limits health insurers and Vermont Medicaid from reducing reimbursement rates for mental health, substance use disorder, or developmental disability services below the previous year’s rate. It requires insurers to provide 90 days’ public notice, host stakeholder meetings, and publish impact analyses before changing billing, coding, or service authorization policies affecting these areas. Insurers must also monitor access metrics like provider availability and wait times for 12 months after policy changes and take corrective action if access declines. This directly affects insurers, Medicaid, and mental health providers by standardizing payment stability and increasing transparency in coverage decisions.
This bill (H 585) reforms health insurance company governance and pricing in Vermont. It requires health insurers to have boards where at least 75% of members are subscribers or public representatives (not providers), with the Governor appointing two public members. The bill also mandates a compensation committee with public representatives to review executive pay and limits primary care provider exemptions from prior authorization. Additionally, it allows limited age-based pricing in individual/small group insurance markets and begins implementing site-neutral billing for certain services. These changes directly affect health insurance companies operating in Vermont’s individual and small group markets.
H.833 creates a study committee to evaluate the feasibility of a public option health insurance plan for Vermont. The committee would assess a high-deductible plan designed for public employees initially, with potential future expansion to others, including reimbursement rates capped at 10-15% above Medicare (higher in rural areas) and requirements for price transparency. It would analyze cost projections, funding options (like premium tax credits for small businesses and a stabilization fund), and integration into a single risk pool. The committee must submit a report and draft legislation for a potential pilot program by January 15, 2027. This bill does not implement the plan but studies its viability.
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.
