Vermont Health Insurance

According to the Center for Disease Control, an average of 9.9% of Vermont residents went uninsured for Vermont health insurance each year from 2001 to 2003.

Vermont Health Insurance Regulations

Any individual who has Vermont health insurance through a group or employer cannot be denied or limited access to health insurance coverage under that plan. Individuals looking for health insurance in Vermont cannot be turned down on the basis of health, age or any other factor. This is called guaranteed issue. Furthermore, most Vermont health insurance is guaranteed renewable which means that any individual has the right to renew an existing Vermont health insurance policy provided there was no fraud and all premiums were paid on time.

All individual Vermont health insurance plans must offer an option to cover family, spouses and dependents to any interested customer. No resident can be turned away for health or any other reasons. Vermont health insurance companies cannot impose elimination riders which would permanently exclude coverage of a condition or body part. They can, however, have pre-existing exclusion periods of up to 12 months. The Vermont health insurance company can look back six months prior to coverage and see if a condition was treated. It can then exclude the condition from coverage for up to 12 months.

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Rates

Vermont health insurance rates cannot vary due to health. Rates can vary, however, due to age, family size, and upon renewal of a plan every 12 months, but cannot be increased more than 20%.

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Pregnancy

Pregnancy can be considered a pre-existing condition under Vermont health insurance law. Newborns and adopted children are automatically covered under a parent’s individual Vermont health insurance policy for the first 31 days after birth or adoption. Under some conditions children with disabilities may remain under a parent’s health insurance policy past the point at which dependent coverage usually ceases.

Alternative Vermont Health Insurance Options

Individuals who have difficulty pertaining to acquiring or dealing with Vermont health insurance may find help in the following state programs:

• Vermont Office of Health Care Ombudsman helps with individuals who are having difficulty with state-regulated health plans and need to file complaints or need help in resolving issues.
• Vermont Medicaid is available to qualified individuals who meet income and other eligibility requirements.
• Dr. Dynasaur is the state’s Children’s Health insurance program that is designed to provide health insurance to children under 19 whose families do not qualify for Medicaid and who may not be able to afford health insurance.
• Vermont Health Access Plan (VHAP) helps provide health insurance to adults and health plans that involve prescription drugs and eyeglasses.

Vermont Health Care Administration

89 Main St. Drawer 20
Montpelier, VT 05620-3101

General Number: 802-828-2900
Toll-free in Vermont: 1-800-631-7788

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For other Vermont Insurance Resources, See:

• Vermont Auto Insurance
• Vermont Home Insurance
• Vermont Health Insurance

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