Vermont insurance laws

What it would do: Requires the Green Mountain Care Board to implement reference-based pricing for Vermont hospitals by fiscal year 2027, establishes regulatory oversight of hospital outsourcing of clinical services, repeals health care provider bargaining group authority, clarifies Board appeal procedures, and authorizes hospital audits and a health system performance tool.

What it would do: Requires health insurance plans and Medicaid to cover biomarker testing for diagnosis, treatment, management, and monitoring of disease when supported by FDA approvals, Medicare determinations, or nationally recognized clinical practice guidelines, effective January 1, 2026.

What it would do: Requires hospital service corporations to establish governor-appointed public board members and compensation committees, mandates executive compensation reporting to regulators, expands association health plans access, requires site-neutral reimbursement for physical therapy and occupational therapy, and establishes reporting requirements for health care sharing plans.

What it would do: Prohibits insurers from deducting at-fault driver liability insurance payments from underinsured motorist coverage and eliminates insurers' subrogation rights against third parties for medical payments coverage. Applies to policies offered, issued, or renewed on or after January 1, 2026.

What it would do: Limits health insurers from reducing mental health reimbursement rates and requires health insurers and Vermont Medicaid to provide 90 days' notice, conduct stakeholder meetings, and publish fiscal and access impact analyses before implementing changes to mental health, substance use disorder, or developmental disability service policies.

What it would do: Creates a study committee to evaluate feasibility of a public option high-deductible health insurance plan administered by private insurers, paired with health savings accounts, starting with public employees and capping provider reimbursements at 10-15 percent above Medicare rates, with a report due January 15, 2027.

What it would do: Requires health insurance plans to cover scalp cooling systems used during cancer chemotherapy to prevent or reduce hair loss, effective January 1, 2027 for all plans issued or renewed by January 1, 2028.

What it would do: Requires health insurance plans to cover medically necessary diagnosis and treatment of PANDAS and PANS, including antibiotics, medications, mental health services, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy, without imposing greater cost-sharing than other conditions.

What it would do: Requires motor vehicle insurance policies with comprehensive coverage to provide complete coverage for repair or replacement of damaged motor vehicle glass without any deductible or minimum amount, applicable to policies offered, issued, or renewed on or after October 1, 2026.

What it would do: Requires motor vehicle insurance companies to provide a discount to insureds who complete a State-approved driver safety or defensive driving course, designed to be revenue neutral to the State.

What it would do: Prohibits persons from using surveillance pricing to distribute, sell, or offer consumer products in Vermont, with exceptions for cost-based pricing differences, equal-terms discounts with consumer consent, and licensed insurance businesses complying with rate standards. Effective July 1, 2026.

What it would do: Requires health insurance plans and the Dr. Dynasaur program to cover pasteurized donated human breast milk for infants under 12 months of age under certain circumstances.

What it would do: Allows registered health insurance carriers in Vermont to vary premiums for individual and small group health benefit plans based on age with a maximum 3 to 1 rate differential and tobacco usage with a maximum 1.5 to 1 rate differential, effective January 1, 2026.

What it would do: Requires the Secretary of Human Services to apply to the U.S. Department of Health and Human Services for a waiver by January 1, 2026, to expand catastrophic health plan eligibility to individuals under 40 years of age.

What it would do: Requires health insurance plans to cover prosthetic and orthotic devices at least equivalent to Medicare coverage, including devices for medical needs, physical activities, and bathing, with repair and replacement without lifetime limits. Requires health insurers to report claims experience for plan years 2026-2028 to the Department of Financial Regulation by July 1, 2029.

What it would do: Requires the Commissioner of Financial Regulation to survey automobile repair labor rates in Vermont and other New England states, then establish a minimum hourly insurance reimbursement rate for labor on all automobile insurance claims filed on or after January 1, 2026, with annual adjustments based on the Consumer Price Index.

What it would do: Requires health insurance plans to cover fertility diagnostic care, fertility treatment including at least four IVF retrievals, and fertility preservation services for all covered individuals, and directs the Agency of Human Services to seek federal approval for equivalent Medicaid coverage by September 1, 2025.

What it would do: Prohibits health insurance plans and Vermont Medicaid from requiring clinician referrals or signed care plans for physical therapy coverage. Caps copayments and coinsurance for physical therapy at primary care provider levels and increases Medicaid reimbursement rates for physical therapy by 10 percent over two years.

What it would do: Requires health insurers offering Medicare supplement policies to guarantee acceptance during six months after age 65 and annual open enrollment periods, prohibits charging additional premiums for late enrollment, prohibits preexisting condition exclusions, and allows enrollees to switch to comparable or lesser benefit policies anytime.

What it would do: Requires health insurers to cover diabetes treatment equipment, supplies, and education without cost-sharing requirements and removes language allowing insurers to require treatment from contracted providers only.

What it would do: Includes health insurance market value in workers' compensation wage definition, requires employers to pay for translation services for non-English-fluent employees, establishes medical case management services with preauthorization procedures, and increases late payment penalties from 5% to 5-25% based on payment sequence.

What it would do: Requires the Secretary of Administration to implement a reference-based pricing program for inpatient and outpatient hospital services at non-critical access hospitals in the State employees' health plan and limit annual premium growth to not more than the medical care Consumer Price Index change, effective January 1, 2026. Allows school employers to enroll their employees in the plan.

What it would do: Requires health insurance plans and Medicaid to cover biomarker testing for diagnosis, treatment, management, and monitoring of disease when supported by FDA approvals, Medicare determinations, or nationally recognized clinical practice guidelines, effective January 1, 2026.

What it would do: Repeals and reorganizes Vermont's health insurance statutes in 8 V.S.A. chapter 107, updating terminology and cross-references throughout while maintaining existing substantive requirements. Takes effect January 1, 2026.