Vermont Statutes Title 8 Sec. 4088m
Terms Used In Vermont Statutes Title 8 Sec. 4088m
- Contract: A legal written agreement that becomes binding when signed.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Person: shall include any natural person, corporation, municipality, the State of Vermont or any department, agency, or subdivision of the State, and any partnership, unincorporated association, or other legal entity. See
- State: when applied to the different parts of the United States may apply to the District of Columbia and any territory and the Commonwealth of Puerto Rico. See
[Effective January 1, 2024.]
§ 4088m. Coverage for gender-affirming health care services [Effective January 1, 2024]
(a) Definitions. As used in this section:
(1) “Gender-affirming health care services” has the same meaning as in 1 V.S.A. § 150.
(2) “Health insurance plan” means Medicaid and any other public health care assistance program, any individual or group health insurance policy, any hospital or medical service corporation or health maintenance organization subscriber contract, or any other health benefit plan offered, issued, or renewed for any person in this State by a health insurer as defined by 18 V.S.A. § 9402. For purposes of this section, health insurance plan includes any health benefit plan offered or administered by the State or any subdivision or instrumentality of the State. The term does not include benefit plans providing coverage for a specific disease or other limited benefit coverage, except that it includes any accident and sickness health plan.
(b) Coverage.
(1) A health insurance plan shall provide coverage for gender-affirming health care services that:
(A) are medically necessary and clinically appropriate for the individual’s diagnosis or health condition; and
(B) are included in the State’s essential health benefits benchmark plan.
(2) Coverage provided pursuant to this section by Medicaid or any other public health care assistance program shall comply with all federal requirements imposed by the Centers for Medicare and Medicaid Services.
(3) Nothing in this section shall prohibit a health insurance plan from providing greater coverage for gender-affirming health care services than is required under this section.
(c) Cost sharing. A health insurance plan shall not impose greater coinsurance, co-payment, deductible, or other cost-sharing requirements for coverage of gender-affirming health care services than apply to the diagnosis and treatment of any other physical or mental condition under the plan. (Added 2023, No. 15, § 3, eff. January 1, 2024.)