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Private Insurance Data Requirements in Vermont

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A health insurer must not disclose personal health information about an enrollee without a written authorization.1 A health insurer may not discriminate against an individual due to his or her medical or genetic information.2

Health insurers must establish a grievance procedure to resolve its members’ complaints.3 An individual has a right to request an independent external review of an adverse determination of his or her health insurer.4 New Hampshire’s Office of the Health Care Ombudsman is established to help assist consumers with health insurance issues.5

Health insurers must disclose the terms and conditions of a health plan to every new member.6

The commissioner of financial regulation is authorized to review a health insurer’s policies and procedures to determine whether it is complying with state law.7

 

Footnotes

  • 1. Vermont Administrative Code §§4-3-42:17; 4-3-46:6
  • 2. 8 Vermont Statutes §4724; 18 Vermont Statutes §9332
  • 3. 8 Vermont Statutes §5102a
  • 4. 8 Vermont Statutes §4089f
  • 5. 8 Vermont Statutes §4089w
  • 6.   8 Vermont Statutes §4902
  • 7. 18 Vermont Statutes §9414

 

Private Insurance Data Requirements in Vermont

Subtopic Statute/Regulation Description
Private Insurance Data Requirements 4-3 Vt. Code R. 19:5 - Common health plans under the Department of Financial Regulation regulations “Common health plans under the Department of Financial Regulation regulations” (2)(b) A small group insurer may limit coverage for pre-...
4-3 Vt. Code R. 37:6 - Production of health insurer records under the department of financial regulation regulations “Production of records under the department of financial regulation regulations” Health insurers’ records that are required to be...
4-3 Vt. Code R. 37:7 - Health insurer retention under the department of financial regulation regulations “Retention under the department of financial regulation regulations” Health insurers must maintained records for the following periods...
4-3 Vt. Code R. 37:8 - Foreign insurers under the department of financial regulation regulations “Foreign insurers under the department of financial regulation regulations” Insurers that are incorporated in other states must comply...
4-3 Vt. Code R. 42:17 - When authorization required for disclosure of nonpublic personal health information under the Department of Banking, Insurance, Securities, and Health Care Administrative regulations “When authorization required for disclosure of nonpublic personal health information under the Department of Banking, Insurance, Securities,...
4-3 Vt. Code R. 46:3 - Information security program under the Department of Financial Regulation regulations “Information security program under the Department of Financial Regulation regulations” An insurer must implement a comprehensive written...
4-5 Vt. Code R. 10:1 - Purpose of the Health Care Price and Quality Transparency Rule under the Department of Financial Regulation regulations “Purpose under the Department of Financial Regulation regulations” The purpose of the Health Care Price and Quality Transparency Rule is...
4-5 Vt. Code R. 10:5 - Security measures under the Department of Financial Regulation regulations “Security measures under the Department of Financial Regulation regulations” A health insurer may establish security procedures for...
4-5 Vt. Code R. 10:6 - Consumer charge and quality information for uninsured consumers under the Department of Financial Regulation regulations “Consumer charge and quality information for uninsured consumers under the Department of Financial Regulation regulations” Each hospital...
4-5 Vt. Code R. 3:10.100 - General provisions under the Department of Financial Regulation regulations “General provisions under the Department of Financial Regulation regulations” (1.1) Managed care organizations must comply with consumer...
4-5 Vt. Code R. 3:10.200 - Basic consumer protections required of all managed care organizations under the Department Financial Regulation regulations “Basic consumer protections required of all managed care organizations under the Department Financial Regulation regulations” (2.1) Each...
4-5 Vt. Code R. 3:10.300 - Additional requirements if utilization management mechanisms are used under the Department of Financial Regulation regulations “Additional requirements if utilization management mechanisms are used under the Department of Financial Regulation regulations”  (3...
4-5 Vt. Code R. 4:1 - Purpose of independent external reviews under the Department of Financial Regulation regulations “Purpose under the Department of Financial Regulation regulations” The purpose of the regulations is to establish a process for...
4-5 Vt. Code R. 4:5 - Requests for independent external review under the Department of Financial Regulation regulations “Requests for independent external review under the Department of Financial Regulation regulations” An insured may obtain independent...
4-5 Vt. Code R. 4:6 - Review by independent review organization under the Department of Financial Regulation regulations “Review by independent review organization under the Department of Financial Regulation regulations” (A) An independent review...
4-5 Vt. Code R. 4:8 - Independent review organizations under the Department of Financial Regulation regulations “Independent review organizations under the Department of Financial Regulation regulations” The Department of Financial Regulation must...
4-5 Vt. Code R. 4:9 - External review reporting requirements under the Department of Financial Regulation regulations “External review reporting requirements under the Department of Financial Regulation regulations” An independent review organization must...
Vermont Administrative Code §4-5-4:10 “Costs of independent external reviews under the Department of Financial Regulation regulations” A health insurer is responsible for...
Vermont Administrative Code §4-5-4:11 “Confidentiality under the Department of Financial Regulation regulations” All records relating to independent external reviews are...
Vt. Stat. Ann. tit. 18, § 9332 - Genetic testing; limitations under the health law “Genetic testing; limitations under the health law” Genetic testing must be performed only with the individual’s informed consent...
Vt. Stat. Ann. tit. 8, § 4089f - Independent external review of health care service decisions under the banking and insurance law “Independent external review of health care service decisions under the banking and insurance law” An enrollee of a health plan has the...
Vt. Stat. Ann. tit. 8, § 4724 - Unfair methods of competition or unfair or deceptive acts or practices defined under the banking and insurance law “Unfair methods of competition or unfair or deceptive acts or practices defined under the banking and insurance law” Unfair methods of...
Vt. Stat. Ann. tit. 8, § 4902 - Disclosure and public information under the banking and insurance law “Disclosure and public information under the banking and insurance law” The commissioner of financial regulation is authorized to...
Vt. Stat. Ann. tit. 8, § 5102a - Health maintenance organization grievance procedures under the banking and insurance law “Grievance procedures under the banking and insurance law” A health maintenance organization must establish a grievance procedure to...
Vt. Stat. Ann. tit. § 18, 9414 - Quality assurance for managed care organizations under the health law “Quality assurance for managed care organizations under the health law” The commissioner of financial regulation must review a managed...
§4-3 Vt. Code R. 37:4 - Records to be maintained under the department of financial regulation regulations “Records to be maintained under the department of financial regulation regulations” Every health insurer must maintain its records so...
Click on the individual state law in the table above to see our summary of the individual law.


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